Generally, the approach is done from the left side to avoid the liver and the vena cava.
The patient is placed onto a radiolucent table and turned into the lateral decubitus position.
The arm ipsilateral to the approach is elevated and placed in a well-padded support and a cushion pad should be placed underneath the contralateral axilla.
The knees should be slightly flexed. The knee and hip flexion allows relaxation of the psoas muscle.
Depending on surgeon preference, the table could have a tilting option. If selected, the tilting option should be located underneath the patient's thoracolumbar junction, which gives the possibility to open the intercostal space.
Pitfall If the tilting option is used in the table, be careful to straighten the table prior to performing the instrumented fusion.
General anesthesia with endotracheal intubation is required.
Single lung ventilation is optional.
3. Preoperative antibiotics
Antibiotics should be administered well prior to the incision and also at intervals during the procedure or when the blood loss exceeds 2 liters.
A cephalosporin antibiotic with good Gram-positive coverage is generally recommended.
4. Spinal cord monitoring
Spinal cord monitoring is optional.
5. Fluoroscopy/x-ray control
The incision can be planned based on the lateral fluoroscopic view.