The patient is placed onto a radiolucent table in a supine position.
The neck is put into a slight hyperextension by placing a pillow under the shoulders.
An additional small pillow is placed under the neck to prevent the cervical spine from moving when the anterior spine is manipulated.
When lower cervical levels needs to be seen in lateral imaging, adhesive straps are used to pull the shoulders downwards.
Place the patient in a slight reverse-Trendelenburg position to decrease the venous pressure at the surgical site. A pillow is placed under the knees of the patient to prevent from sliding down the table.
A C-arm should be placed to allow for intraoperative fluoroscopy.
With highly unstable cervical tumors, either an awake or fiberoptic intubation should be performed. In patients with severe spinal cord compression, it is essential to avoid hypotensive anesthesia and the mean arterial blood pressure should be maintained above 80 mmHg.
3. Preoperative antibiotics
Antibiotics should be administered 30-60 min prior to the incision. 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.