ACDF
| Attending | Vendor | Side | Bump | Localization | Neurophys | Platysma | Drill bit | Caspar pins | Retractor system | Drain | Closure |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Hamilton | |||||||||||
| Gerszten | Zimmer | Right | Transverse | Before prep, tape a blunt needle to the side of the neck to mark space. | SSEPs only and always | Transverse, undermine | M8 | Yes | Rare | Platysma 3-0 poly; skin Biosyn subcu, no glue | |
| Miele | DePuy | Right | Vertical, two blue OR towels | Intraop only, use bent spinal needle, lateral flat plate | Rare | Vertical, overmine | Diamond, length set to "4" | No | Trimline | Context-dependent | Platysma 3-0 poly; skin quill stitch subcu, skin glue |
| Okonkwo | DePuy | Right | Transverse | Before prep, C arm, sponge forceps | SSEPs only, prepositions if cord compression | Spread with Metz in direction of fibers (~vertical) | M8 | Yes | Shadowline | Yes | Platysma 3-0 poly, skin Biosyn subcu, glue |
| Kaufmann | Zimmer | Right | Transverse, rolled blanket | None preop, Caspar pin intraop with flat plate | SSEPs always | Vertical, overmine | M8 | Yes | Trimline | No | Platysma 3-0 poly, skin Velasorb, steri strips, Telfa, paper tape. No glue |
| Lang | DePuy | Left | Vertical, A line pressure bag | None preop, Caspar pin intraop with flat plate | SSEPs and motors in setting of trauma | Vertical, undermine | M8 | Yes | Trimline | Sometimes | Platysma 3-0 poly, deep dermal 3-0 poly, skin Quill, steris no other dressing |
| Moossy | DePuy | Right | Vertical, rolled chuck | Anatomic landmarks only | None | Doesn't care | M8 | Yes | Shadowline | No | Platysma and dermals 3-0 Maxon, skin 3-0 Biosyn subcu, steri strips |
| Bayley | Medtronic | Right | Horizontal, small gel roll | Anatomic landmarks (okay with C-arm if resident wants) | SSEPs + preposition if cord compression | Doesn't care, undermine | M8 | Yes | Trimline | Context dependent | Platysma and dermal with 3-0 Polysorb, skin with 4-0 Monocryl, skin glue, no bandage |
Hamilton
For 3 or more levels, every patient should be put in a cervical collar beginning on POD1. This improves fusion rates from 88% to >90%. Collar to be worn any time patient is on their feet. Continue for 4-6 weeks postop.
Miele
He uses a hand drill to ‘tap’ for screws. Place the ball of the hand drill within the hole first then engage the drill bit
He uses a quill stitch to run a subcuticular layer; double ended suture, start in the middle and go each direction, finish the suture by going through the corner then out the side of the incision through the skin. Skin glue, then basic opsite dressing.
Moossy
When doing multiple levels, Expose and complete 2/3rds of the diskectomy for each level before going under scope. The top and bottom levels should have Caspar pins and all levels should be partially diskectomized before you take your loupes off.
Bayley
No need for Foley for a single level. No need to localize preop, use anatomic landmarks in the form of the thyroid cartilage. SSEPs and prepositions if there is cord compression. Place purple foams on the inside of the arms then wrap with the sheet. Do not go all the way around the bed with the tape, instead just use small strips to tape across the top of the sheet to hold the two ends together. Place a bump transversely under the shoulder blades. Drape with four blue towels but don't place a whole piece of Ioban over the field, just use small strips to hold the towels down and leave the center of the field devoid of Ioban. Down sheet, thyroid drape with the feet towards the feet (i.e. thyroid drape is not reversed). Skin with 15 blade, lift skin with Adsons and Bovie to the platysma on 35 and 35. Bayley doesn't care if the platysmal incision is vertical or horizontal but does want you to undermine the platysma with Metzenbaum scissors and bipolar. Follow the medial border of the SCM to the carotid sheath then go medial to the spine. Sweep the soft tissue off the spine with a peanut. Localize with a bent 18 gauge spinal needle placed in the vertebral body not the disc space before dissecting the longus. Feel with a finger for the lateral borders of the spine to define midline before going down on midline with a Bovie and dissecting out laterally. Place the Trimline retractors, both smooth, neither toothed. Follow with Caspar pins that are angled towards one another. Use the M8 drill to drill away the osteophytes before entering the disc space. Bayley is okay with discectomy either entirely with the drill or with curettes.