ACDF
| Attending | Vendor | Side | Bump | Localization | Neurophys | Platysma | Drill bit | Caspar pins | Retractor system | Drain | Closure |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 | 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 |
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.