Preop

Vancomycin and gentamicin for preop prophylaxis, not Ancef. 

TXA 50 and 5. 

Monitoring

SSEPs and EMGs only. 

Positioning

Make sure there is no bed sheet under the jelly rolls. This can cause the positioning to slip. 

Under the expected location of the hips, place two stacked large purple foams followed by a pillow. This allows for appropriate retroversion of the hips. Under the expected location of the feet place three stacked pillows. 

Make sure head is properly extended with the back of the occiput at the level of the thoracic kyphosis. Unscrew the four pegs holding the anesthesia mirrored face holder until it is fully extended. Have a stack of blue towels available for placement under the head holder in case you need more extension.

Make sure the sheet comes up over the shoulders before being pulled back. 

In the picture above, the sheet is correctly pulled over the right shoulder. The sheet should be more fully on top of the left shoulder. Note both sides of the sheet are twisted together just above the buttocks. The tape over the shoulders is applied loosely, mostly to keep the arms from sagging. 

The twisted portion of the sheet is pulled back and taped to the center of the handle at the base of the bed. The shoulder tapes are also secured to this handle. 

Thoracic Screws

The entry points for the T10, 11, and 12 thoracic screws are as depicted below. First, use a Leksell to bite down the TP to expose the cut end of the pedicle. The cancellous bone will bleed and show the location of the pedicle. Divide the pedicle into thirds. At T10, the entry point is in the top third. At T11, the middle third. At T12, the bottom third.