Procedure

Incision and exposure

Skin knife #20

Adson forcep x 2

Diathermy x 2

Plastic sucker x 2

JB retractor x 2

Gelpi retractor x 2

Laminectomy retractor x 2

Large / Medium / Small Cobbs / Harrington

Bipolar (Setting 30)

Floseal

Surgicel

Gelfoam

Bone wax

Disect muscle

Retroperitoneal space entered

Decompression

Annulus punctured with needle, guidewire position confirmed with XR

Serial dilator and table amount retractor inserted and expanded

annulotomy with knife, discectomy

cartilaginous end plate removed and contralateral annulus bluntly opened with cobbs

dilator to increase the disc space

Cage insertion

Irrigation

Trial

Closure

Gentamicin mixed saline irrigation

Diluted Betadine solution (30ml 10% betadine in 1L NS)

Vancomycin powder

Muscle closure with 2/0 vicryl round body

Wound closed with 2/0 polysorb, stratafix monocryl

+/-Percutaneous screw insertion

Prone on OSI

Stable incision 

Giudewire insertion for pedicle screw under XRC

Rod and set screw inserted