Anterior Cervical

Gown and Gloves

Size 8 gloves — Biogel underneath + size 8 white gloves on top

Size XL gown x3

Position & table

• Supine. Standard/regular OR table, rotated 180 degrees for Flouro c-arm
• Shoulder roll / inflatable IV (pressure) bag between the scapulae to control extension; inflate to extend neck, re-check neuromonitoring after extension.
• Head neutral on foam donut; slight extension.
• 2 blankets (rolls blankets around arms) and 2 draw sheets (both are narrow and long)

Arm Tuck Technique – double-draw-sheet technique

Technique:

• A standard OR blanket is folded to approximately 24 inches in width and rolled.
• The blanket roll is wrapped around each elbow, centered at the elbow.
• As the roll wraps the elbow, it is unrolled toward the patient.
• Neuromonitoring leads, IV lines, and tubing are held laterally so that the padding roll lay directly against the patient rather than compressing lines.
• The blanket roll pads from just proximal to the wrist to approximately halfway up the humerus.
• Additional egg-crate padding with Velcro can be used at the wrist if needed.
• Two draw sheets are placed under the patient (before the patient even transfers to the OR table):
  • The first draw sheet is brought upward between the torso and arm and draped over the patient.
  • The second draw sheet is brought up lateral to the elbow and tucked underneath the patient.
  • The first draw sheet is then brought back around the arm from medial to lateral and tucked under the patient/table.
• No tape is required to secure the arms.
• The arms remain securely tucked for both stages in cases where both anterior and posterior approaches are necessary.

After arm tucking:

• IV patency is checked.
• The anesthesia team confirms access to the arterial line and IVs.
• Neuromonitoring leads and lines are confirmed free from compression.
• Shoulder taping: baseline motors FIRST (see neuromonitoring), then tape shoulders down — 3 inch silk tape or Sterix cervical retraction system starting at lateral acromion, looping to the foot of the table with ~5 lbs traction on the shoulders.
• Re-check neuromonitoring baselines after taping (rule out positioning neuropraxia).
• 1010 drapes; wide prep so chin, sternal notch, and clavicles are exposed. Side 1010 drapes go from ear to coracoid.

Prep, drape & cautery

Item — exact product	Size	Vendor	Catalog #	Open	PRN
Positioning · warming · DVT prophylaxis (non-sterile, in room)
Sequential compression device (SCD) pump		Cardinal / Kendall	SCD 700	1
SCD compression sleeves (Vasopress), size to patient	M / L	Cardinal	VP501MG / VP501LG	1 pr
Forced-air warming blanket, upper body (Bair Hugger) + unit		3M	52200	1
Foam positioning kit / arm pads / gel rolls		Xodus	SPK10113	1
Surgical skin marker (black) + field marker (purple)		Viscot	1450XL	1
Foley catheter + insertion tray, 16 Fr	16 Fr	BD	903016A	1
Skin prep · antisepsis
Chlorhexidine (Hibiclens) scrub brush				1
ChloraPrep applicator — 2% CHG / 70% IPA, tinted	26 mL	BD (CareFusion)	930815	2
Major basin pack (RSP)		Novo Health	124514C	1
Mastisol liquid adhesive vial	0.66 mL	Ferndale	52348	1
Draping
Blue OR towels (per pack)	17×30 in	Medical Action	7048	2
Steri-Drape impervious towel drape ('1010')	23×35 in	3M	1010	4
Medline Sterile Surgical Utility Drapes with Tape, 200 EA/CS	38 x 66 cm	Medline	DYNJP2405	4	2
Medline InvisiShield towel drape ON ROLL (prep stand)	18×12 in	Medline	DYNJSD1000RL		1
Ioban 2 antimicrobial incise drape (iodophor)	33×35 in	3M	6651EZ	1
Spine custom pack (PPMC)		Medline	DYNJ69083	1
Split-sheet drape	77×120 in	Medline	DYNJP8304	1
3/4 sheet drape		Medline	DYNJP2414	1
C-arm drape (PPMC Ecolab / CCH Tidi C-Armor)	27×60 in	Ecolab / Tidi	4951 / 5523	1
Skin stapler	35 W	Covidien Appose	8886803712	1
Sponges
Raytec gauze sponge, 12-ply, X-ray detectable	4×4 in	Cardinal Health	6939	1
Laparotomy sponge (lap pad), 18×18, per pack	18×18 in	Medline	MDS72038	1
Lap-tape sponge (long/thin), X-ray detectable — narrow channels / gutters	4×18 in	Medline	MDS251504LF	1	2
Cottonoid patty (neuro)	0.5×0.5 in	Integra	801400		1
Sharps · needles · syringes
Surgeon's blade #10 / #15	#10 / #15	Aspen	371110 / 371115	1 ea
Surgeon's blade #11	#11	Aspen	371211	1
Hypodermic needle 22G / 25G		BD	305127	1
IV catheter / angiocath 18G (local / irrigation)	18G	BD	381454	1
Luer-lock syringe 20 cc		BD	302995 / 302830	1 ea
Spinal needle — level localization 18G		BD	405181	1
Needle counter box, magnetic	40-ct	Medline	NC40FBR	1
Hemostasis
Floseal (5 cc for 1–2 levels, 10 cc for 3+)				✓
Recothrom + Thrombin 5000 units – uses on cottonoids				✓
Gelfoam size 100, bone wax.				✓
2-0 silk ties				✓
Small and medium vascular clips (PRN)				✓
Surgicel PRN, HemaSorb Plus (PRN).				✓
Cautery & suction
ESU pencil + integrated holster		Valleylab / Bovie	E2515H / ESPH	1
Bovie tip scratch pad		Bovie	ESSP	1
Bipolar forceps cord + adaptor (Storz) + pedal		Storz	—	1
Grounding pad / return electrode (REM)		Medtronic	7507	1
Yankauer suction tip		Sage	006629	1
Disposable plastic Frazier suction tips (assorted Fr) 12Fr x2, 10Fr x2, 8Fr x1				1
Neptune 2 Ultra suction unit + tubing + canister		Stryker	—	1
Closure · drains · dressing
2-0 Vicryl — platysma/fascia				✓
3-0 Vicryl — dermis				✓
3-0 Monocryl — subcuticular.				✓
¼” inch Penrose drain out through the incision				✓
Soft collar default				✓
Aspen rigid collar for 3-level only				✓
¼” inch steristrips + ABD pad + 3 inch foam or medipore tape.				✓
Cautery settings: cervical = Bovie 20 / 20 cut-coag, Bipolar 20 · 1 bovie + 2 suctions off bottom of field · grounding pad on thigh. Meds (pharmacy): Local: bupivacaine/Marcaine 0.5% w/ epi 1:200,000 (dose ≈ pt kg); TXA (tranexamic acid): 30 mg/kg load + 1 mg/kg/hr infusion throughout the case; Antibiotic: 2g Ancef unless patient has an allergy

Neuromonitoring

Baseline motors before shoulder taping → re-check after taping → after neck extension → after distraction → after trialing → after final instrumentation. Confirm final neuromonitoring before leaving.

Magnification

Microscope (Zeiss Pentero 800 or Leica — either). Draped microscope.

Imaging

C-arm for level localization and final construct; remains draped out at head of bed in lateral. Lateral marker x-ray after needle/level confirmation.

Sets & instruments

• Core: Spine Basic, Cervical Extras
• Retractor:
  • ACDF / corpectomy → Phantom CS Retractor (Shadowline ACF and Shadowline Table Arm is an acceptable alternative).
  • Cervical disc replacement → Thompson retractor + Synthes ProAccess bone levers (03.609.916 / 03.609.919).
  • Caspar Set: peel packed pins (12 mm, 14 mm, or 16mm) + Caspar distractor (Cloward-style vertebral body spreader as backup if soft bone)
  • Lone Star retractor (CooperSurgical) — PRN, revision approach only (scarred re-do exposure).
• Curettes: Karlin cervical curettes (open), LifeInstruments Rainbow Micro curettes (PRN).
• Kerrisons: Black Kerrisons (1–5 mm) or Life Spine Kerrisons
• Bipolar: Silverglide bayonet (0.7 mm + 1.2 mm), insulated.

Power

Stryker Sumex Pi Drive 2+ (primary) / Midas Rex MR8 (alternative).

2 mm round-cutter ball burr for screw pilot holes; 3mm matchstick high-speed burr for endplate prep / corpectomy trough.

4 mm diamond top, round burr for corpectomy

Implants (loaner / rep-brought — confirm vendor at new site)

• Anterior cervical plate + cage system — 14 mm screws typical; locking driver.
• Corpectomy: expandable cage / strut + longer plate.
• TDR: cervical disc prosthesis (motion-preserving — no plate, no fusion graft).

Graft / interbody / plating

ACDF: Allograft or Titanium 3D printed cage with Cerapedics iFactor 1cc

Corpectomy: allograft strut (fibula allograft) or expandable cage

Anterior cervical plating system

Hemostasis

Floseal (5 cc for 1–2 levels, 10 cc for 3+)

Recothrom + Thrombin 5000 units – uses on cottonoids

Gelfoam size 100, bone wax.

2-0 silk ties

Small and medium vascular clips (PRN)

Surgicel PRN, HemaSorb Plus (PRN).

Medications

• Local: bupivacaine/Marcaine 0.5% w/ epi 1:200,000 (dose ≈ pt kg).
• TXA (tranexamic acid): 30 mg/kg load + 1 mg/kg/hr infusion throughout the case.
• Antibiotic: 2g Ancef unless patient has an allergy

Drain

¼” inch Penrose drain out through the incision

Collar

Soft collar default

Aspen rigid collar for 3-level only

Closure

2-0 Vicryl — platysma/fascia

3-0 Vicryl — dermis

3-0 Monocryl — subcuticular.

Dressing

¼” inch steristrips + ABD pad + 3 inch foam or medipore tape.