Anterior Thoracoabdominal / Anterior Spinal Fusion
Dr. Aaron Wey · surgeon-performed approach · covers: anterior instrumented fusion (standalone) · anterior release for staged posterior · corpectomy + anterior column reconstruction · anterior open VBT
CPT range: 22532/22533/22534 (anterior thoracic/lumbar arthrodesis ± addl), 22808–22812 (anterior deformity), 22556/22558, 22845/22846/22847 (anterior instrumentation), 63085/63087/63090 (corpectomy), 22853 (interbody device), 0656T/0657T (anterior VBT), 20931/20936/20937 (graft). Rib + local autograft + allograft, no BMP.
Open VBT overlaps the planned Lumbar VBT card — may consolidate.
Attire
Size 8 gloves — Biogel underneath + size 8 white gloves on top
Size XL gown ×3
Approach / anesthesia (surgeon-performed)
- Surgeon does own approach. Corridor by level: thoracotomy (mid-thoracic), thoracoabdominal w/ diaphragm takedown (thoracolumbar junction T12–L1), retroperitoneal (lumbar).
- Single-lung ventilation — coordinate with anesthesia for double-lumen ETT or bronchial blocker (thoracic approaches).
Position & table
- Lateral decubitus — convexity up (deformity/VBT) or approach side up. Beanbag, axillary roll, table break, arm holder. Tape (3" cloth + Mastisol). Foley.
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 | |
| BD Surgiphor wound irrigation — 0.5% PVP-I | 450 mL | BD | 910110 | 1 | |
| 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 InvisiShield towel drape ON ROLL (prep stand) | 18×12 in | Medline | DYNJSD1000RL | 1 | |
| Medline Sterile Surgical Utility Drapes with Tape, 200 EA/CS | 38×66 cm | Medline | DYNJP2405 | 4 | 2 |
| 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 | ||
| Pocketed CV top drape — bilateral pouches | Medline | DYNJP4220 | 1 | ||
| Instrument pouch — adheres to drape | 10×11 in | Microtek / Medline | 8918 | 1 | |
| C-arm drape (PPMC Ecolab / CCH Tidi C-Armor) | 27×60 in | Ecolab / Tidi | 4951 / 5523 | 1 | |
| Leg-cover drape | 31×48 in | Medline | DYNJP2460 | 1 | |
| Skin stapler | 35 W | Covidien Appose | 8886803712 | 1 | |
| Sponges | |||||
| Raytec gauze sponge, 12-ply, X-ray detectable | 4×4 in | Cardinal Health | 6939 | 2 | |
| Laparotomy sponge (lap pad), 18×18, per pack | 18×18 in | Medline | MDS72038 | 3 | |
| Lap-tape sponge (long/thin), X-ray detectable — narrow channels / gutters | 4×18 in | Medline | MDS251504LF | 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 | 302830 | 1 ea | ||
| Spinal needle — level localization 18G | BD | 405181 | 1 | ||
| Needle counter box, magnetic | 40-ct | Medline | NC40FBR | 1 | |
| Hemostasis | |||||
| Bone wax, sterile | 2.5 g | Medtronic / Covidien | BW25G | 1 | |
| Floseal hemostatic matrix | 10 mL | Baxter | 1503350 | 1 | |
| Recothrom thrombin topical | 5000 u | Baxter | ADS202110 | 1 | |
| Surgifoam / Gelfoam absorbable gelatin | Ethicon | 1974 | 1 | ||
| Aquamantys bipolar sealer wand + cover | Medtronic | 01-0020 | 1 | ||
| 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 + Poole (anterior) | Sage | 006629 | 1 | ||
| Disposable plastic Frazier suction tips — 16Fr ×2, 12Fr ×2, 10Fr ×2 | 1 | ||||
| Neptune 2 Ultra suction unit + tubing + canister | Stryker | — | 1 | ||
| Closure · drains · dressing | |||||
| Chest wall / diaphragm repaired by surgeon; rib approximator. Layered: 0 / 2-0 Vicryl, 3-0 Monocryl skin. (Deformity peds closure: #1 Vicryl pop-offs · 1-0 Stratafix · 2-0 Vicryl · 3-0 Monocryl PS-2.) | ✓ | ||||
| Sylke dressing + 4×4 + Tegaderm (Prineo alternative); chest-tube site dressing. | ✓ | ||||
| Cautery settings: Bovie 35 / 35 cut-coag, Bipolar 35 · 1 bovie (open) + 1 additional bovie PRN (if co-surgeon) · 2 suctions off bottom of field · grounding pad on thigh. Meds (pharmacy): 0.25% Marcaine w/ epi 1:200,000; Vancomycin 1 g; have Tobramycin 1.2 g available (syndromic peds); TXA at start AND end of case | |||||
Neuromonitoring — every case
MEP + SSEP baselines before positioning; monitor through correction/instrumentation.
Sets & instruments
- Thoracic exposure: Harms Chest Retractors + Finochietto rib spreader, Doyen rib raspatory, rib cutter/shears, periosteal elevators, rib approximator; chest tube(s) + drainage system.
- Anterior Approach set (Wylie renal vein retractor, DeBakeys, Richardsons, Kantrowitz, Foerster, Haas spine) + Large Wylie PMC1575.
- Segmental vessel control: vessel loops, clip appliers (red/blue/green), right-angles, ties; Doppler.
- Cobb, box chisel, endplate rasps/curettes, disc shavers.
Implants (loaner / rep-brought — confirm vendor at new site)
- Anterior instrumented fusion: anterior single/dual-rod + vertebral body screw system.
- Corpectomy: expandable corpectomy cage + anterior plate/rod.
- Anterior open VBT: flexible tether cord + vertebral body screws/staples (e.g., The Tether). Staple/screw set, tensioner.
Graft
Rib autograft (from access rib) + local autograft + allograft — no BMP.
Bony / power
Stryker Sumex Pi Drive 2+ (primary) / Midas Rex MR8 (alt) · BoneScalpel for corpectomy/osteotomy · Misonix bur.
Blood management
Cell saver. TXA (tranexamic acid): 30 mg/kg load + 1 mg/kg/hr infusion throughout. Type & cross.
Hemostasis (open generously — over-prepared for bleeding)
Floseal (5 cc 1–2 levels / 10 cc 3+), Recothrom + Thrombin-JMI, Surgifoam ± 4 mg dex, Gelfoam size 100, Surgicel PRN, bone wax / HemaSorb Plus. Do not mix Floseal with Gelfoam — confirm first.
Medications
- 0.25% Marcaine w/ epi 1:200,000.
- Vancomycin 1 g; have Tobramycin 1.2 g available (syndromic peds).
- TXA at start AND end of case.
Drain / chest tube
Chest tube to water-seal drainage (thoracic/thoracoabdominal); diaphragm repair if taken down. Retroperitoneal/round drain + reservoir for lumbar.
Closure
Chest wall / diaphragm repaired by surgeon; rib approximator. Layered: 0 / 2-0 Vicryl, 3-0 Monocryl skin. (Deformity peds closure: #1 Vicryl pop-offs · 1-0 Stratafix · 2-0 Vicryl · 3-0 Monocryl PS-2.)
Dressing
Sylke dressing + 4×4 + Tegaderm (Prineo alternative); chest-tube site dressing.