Lumbar fusion / Posterior Lumbar Fusion (TLIF)

Attire

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

Size XL gown ×3

Position & table

• Prone on Jackson w/ prone bolsters (4 posts, hard bottom), arms above head on padded armboards.
• Set the Jackson spine frame to the lowest hole/setting at the head, and the lowest hole setting at the foot.
• Allevyn pads on iliac crests before flipping. Foam prone pillow; protect knees; black rolls; safety strap.

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
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
Floseal (10 cc), bone wax				✓
Recothrom + Thrombin 5000 units – uses on cottonoids				✓
Surgifoam soaked with 4 mg Decadron, Gelfoam size 100				✓
Surgicel				✓
Aquamantys 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 — 16Fr ×2, 12Fr ×2, 10Fr ×2				1
Neptune 2 Ultra suction unit + tubing + canister		Stryker	—	1
Closure · drains · dressing
Fascia: #1 Vicryl (GS-21)				✓
Subcut/dermis: 2-0 Vicryl				✓
Skin: 3-0 clear Stratafix (or V-loc) or 3-0 Nylon or staples				✓
Prineo/Opticlose skin glue				✓
Blake drain(s) — 19 Fr. 2-0 Nylon to secure, Biopatch, Tegaderm (pop tart sized) ×2 over drain site.				✓
Sylke dressing + Smith & Nephew [6⅛" × 3⅜"] or [10" × 4"] OpSite dressing				✓
and Tegaderm (pop tart sized) x4				✓
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): Local: bupivacaine/Marcaine 0.25% PF w/ epi 1:200,000; If using 0.25% bupivacaine, give same amount as patient’s kilograms in weight; If using 0.5% bupivacaine, give ½ of patient’s kilograms in weight; Add Ketorolac Tromethamine 30mg/mL (1mL); Surgeon wants an event amount of 60mL, so add 0.9% normal saline flush to make 60mL total; TXA (tranexamic acid): 30 mg/kg load + 1 mg/kg/hr infusion throughout the case; Antibiotic: 2g Ancef unless patient has an allergy; 1g Vancomycin powder, to be placed intra-wound

Magnification

Loupes + headlight

Imaging / navigation — NAVIGATED DEFAULT

I prefer to perform localization with 18 gauge spinal needle and intraoperative flat plate lateral lumbar spine xray (before incision, and again – reconfirmation - after tissue dissection)

Alternatively, C-arm for level localization (marker x-ray); final films PRN.

O-arm + Stealth. Set Spine Medtronic Reference (default-open) + NavLock Instruments + passive spheres 8801075 ×3 packs. Reference Revision tray PRN (navigating off existing rod/screw). C-arm available for confirmation films.

Neuromonitoring — every case

MEP + SSEP + free-run/triggered EMG (pedicle screw stimulation). Baselines before positioning.

Sets & instruments

• Core: Spine Basic, Lumbar Spine Extras.
• Retractor: Phantom CS most cases; ClearLine L PRN for deep/obese; McCullough retractors opened only if specifically called.
• Curettes: Chroma-Line Curettes
• Kerrisons: Black Kerrisons (1–5 mm) or Life Spine Kerrisons
• Bipolar: Silverglide bayonet.
• Osteotome/curette: Lenox-McLaren osteotome & curette set

Bony decompression tool

Misonix BoneScalpel 20 mm blade (PRN, ask if doing open decompression)

Misonix MIS microhook (PRN)

Stryker 3 mm diamond tip round burr #5820-012-040D, set Stryker TPS at 25,000 RPM

Power

BoneScalpel console.

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

Implants (loaner / rep-brought)

• Pedicle screw–rod system (navigated-compatible).
• TLIF expandable interbody cage

Graft

Local autograft (bone mill)

Acupac X (2.5 cc per level) and MagnetOS (5 cc per level)

BMP for TLIFs (2.05 mg per level)

Dural tear management (have available/PRN)

Suturable DuraGen 2×2 (only uses suturable DuraGen)

6-0 dural suture such as Nuralon or Gortex suture with Castro microneedle holders

DuraSeal/Tisseel or Stryker Adherus (Green spray dural sealant)

Hemostasis

Floseal (10 cc), bone wax

Recothrom + Thrombin 5000 units – uses on cottonoids

Surgifoam soaked with 4 mg Decadron, Gelfoam size 100

Surgicel

Aquamantys PRN

Medications

• Local: bupivacaine/Marcaine 0.25% PF w/ epi 1:200,000.
  • If using 0.25% bupivacaine, give same amount as patient’s kilograms in weight.
  • If using 0.5% bupivacaine, give ½ of patient’s kilograms in weight.
  • Add Ketorolac Tromethamine 30mg/mL (1mL)
  • Surgeon wants an event amount of 60mL, so add 0.9% normal saline flush to make 60mL total.
• TXA (tranexamic acid): 30 mg/kg load + 1 mg/kg/hr infusion throughout the case.
• Antibiotic: 2g Ancef unless patient has an allergy
• 1g Vancomycin powder, to be placed intra-wound

Drain

Blake drain(s) — 19 Fr. 2-0 Nylon to secure, Biopatch, Tegaderm (pop tart sized) ×2 over drain site.

Closure

Fascia: #1 Vicryl (GS-21)

Subcut/dermis: 2-0 Vicryl

Skin: 3-0 clear Stratafix (or V-loc) or 3-0 Nylon or staples

Prineo/Opticlose skin glue

Dressing

Sylke dressing + Smith & Nephew [6⅛" × 3⅜"] or [10" × 4"] OpSite dressing

and Tegaderm (pop tart sized) x4