Posterior Cervical

Gown and Gloves

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

Size XL gown x3

Position & table

• Prone on open Jackson spine frame w/ prone bolsters. Allevyn pads on iliac crests before flipping.
• Set the Jackson spine frame to the highest hole/setting at the head, and the lowest hole setting at the foot
• Mayfield skull-pin fixation (Mayfield attachment + skull pins; Integra disposable pins). Horseshoe available as backup.
• Mayfield head holder to attach to C-flex or OSI Levó head positioner.
• Neck flexed slightly per C-spine precautions; black rolls; foam/eggcrate padding; pillow under knees; foam feet pads.
• 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):
  • Ensure the thumbs are pointing down (towards the floor) which is the ‘neutral’ position.
  • 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.
• 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; clip hairline to external occipital protuberance. Use 2in foam tape to hold hairline if needed.

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	2
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	302830	1 ea
Spinal needle — level localization 18G		BD	405181	1
Needle counter box, magnetic	40-ct	Medline	NC40FBR	1
Hemostasis
Floseal (10 cc				✓
Recothrom + Thrombin 5000 units – uses on cottonoids				✓
Gelfoam size 100, Surgicel, bone wax				✓
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 — 12Fr ×2, 10Fr ×2, 8Fr ×1				1
Neptune 2 Ultra suction unit + tubing + canister		Stryker	—	1
Closure · drains · dressing
Fascia #1 Vicryl (GS-21) and #1 PDS				✓
Subcut/dermis 2-0 Vicryl				✓
Skin staples or 3-0 Nylon				✓
Blake drain(s) — 19 Fr, (×2 for long constructs). 2-0 Nylon to secure (×2), Biopatch ×2, Tegaderm ×4 over drain sites.				✓
Aspen rigid collar for fusions				✓
No collar for laminoplasty				✓
Sylke dressing + Smith & Nephew 6⅛" × 3⅜" OpSite dressing				✓
Drain-site Biopatch + Tegaderms x3 (pop tart sized)				✓
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% w/ epi (PF) 1:200,000; 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

Neuromonitoring — every case

Supine baseline before flip, and then again after flip. Final positioning baseline; monitor through decompression, reduction, and instrumentation; motors during closure.

Magnification

Loupes + headlight standard

Imaging / navigation

• Routine fusion → C-arm / fluoro freehand for lateral mass screws.
• Revision / complex / deformity → navigated: O-arm + Stealth, Set Spine Medtronic Reference (default-open on nav cases) + NavLock Instruments + Mayfield navigation reference array. Reference Revision tray PRN if navigating off existing hardware.

Sets & instruments

• Core: Spine Basic (open) and Cervical Spine Extras (PRN)
• Curettes: LifeInstruments Rainbow Micro curettes (open).
• Kerrisons: Black Kerrisons (1–5 mm) or Life Spine Kerrisons
• Bipolar: Silverglide bayonet (0.7 mm + 1.2 mm), insulated.
• Retractor: self-retaining in Spine Basic (Weitlaner/cerebellar/Deep Gelpi retractors). Phantom CS (PRN, open only if needed).

Decompression tool

Misonix 10mm blade BoneScalpel — default for laminectomy/laminoplasty troughs and osteotomies.

High-speed burr, 3 mm matchstick and 1.8 mm round burr.

Power

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

Misonix BoneScalpel console.

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

Fusion: Posterior cervical OCP system (ie Globus/Nuvasive Reline-C or VB/Stryker Yukon)

Laminoplasty: Laminoplasty plates (ie Globus Canopy or VB/Stryker Escalate)

Graft

Local autograft + MagnetOS 5 or 10cc/Acupac X 2.5 or 10cc. Decorticate with burr; pack lateral gutters.

Hemostasis

Floseal (10 cc

Recothrom + Thrombin 5000 units – uses on cottonoids

Gelfoam size 100, Surgicel, bone wax

Medications

• Local: bupivacaine/Marcaine 0.25% w/ epi (PF) 1:200,000.
• 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 for long constructs). 2-0 Nylon to secure (×2), Biopatch ×2, Tegaderm ×4 over drain sites.

Collar

Aspen rigid collar for fusions

No collar for laminoplasty

Closure

Fascia #1 Vicryl (GS-21) and #1 PDS

Subcut/dermis 2-0 Vicryl

Skin staples or 3-0 Nylon

Dressing

Sylke dressing + Smith & Nephew 6⅛" × 3⅜" OpSite dressing

Drain-site Biopatch + Tegaderms x3 (pop tart sized)