Posterior Spinal Fusion / Deformity
adult posterior thoracic fusion (± corpectomy / costotransversectomy / 3-column osteotomy) + peds AIS / EOS / neuromuscular / congenital PSF
CPT / Procedures
- 22800–22804 (posterior arthrodesis for deformity)
- 22810/22812, 22840–22844/22846/22847 (instrumentation)
- 22206/22207 (3-column osteotomy)
- 22210/22212 (Ponte/SPO)
- 63085/63087 (thoracic corpectomy), +20930/20936 graft.
Attire
Size 8 gloves — Biogel underneath + size 8 white gloves on top
Size XL gown ×3
Position & table
- Prone on Jackson w/ Hall frame (open) or prone bolsters. ProneView headrest. Jackson positioning kit, pillow, safety strap ×2.
- Peds: smaller patients on gel rolls instead of bolsters; pelvic-fixation patients in sling.
- Jackson set: 2nd hole at head of bed / 6th hole at foot. Allevyn on iliac crests before flipping.
Prep & drape
- Chlorhexidine sponge + towels + 4×4s with alcohol + Duraprep; 2nd Duraprep by fellow/resident after towels, down-sheet & Ioban strips.
- Drape: 5 blue towels, 3/4 sheet, Ioban cut into strips, CV drape, Ioban.
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 | 4 | 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 | 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 | |||||
| #1 Vicryl pop-offs · 1-0 Stratafix · 2-0 Vicryl pop-offs · 3-0 Monocryl PS-2. | ✓ | ||||
| 1/8" or 3/16" round drain w/ trocar + reservoir (peds). Adult long construct: JP ×2. | ✓ | ||||
| Sylke dressing + 4×4 + Tegaderm (Prineo alternative); drain site: drain sponge + Tegaderm. | ✓ | ||||
| If revision: Mastisol, Steri-Strips, 4×4, Tegaderm. | ✓ | ||||
| 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 — 20 mL; Vancomycin 1 g. Have available: Tobramycin 1.2 g (syndromic patients) | |||||
Neuromonitoring — every case
MEP + SSEP (+ EMG for pedicle screws). Baselines before/after final positioning; monitor through correction/osteotomy/instrumentation.
Sets & instruments
- Core (peds/AIS): Spine Instruments · Spine Retractors · Holt Bone Tray · Midas drill · Misonix handpiece · small slow-speed battery drill + battery.
- Adult thoracic add-ons: Thoracic #1 / #2 / #3 sets · First Rib Tray · New Osteotome set / Lemox-McCleran Osteotome & Curette set · Foot Midas Rex.
- Life Micro Rainbow curettes; surgeon-requested implant/instrument trays (per schedule comments).
Osteotomy & decompression (VCR / hemivertebrectomy / corpectomy)
- BoneScalpel + Midas MR8-9 blue bur (`MR8-9MH30`) (NO spine drill) + Misonix bur (`110-31-1230`) + Life Micro Rainbow curettes (color-coded 6/0–0).
- Patties 1/2×1/2 (801400), 1/2×1 (801402); 20 mL syringe ×2 (302830); 14 G angio for irrigation ×2 (381444); 11 blade (341111).
- Adult corpectomy: costotransversectomy / posterolateral approach; expandable thoracic corpectomy cage (rep). Chest tube available if pleura violated.
- Osteotomy default: Ponte/SPO for flexible AIS; 3-column (PSO/VCR) reserved for rigid/congenital (e.g., post-HGT correction).
Power
Stryker Sumex Pi Drive 2+ (primary) / Midas Rex MR8 (alternative) · Misonix · slow-speed battery drill.
Implants (loaner / rep-brought — confirm vendor at new site)
Deformity pedicle screw–rod system (navigated-compatible); hooks, sublaminar bands/wires, iliac/pelvic fixation as needed.
Graft
Local autograft + allograft + antibiotic (vancomycin) powder + blood mix — no BMP. Crushed cancellous + strips. Slow-speed drill with 2.4 Zimmer pilot drill bit; 10 mL syringe with special tap for graft strips. Confirm mix with surgeon.
Blood management
Cell saver (deformity / multilevel). TXA (tranexamic acid): 30 mg/kg load + 1 mg/kg/hr infusion throughout (deformity). Type & cross per case.
Medications
- 0.25% Marcaine w/ epi 1:200,000 — 20 mL.
- Vancomycin 1 g. Have available: Tobramycin 1.2 g (syndromic patients).
Markers / pearls
Cut Steinman pin for markers (Holt/bone tray); Steri-Strip around the 2.4 pilot drill bit at first marking. Update family every 1.5–2 h.
Drain
1/8" or 3/16" round drain w/ trocar + reservoir (peds). Adult long construct: JP ×2.
Closure
#1 Vicryl pop-offs · 1-0 Stratafix · 2-0 Vicryl pop-offs · 3-0 Monocryl PS-2.
Dressing
Sylke dressing + 4×4 + Tegaderm (Prineo alternative); drain site: drain sponge + Tegaderm.
If revision: Mastisol, Steri-Strips, 4×4, Tegaderm.