ACDF

Gerszten Hamilton Miele Moossy Buell Bayley

Attending	Vendor	Side	Bump	Localization	Neurophys	Platysma	Drill bit	Caspar pins	Retractor system	Drain	Closure
Hamilton	Stryker No microscope	Right	Transverse. Rolled sheet or chuck.	C arm. Before preop. Sponge sticks	SSEPs usually, prepositions if cord compression	Transverse, undermine	M8	Yes	Trimline, I think	Usually	Plastyma 3-0 poly, skin Biosyn subcu, no glue
Gerszten	Stryker	Right	Transverse. Rolled sheet or chuck.	C arm. Before prep, tape a blunt needle to the side of the neck to mark space.	SSEPs only and always	Transverse, undermine	M8	Yes	Trimline	Rare	Platysma 3-0 poly; skin Biosyn subcu, no glue
Miele	DePuy	Right	Vertical, two blue OR towels	Intraop only, use bent spinal needle, lateral flat plate	Rare	Vertical, overmine	Diamond, length set to "4"	No	Trimline	Context-dependent	Platysma 3-0 poly; skin quill stitch subcu, skin glue
Okonkwo	Nuvasive plate DePuy bone Chin strap before SSEP leads	Right	Transverse	Before prep, C arm, sponge forceps	SSEPs only, prepositions if cord compression	Spread with Metz in direction of fibers (~vertical)	M8	Yes	Shadowline	Yes	Platysma 3-0 poly, skin Biosyn subcu, glue
Kaufmann	Zimmer	Right	Transverse, rolled blanket	None preop, Caspar pin intraop with flat plate	SSEPs always	Vertical, overmine	M8	Yes	Trimline	No	Platysma 3-0 poly, skin Velasorb, steri strips, Telfa, paper tape. No glue
Lang	DePuy	Left	Vertical, A line pressure bag	None preop, Caspar pin intraop with flat plate	SSEPs and motors in setting of trauma	Vertical, undermine	M8	Yes	Trimline	Sometimes	Platysma 3-0 poly, deep dermal 3-0 poly, skin Quill, steris no other dressing
Moossy	DePuy	Right	Vertical, rolled chuck	Anatomic landmarks only	None	Doesn't care	M8	Yes	Shadowline	No	Platysma and dermals 3-0 Maxon, skin 3-0 Biosyn subcu, steri strips
Bayley	Medtronic	Right	Horizontal, small gel roll	Anatomic landmarks (okay with C-arm if resident wants)	SSEPs + preposition if cord compression	Doesn't care, undermine	M8	Yes	Trimline	Context dependent	Platysma and dermal with 3-0 Polysorb, skin with 4-0 Monocryl, skin glue, no bandage
Buell	Nuvasive	Left	Horizontal, rolled blanket	Preop C arm, intraop Caspar pin	SSEPs, UE EMG. Add MEPs for trauma	Transverse, undermine	M8	Yes	Shadowline	Always	Platysma and dermal 3-0 Poly, skin 4-0 Mono, skin glue, Primapore

Gerszten

Hamilton

No microscope.

For 3 or more levels, every patient should be put in a cervical collar beginning on POD1. This improves fusion rates from 88% to >90%. Collar to be worn any time patient is on their feet. Continue for 4-6 weeks postop.

Miele

He uses a hand drill to ‘tap’ for screws. Place the ball of the hand drill within the hole first then engage the drill bit

He uses a quill stitch to run a subcuticular layer; double ended suture, start in the middle and go each direction, finish the suture by going through the corner then out the side of the incision through the skin. Skin glue, then basic opsite dressing.

Moossy

When doing multiple levels, Expose and complete 2/3rds of the diskectomy for each level before going under scope. The top and bottom levels should have Caspar pins and all levels should be partially diskectomized before you take your loupes off.

Buell

Left sided approach

Bayley

No need for Foley for a single level. No need to localize preop, use anatomic landmarks in the form of the thyroid cartilage. SSEPs and prepositions if there is cord compression. Place purple foams on the inside of the arms then wrap with the sheet. Do not go all the way around the bed with the tape, instead just use small strips to tape across the top of the sheet to hold the two ends together. Place a bump transversely under the shoulder blades. Drape with four blue towels but don't place a whole piece of Ioban over the field, just use small strips to hold the towels down and leave the center of the field devoid of Ioban. Down sheet, thyroid drape with the feet towards the feet (i.e. thyroid drape is not reversed). Skin with 15 blade, lift skin with Adsons and Bovie to the platysma on 35 and 35. Bayley doesn't care if the platysmal incision is vertical or horizontal but does want you to undermine the platysma with Metzenbaum scissors and bipolar. Follow the medial border of the SCM to the carotid sheath then go medial to the spine. Sweep the soft tissue off the spine with a peanut. Localize with a bent 18 gauge spinal needle placed in the vertebral body not the disc space before dissecting the longus. Feel with a finger for the lateral borders of the spine to define midline before going down on midline with a Bovie and dissecting out laterally. Place the Trimline retractors, both smooth, neither toothed. Follow with Caspar pins that are angled towards one another. Use the M8 drill to drill away the osteophytes before entering the disc space. Bayley is okay with discectomy either entirely with the drill or with curettes.