Prep Stand Items
Wilson crank
Chloraprep Orange × 2
10/10s × 4
Adhesive prep mit × 2
2 in. Silk tape (if adhesive prep mit unavailable)
Shaver with blade
4×4 bucket
Alcohol
Upper-body Bair hugger
White towels × 2 (for positioning)
C-clamp on bed (opposite side of CK at bend of knee)
Start of Case
7½ hydrogels, 7 latex × 2 for CK
6.5 PROTEXIS × 2 (for Alex)
7 Underglove Blues × 2 (for Alex)
4 Blue towels
Large Ioban × 2 cut into eight strips
If previous surgery, no large ioban over incision
Major abdominal surgical drape with pockets
DYNJP3103 at AH (or wide laparotomy drape)
¾ Sheet × 3
C-armor
Shower cap
O-arm drape × 1
Medium tegaderm × 3
Protected bayonetted bovie tip (start with the curved tip)
½ inch Steri strips (to hold long bayonetted bovie tip)
Silverglide bipolars – straight and angled
Suction tubing × 2
Suction tips
Short fat × 2
Short skinny × 2
Long skinny × 2
SureTrac – medium clamp / silver 4-prong array (ending in #579)
STRYKER PI/MAESTRO drill + burrs
3 mm Stryker Precision Neuro matchstick (5820-107-530)
5 mm Stryker round fluted soft touch (5820-010-150) or round fluted aggressive (5820-010-250)
Only use Stryker attachments ending in #482
See reference 2 for backup burrs
Start with 3 mm on the first dash; switch to 5 mm on the third dash after registration
Toomey syringe 70 cc or bulb irrigation × 2
Clamps × 6
Light handles
1018 pouches × 4
½ × ½’s
Cleaners for suctions
Retractor lights
Retractor arm
Retractor bed clamp
Meds
0.5 % Marcaine with epinephrine
18 gauge needles and 20 cc syringes × 2
Tissel
2 ccs per level (2 ccs = 1 container)
Floseal – use only 1 cc of thrombin
Duragen on hold in room
Room Setup
Allen table + Wilson bow frame
Silver arm-board clamps at proximal aspect of bed
End of Jackson frame on surgeon’s side of bed under light post
C-clamp at fold in back of knee (opposite CK)
Pillows × 4 (3 for feet, 1 for knees)
Overhead lights – “W” configuration with elbows away from CK
Light 1 – most north, toward anesthesia
Lights 2 and 3 – north & south positions
Bovie/bipolar settings: Bipolar 30 / Cut 40 / Coag 40
Fluoro shields × 2
Test drill (not rep’s)
Bipolar pedal on side closest to patient’s head (~1½ ft from bar under table)
Drill pedal on side closest to patient’s feet
Suction – two cables plugged into separate empty canisters; set to maximum power
C-arm always opposite Dr. Kim; OEC 3 preferred at Palomar
Wipe down C-arm before every case
Steps (fluoroscopy & burr-cord management)
3 vertical lateral steps and 2 horizontal steps under the table
Move steps and burr cord after O-arm spin; align centre
TRAY 1 – Incision Tray
Laps × 5 for CK
Skin knife – 10 blade & 15 blade
Marking pen
Weitlander (regular) × 1
Baby Weitlander × 1
Patient reference frame & top hat
Long perc pin (150 mm) with impaction cap
Mallet
Army navy retractor
If ROH, see reference 4
FRONT MAYO
Chickenfoot – Alvarado only
Navigation dilator – Alvarado only
J-Lo instrument
BACK MAYO
Under rack
Raytecs (small stack)
Laps (small stack)
Nerve hook
Floseal
Silver Woodson
Large hospital silver Cobb
Scanlon pickups (bayoneted)
Safe suckers (sterile)
Leksell (bull-nose)
Blue baby Cobb
Curette rack – left to right
1D, 2D, 3B, 4D
Black matted
4B, 3A, 2A, 1C
Extras 1B, 2B, 3B (sharpie line on handle)
TRAY 6
Navigation thoracic probe
Trackers × 4 (set up with balls)
Drivers – orange & purple
Silver thoracic probe (requires non-ratcheting handle)
Green 7 mm shaver
Floseal
Opened-up raytecs
Use 4 for one–two levels; 6 for three or more levels
Blue towels
3 mm burr on first dash
5 mm burr on third dash
Ifactor loaded in funnels × 2
See reference 3 for screws with C-arm
See reference 6 if cement is used
Note – Do Not Forget
Steps for CK
Wilson crank for rod
TRAY 11 – Closing Tray
Navigation slap hammer
Opened-up raytecs
4 for one–two levels; 6 for > 3 levels
Bonnies × 2
Adsons × 2
Needle driver (right-angle for CK) × 1
Needle drivers × 2 (1 fine, 1 regular)
0 Stratafix CT × 2 (SXPP1A406)
0 Vicryl (UR-5) × 2 (VCP376)
2-0 Vicryl SH × 2 (VCP417)
3-0 Stratafix Monocryl PS-1 × 2 (SXMP1B102)
Telfa × 1 (8 × 3 inches)
Tegaderms × 3
Army navy retractor
Blue towels × 3
Mayo scissors
Dermabond × 2
Wet & dry lap
Floseal (or Surgiflo) × 2
Vanco powder in cup
Exparel 20 cc diluted with 20 cc saline
If drain is used, see reference 5
Disposables
Light cable
Annulotomy knife
Kerrison Curette Tray
Suction tips – 5 pieces
Short fat × 2
Long fat × 1
Short skinny × 1
Long skinny × 1
J-Lo instrument
Suction wires with ball tip × 2
Lightning-bolt nerve root retractor
Osteotome
Mallet
Jerrad Cobb (lumbar)
Rack / stand
Kerrisons – 2 mm, 3 mm, 4 mm
2 mm straight black pituitary
4 mm silver pituitaries (straight/up/down) × 3
Silverback instrument
Foraminotomy Kerrisons – 2 mm & 3 mm
Small curettes – 1, 2, 3, 4 (straight/up/down)
Large curettes – 1, 2, 3, 4 (straight/up/down)
“Adam” curette (all black)
Penfield 4s × 2 (wide)
Penfield 2s × 2 (skinny)
MARS 3V Exposure Tray
3-blade retractor
Blades (50s/60s/70s)
Metal dilator – FAT (custom one-step)
Oval dilator
Attachment for 3-blade retractor (with navigation only)
TRAY 4
L handles × 2
12 mm trials (5–12 mm) – with 5 mm & 6 mm loaded
Expandable trial (8 mm/10 mm) – start with 8 mm
Blue Egg torque-limiting handle (5 N·m palm)
Counter-torque handle (MIS handle)
TRAY 7
Small ratcheting Egg handles × 2
Blue Egg handle × 1
10 mm MIS CREO O-arm drivers × 3
Tulip inserters × 2
Tulip remover × 1
CREO MIS tulips
CREO screws (loaded with tulips)
Custom Medtronic 5.5 mm + 6.5 mm CREO tap (hold)
Standard 5.5 mm tap + 6.5 mm CREO tap (hold)
Reamer × 2
Pearl cannulated gear-shift probe
7 mm navigated shaver
TRAY 8
Calipers
Articulating rod inserter × 2 (used for one-level cases)
Articulating rod inserter silver caps × 2
Fixed rod inserters (> 4) (used for ≥ 2 levels)
Fixed rod internal shaft × 2
Marc Anthony × 2
French bender (every case)
Stabilizer cuffs × 4
Rods – MARS auxiliary
Rods – CREO MIS (open for ≥ 2-level cases)
TRAY 9
Cap drivers × 4
Tuning forks × 2
Custom blue Egg torque handles × 2
Black T-handle × 1
Tab removers × 4
Cap caddy
Reminders/Notes
Check CK mic
Check irrigation balls
Add irrigation to pouches
Lateral view first for O-arm
CK wants to check patient reference frame balls before spin
Remind CK: 5 mm burr is set on #3 / 3 mm burr is set on #1
Light elbows opposite CK for all surgeries
Sable cage projection values – 30 mm = 34 mm negative projection; 26 mm = 30 mm negative projection
Put vanco in!
Let crank out of Wilson frame before rods go down
References
Cage references
SABLE cages: 12×26 mm 6–12 mm 8°, 12×26 mm 9–16 mm 8°, 12×26 mm 7–14 mm 15°, 12×26 mm 10–17 mm 15°, 12×26 mm 9–17 mm 22°
Drill reference
5 mm Stryker ACORN (5820-030-050)
Burrs
Medtronic ball fluted 5 mm round cutting burr (Ref 14BA50)
Medtronic AM-8 burr
Matchstick tip
Matchstick tip (Ref 14MH30)
Drain tray
15 blade
Kocher clamp
Medium hemostat
Small tegaderms × 2
Blue towel
Scissors
General Notes
Opened raytec × 10 at start; 4 at end of case for 1–2 levels; 6 for ≥ 3 levels
½ × ½’s for bleeders (use Scanlon pickups)
After cage goes in – use 4 large curettes to free the nerve, irrigate and apply Tisseel
After retractor comes out – apply Floseal + 2 raytecs (O-arm comes in for spin next)
Remove raytec before O-arm spin
Let crank out of Wilson frame before rods go in
Always have Floseal (2 on back mayo); mixture should use only 1 cc thrombin
Have the surg-tech guide on iPad
Bring paper copy of surg-tech guide for visiting doc cases
Use ratcheting handles only for screwdrivers
After cage insertion, 5 mm burr uses matchstick
BMP Protocol
Use 5/3 pieces per level – facet (1/3 with Kinex in “roach”), cage (1/3) and disc space (3/3)
Start screws on side opposite CK
Longer drill when using 70 mm blades or longer (second-largest attachment)
For patients ≥ 300 lbs, perform six steps
Burrs
Navigated Midas Rex at Alvarado
Straight and angled attachments
Straight attachment AS14 – use with Medtronic ball-fluted 5 mm round cutting burr (Ref 14BA50)
Angled attachment AA14 – use with Medtronic AM-8 matchstick tip (Ref 14MH30)
Backup burr at Alvarado: Maestro
Decompression tool: Stryker 3.0 Precision Neuro match head (5820-107-530)
Screw tool: Stryker 5.0 mm round fluted soft touch (5820-010-150)