Medications
Local: 0.25% Marcaine with epi (20 mL per level)
Depomedrol: 40mg per level
Irrigation
3L NaCl bag
2-3 bags per level
Contrast: One mixture per level
2cc of 0.5% methyl blue (Provay 5mg/mL) + 9cc Omnipaque 300mg/mL
RN Setup
C-arm on opposite side (before opening)
Bed
Bed
Jackson table with Wilson frame
Foam arm pads x2
Pillows x4
Prone View facemask
Prep stand
Wilson crank
Shaver with blade
Adhesive prep mitts x2
Isopropyl alcohol
4x4 sponges
1010 sticky drape x4
Chloraprep x2
Upper body air warmer
2 white towels for armpits
SCDs
+/- Foley catheter
6 steps
Draping
Draping Materials
6 strips ioban
2 for CK sleeves (3 fingers width)
4 for securing towels
7 blue towels
4 towels for draping
3 for suctions
Blue abdominal drape
¾ sheet x 2
Pocket drape (3M 6658)
C-armor
C-Arm Showercap
Suction x 4
1 in C-armor
2 in pouch drape
1 for bumper
Instrument pouch x1 (1018)
Irrigation tubing (cysto tubing)
8 Allis clamps
Light cord to say "ND" (extra long)
Stryker camera (384 is #1, cleaned)
L2-3 or higher: need >2 needles for counting - 18 gauge
Draping Steps
Start with down sheet, 1 cm below the 10x10
Start with bottom blue towel – one 1 cm cranial to down sheet
Top blue towel
Lateral blue towel on opposite side first with 4 cm ioban, bring extra ioban down onto down drape
Other lateral blue towel with 4 cm ioban on surgery side, use extra ioban for down drape
Lap drape with circumferential pockets for irrigation – go slightly lateral to surgery side to allow for TF approach, if also IL make sure you can still see the midline
C-arm cover - opposite side of C-arm
Throw off suctions towards suction machine - will have three with tips cut off and clamps
Measure suctions by putting into most south part of drape so X-ray does not see, clamp to towel, ensure suction holes are not covered
Cut 2 small holes in cranial part of pocket drape to feed suctions on each side through, C-armor suction does not go through hole
One suction in C-armor, one in each side of pocket drape (3 total)
Pocket for Triggerflex on opposite side of surgeon on patient’s shoulder blade
Secure suctions with right white Velcro
Secure Triggerflex +/- drill with left Velcro
Measure Triggerflex and drill by putting ends into south white Velcro/on Mayo stand
Assembling drill
Lubricate drill bit with mineral oil
Put handpiece in open position
Connect handpiece to motor
Twist handpiece until it locks into place
Insert drill bit
Twist handpiece to closed position
Twist support tube to lock down
Press foot pedal slowly to test drill
Attach light cord
Attach stopcock to southmost outflow of scope
Attach irrigation to stopcock
Scope condom for TF
Cut a small hole in the top of the condom and put on base - this should go to about 1 inch past connection for the black cord
White balance camera (Hold W) and make sure zoom is good, check quality
Make sure laser on field with towel over cord
Last special clamp on Mayo
C-arm shower cap
If retractor: put on retractor clamp onto clamp on bed
Arm of retractor should have flat face facing out
Angle second arm 45 degrees
Equipment
Endo Cam, Tower and Device Setup
Elliquence Spinal Endoscope
10-2022 for transforaminal (181mm, 30deg, 7mm Diameter)
10-1023 for interlaminar (130mm, 15deg, 7mm diameter)
Clean camera, coupler lens, and scope lens with "no fog"
Wipe off film with dry raytec
Triggerflex Radiofrequency Probe: 31cm for transforaminal, 25cm for interlaminar
Turbo ablation: 45
Hemostatic: 0
Bipolar: 25
*Make sure on turbo for case
Elliquence Drill
Program 4
Plug into M1
Drill hand piece (#3 preferred, #1 as backup, #2 broken)
Mineral oil
Elliquence Implanet ultrasonic bone scalpel
Blade tip
Trephine tip
Stryker endoscopic tower with camera
Screen: universal, brightness 50, contrast 50, sharpness 5
Camera box: arthroscopy, brightness: 5, zoom 1: SPY intensity: 0
Light source: 50%
Light cord adaptors
Trimedyne Laser Probe
30cm handpiece for tLESS
25cm for iLESS
Lumenis laser generator
Starting at: Energy: 2.2
Frequency: 20
11×= energy 2.5, frequency 20
Extra Interlaminar / using drill
Interlaminar/using drill
Drill hand piece (#3 preferred, #1 as backup, #2 broken)
IL or TF support tube and burr tip (IL: 103, 206; TF: 104, 202 – do not open until confirmed using)
Mineral oil
Incision Starting Tray
Gowns + Gloves
Surgeon: 7 blues and 7 protexis
PA: 6.5 outer, 6 blues inner
Marking pen
10 blade and knife handle (#4 at UCSD)
Specimen cups x2 (one for local, one for contrast)
Syringes
10cc x 2 for local
5cc for contrast/dye
TB for depo (this will be used right before closing)
Spinal Needles
8" 18 G - for local
10" 22 G - for chromatodiscogram
Mallet
Endo Pusher
Endo Pencil
Elliquence guidewire – run guidewire through favorite/1st dilator then place on back table
Elliquence 5 dilators, 3 reamers: line up with corresponding dilators inside reamers
Initial Spaghetti Noodle dilator
#1 dilator inside #1 reamer
#2 dilator inside #2 reamer
#3 dilator inside #3 reamer
Custom 5th dilator
Glorybell bumper (blue end of suction tubing, 1.5, 1 cm and 0.5 cm pieces)
Custom Cannulas
Uniportal IL: 9 iron and standard
Biportal IL: Micky's Bigmouth
Uniportal TF: Standard TF cannula
Endoscopic Instruments
Endo Pituitaries & Rongeurs
Favorite (up-biting) 12-1834 TF / 12-1837 IL
Curly Q (curved with spring tip) 12-1730
Regular (straight, no teeth) 12-1624 TF / 12-1627 IL
Endo Kerrisons (45 & 90 degree)
Pacman Biting Basket (angled + straight)
Curved ball tip feeler
Salt and Peppa articulating curette
Paprika articulating curette
Endoscopic reamer
Blue rubber stopper – prefers medium
Biportal/Multiportal (available, but not open)
Biportal curettes
Biportal cannulas (Mickey’s Bigmouth, Halfy)
Stryker drill (5mm diamond)
Closing Tray
Telfa and ruler for disc fragment picture
Adsons
Needle driver
Suture: 3-0 vicryl SH
Dermabond
Bandaid in room (1 per level)