- Mini open approach (L4-S1)
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Positioning for mini open approach (L4-S1)
The patient is placed onto a radiolucent table in a supine position.
A pillow is placed underneath the knees. Slight knee/hip flexion allows the psoas muscle to relax, which eases the approach.
Anesthesia
General anesthesia with endotracheal intubation is required.
Pulse-Oximetry should be placed on the left great toe.
Blood management
The use of a blood salvage techniques (eg, cell saver) is recommended.
Preoperative antibiotics
Antibiotics should be administered well prior to the incision and also at intervals during the procedure or when the blood loss exceeds 2 liters.
A cephalosporin antibiotic with good gram positive coverage is generally recommended. Local bacterial spectrum will need to be taken into account; this should be discussed with the hospital microbiologist.
Spinal cord monitoring
Spinal cord monitoring is optional.
Fluoroscopy
Fluoroscopy is mandatory. Preoperatively, it has to be assured that the C-arm can be moved around the patient freely.