Executive Editor: Luiz Vialle General Editor: German Ochoa (in memoriam)

Authors: Alex Vaccaro, Frank Kandziora, Michael Fehlings, Rajasekaran Shanmughanathan

Thoracic and lumbar trauma

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MIS right sided thoracic(T4-T10)
Thoracic and lumbar fractures: Positioning and preparation enlarge

Positioning for minimally invasive right sided thoracic approach (T4-T10)

The patient is placed onto a radiolucent table and turned into the lateral decubitus position, right side up. 

The right arm is elevated and placed in a well-padded support and a cushion pad should be placed underneath the left axilla.

Depending on surgeon preference, the table could have a tilting option. If selected, the tilting option should be located underneath the patient's thoracolumbar junction, which gives the possibility to open the intercostal space.

If the tilting option is used in the table, be careful to straighten the table prior to performing the instrumented fusion.


General anesthesia with endotracheal intubation is required.

Single lung ventilation is recommended. 

Preoperative antibiotics

Antibiotics should be administered well prior to the incision and also at intervals during the procedure or when 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/x-ray control

Fluoroscopy or x-ray control is mandatory. Preoperatively, it should be assured that the C-arm can be moved around the patient freely.

v1.0 2014-12-99