Supine position for Anterior lumbar interbody fusion (ALIF)

The patient is placed on a radiolucent table in a supine position and in a mild lordosis.

A pillow is placed underneath the knees. Slight knee/hip flexion allows the psoas muscle to relax. It also allows the vessels to relax, which eases their retraction.

Another option is to position the patient with arms folded across the chest. This position allows for easier positioning of the C-arm.

General anesthesia with endotracheal intubation is required.

Pulse oximetry should be placed on the left great toe.

Antibiotics should be administered prior to incision and at two-hour intervals during the procedure.

A cephalosporin antibiotic with good Gram-positive coverage is generally recommended.

Patients with penicillin allergies should receive vancomycin or clindamycin.

Fluoroscopy is mandatory. Preoperatively, it has to be assured that the C-arm can be moved around the patient freely.