**3.1 Preoperative planning**

A thorough preoperative patient history and examination is performed. Preoperative radiographic workup includes plain X-rays with AP, lateral, flexion, and extension views. Magnetic resonance imaging (MRI) of the lumbar spine is performed. In reoperation cases or in patients with scoliosis, a computed tomography (CT) myelogram can be helpful in defining bony anatomy, foraminal, and central canal stenosis better. In patients without significant neural compression and relatively preserved disk height, lumbar diskography with post-diskography CT confirming annular tears can be a method to identify the origin of discogenic back pain that can respond favorably to interbody fusion [27].

### **3.2 Patient positioning**

We prefer general anesthesia with endotracheal intubation for most patients as these cases average 3 hours. Once the patient is intubated, a Foley catheter is placed and the patient is log-rolled onto a Jackson table in the prone position (**Figure 3**). The Jackson table is helpful, because it allows unencumbered fluoroscopic visualization of the spine along with easy removal of the fluoroscopic unit from the surgical field. All pressure points are adequately padded. A time-out is called to confirm surgical level and procedure, proper padding of patient, etc.
