When the vertebræ are bared the next step is the removal by saw,
bone-forceps or chisel of the posterior bony wall of the spinal canal
in such a manner as to expose the cord and permit of its removal
without causing any damage to it, either from the instruments or
from fragments of broken bone. A single-bladed saw with curved ends
may be used to saw through the laminæ on both sides of the spinous
processes; or even the small bone-saw (Fig. 9) may be used for this
purpose. The blade of the saw should be held obliquely against the
spinous processes with the sawing edge directed outward so as to
cut the laminæ close to the medial borders of the ascending and
descending transverse processes. The sawing is complete when the
spinous processes become movable. The straight-edged chisel may be
used to cut any adhesions left after sawing, and the bone-forceps
may be used to cut the atlas and axis. When the laminæ have been cut
through on both sides of the spinal column for its entire length,
including the sacrum, the posterior ligament between the atlas and
occiput is cut with the cartilage knife; and the strip of bone and
ligaments loosened by sawing is torn off from above downward by
grasping it in the upper cervical region with a pair of bone-nippers
and jerking it off forcibly downward toward the sacrum, thus exposing
the spinal canal. It may be taken off in the opposite direction by
cutting the ligament between the last lumbar vertebra and the sacrum
and stripping upward.
The use of the single saw is not advised, however, as it is too
time-consuming. The laminæ on both sides of the spinous processes
may be cut at the same time by the use of _Luer’s rhachiotom_e (Fig.
11). The blades are separated according to the size of the vertebral
arches and are set so as to include the spinous processes and cut the
outer border of the laminæ close to the transverse processes in such
a manner as not to injure the cord. Since the spinal canal is broader
in the cervical and lumbar regions than in the dorsal, the distance
between the saw-blades must be regulated accordingly. The dorsal
portion is first sawed. The sawing should be in long cuts without too
great pressure, the instrument being steadied by placing the left
hand on the upright bar. As soon as the spinous processes become
movable on slight pressure the sawing should be stopped. Should the
blades become caught in the saw-cuts great care should be taken to
avoid injuring the cord while releasing them. The straight-edged
chisel may be inserted into the cuts and any parts still adherent
may be carefully sprung apart. This is necessary particularly in the
upper cervical region. The entire posterior wall of the canal may be
loosened in this way, the sacrum being also sawed, when it is desired
to open this part of the canal. When all the spinous processes are
movable the attachments either above or below are cut with the
cartilage-knife, and the spinous processes and laminæ torn off by the
Public-domain text, read in full here on John Shaqi.
Reviews
Reviews
No reviews yet
Be the first to share your thoughts on this work.
Join the Discussion
Join the discussion
Sign in to leave a comment or review.
Sign InorCreate an account