obtained the spinal canal can be opened in this way more quickly than
by any other method. In private practice the noise made by the hammer
upon the head of the handles of the chisels is unpleasant, and should
be avoided by the use of felt or something else on the head of the
chisel or mallet to deaden the sound.
Another easy and convenient way of opening the spinal canal
posteriorly is the cutting of the laminæ by means of special
bone-forceps designed for this purpose. The cutting-edges may engage
the laminæ from without or the lower blade may be introduced into
the canal as a blunt probe, while the upper blade cuts down upon it
through the side of the arch. Such bone-forceps should be very strong
and have long handles to give sufficient purchase, as a good deal of
force is necessary to cut through the laminæ. With a good instrument
the canal can be opened in this way in about 10-15 minutes. It
requires much less skill than is needed for good and quick work with
the Brunetti chisels, and for that reason is recommended, as is also
the use of Luer’s rhachiotome, for the general practitioner.
In the case of marked curvatures of the spine it may be impossible
to use either rhachiotome or Brunetti chisels. The straight single
chisel and small saw can be used on the concave and convex sides of
the curvature respectively. In children and young adults the canal
can be easily opened with the bone-forceps.
After the removal of the posterior wall of the spinal canal the
peridural adipose tissue and the dural sac are exposed in the canal.
The cord may now be removed with dural sac intact, and when the cord
is soft this should be done, but in so doing the spinal fluid is
likely to be lost; and, as it is very important to obtain a knowledge
of the amount and character of this fluid, care should be taken to
preserve it. With the block placed under the cervical region to keep
the cervical and dorsal vertebræ higher than the lumbar the dural sac
may be opened in the median line from above downward. The cervical
dura is grasped with a pair of forceps and lifted so that a cut can
be made in it with the small bent, probe-pointed shears. The blunt
probe-point is then introduced into the subdural space and the dura
cut in the median line downward toward the sacrum. With care the
arachnoideal sac with its fluid may be preserved intact. What fluid
there is in the subdural space will collect in the lumbar region
and may be secured while the lumbar dura is cut. The fluid in the
subarachnoideal space will likewise collect in the lower portion of
the cord, and it is best at this stage of the operation to introduce
a sterile pipette through the delicate arachnoid and draw up the
fluid, preserving it for bacteriologic and microscopic examination.
Public-domain text, read in full here on John Shaqi.
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