The thirty pairs of spinal nerves are now cut from above downward,
beginning on the right side. The cut edge of the dura or a dural
fold, if the dura is left uncut, is seized with the dissecting
forceps and pulled over to the left, so that as much of the nerve
can be secured as possible. A long, narrow, sharp-pointed scalpel
is inserted, outside of the dura, into the intervertebral foramina,
as far as possible, and the nerves are cut while traction is made
upon the dura to the opposite side. The same procedure is then
carried out upon the left side. When all of the spinal nerves are
cut, the scalpel is introduced in the spinal canal upward, as near
to the foramen magnum as possible, and the cord and dura are cut
transversely. The cord should be held by the dura; direct pressure
with forceps or fingers upon the soft substance of the cord should
never be made. If the forceps cannot be used to hold the dura with
advantage, then the cord enclosed in the dural sac may be gently
but firmly held in the _palm_ of the left hand and lifted and drawn
downward towards the sacrum with the greatest care. As the cord is
removed the fibrous attachments between the dura and the longitudinal
fascia of the anterior wall of the canal are cut with the small
scalpel by means of oblique cuts upon the bodies of the vertebræ.
Any fragments of bone impeding the removal of the cord should be
trimmed off with the bone-forceps. The forcing of the cord through a
tight aperture in the open canal may ruin that portion of the cord.
In some cases it may be better to sever the dura and cord at the
sacral end, below the cauda equina, and remove it toward the head,
using the same method of holding the dura, and cutting the spinal
nerves and peridural tissue. When this is done the importance of
saving the spinal fluid should be borne in mind. Some prosectors
prefer to sever the dura and cord above before cutting the spinal
nerves, and to cut these and the epidural fascia while removing the
cord. An experienced operator may save time in this way, but there
is greater danger of injuring the cord. The cord may also be removed
by severing the spinal nerves and vessels inside of the opened dura
and lifting the cord out of the dura, but it is more likely to be
damaged by this method. When the brain has been removed before the
cord the dural attachments as high as the foramen magnum should be
severed and the cord removed up to the point where it was severed
from the brain. If it is desired to remove the cord attached to the
brain, the cord is first loosened throughout its length from below
up to the foramen. It is then carefully protected while the skull
is opened; and after the brain-connections have been severed it is
drawn up through the foramen as the brain is lifted out of the skull.
After its removal from the body the cord is stretched out upon table
or board and the dura opened in the median line both anteriorly and
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