When the canal is fully
exposed the examination of the dura and the removal of cord and
dura proceed as when the canal is opened posteriorly. The straight
chisel and the bone-forceps are also used to open the spinal canal
anteriorly, but the Brunetti chisels are especially recommended for
this operation.
=Examination of Spinal Ganglia.= While these may be examined when
the canal is opened posteriorly, they can be exposed with less
danger of damage in the anterior examination. To expose them in the
posterior examination they must either be drawn forcibly through the
intervertebral foramina, or the articular processes must be cut away
with the chisel.
When it is desired to remove a part of the spinal column for
preservation as a specimen, the intervertebral cartilages and the
cord above and below the portion to be removed are cut through with
the knife, and the ribs severed with a chisel, while the adherent
soft parts are cut away. The saw or chisel is then used to complete
the disarticulation if necessary and the loosened portion is removed.
The entire spine may be removed, if desired; and may be bisected with
a band-saw. A stick of wood may be put in the place of the spine and
covered with plaster-of-Paris.
After the cord and dura have been removed the inner surface of the
canal should be examined. The character of the cut surface of the
vertebral bodies is also noted, and the bones examined for pathologic
conditions.
=2. POINTS TO BE NOTED IN THE EXAMINATION OF THE SPINAL COLUMN=.
1. =Dorsal Incision.= Note color of skin as it is cut, number
of bleeding points, moisture, bedsores, amount and character of
panniculus, color and blood-content of muscles, hemorrhages, purulent
and tuberculous processes (usually infiltrations from diseased
vertebræ) trichina in spinal muscles, etc.
2. =Vertebrae.= Necrosis from bedsores, surfaces smooth or rough,
purulent and tuberculous processes (most common anteriorly),
exostoses, curvatures, fractures, dislocations, erosions,
malformations (spina bifida and supernumerary vertebræ most common),
neoplasms (secondary carcinoma, primary sarcoma, myeloma and chloroma
most common), actinomycosis, syphilis, rachitis, etc.
3. =Dura.= Note epidural tissue first, then dura, its thickness,
color, translucency, blood-content, intradural pressure, character of
inner surface (normally it is grayish-white, smooth and shining).
defects, bone-formation, organizing blood-clots, hæmatoma, gumma,
neoplasm, etc. Most common pathologic conditions are chronic
pachymeningitis, syphilis, tuberculosis, traumatic lesions and
secondary carcinoma. Primary tumors (sarcoma) and parasites
(echinococcus and cysticercus) are rare. Teratomata occur in sacral
and coccygeal regions. A diffuse formation of adipose tissue is
common, as is also the development of bony plates in the dura in old
chronic pachymeningitis (usually syphilitic). Note character and
amount of contents of subdural space (blood, pus, serous exudate,
etc.).
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