. Contributions from the Department of Neurology and the Laboratory of Neuropathology (reprints). canal duringthe operation it should be removed by irrigation and notby sponging, in order to avoid every possible source of trauma,and before the dural wound is finally closed every vestigeof blood should be removed in the same way, as a smallclot, if allowed to remain, might cause undesirable pressuresymptoms. It is needless to say that once the meningeshave been opened one must be scrupulously careful to avoidtraumatizing the cord and its roots. The avoidance oftrauma, of hemorrhage, and infecti
. Contributions from the Department of Neurology and the Laboratory of Neuropathology (reprints). canal duringthe operation it should be removed by irrigation and notby sponging, in order to avoid every possible source of trauma,and before the dural wound is finally closed every vestigeof blood should be removed in the same way, as a smallclot, if allowed to remain, might cause undesirable pressuresymptoms. It is needless to say that once the meningeshave been opened one must be scrupulously careful to avoidtraumatizing the cord and its roots. The avoidance oftrauma, of hemorrhage, and infection are absolutely essentialto success. 19 As to what roots should be divided, tiiis will dependupon the indivitiual ease; in our own it was the second,third, and fifth lumbar roots. One must have a way ofdistinguishing one root from another, or at least of beingable to identify any one of the several roots exposed, andForsters plan is simple and practical. Before the spinousprocesses are removed a pin or suture is introduced intothe skin to one side of the incision on a level with the spinous. Fig. 11.—lUustaation from photograph showing the arrangementof gauze pads, traction sutures, and a hook passed around both theanterior and posterior roots. process of the fifth lumbar vertebra. This correspondsto the level at which the first sacral nerve leaves the duralsac. With any one nerve identified it is a very simple matterto identify the others. The actual division of the sensory roots is not a difficultthough a delicate procedure. My apprenticeship wasserved many years ago when for experimental purposesI divided a number of posterior spinal roots on dogs. Here 20 tlie roots were much smaller and not so easily distinguish the posterior from the anterior roots onemust remember that the posterior root has its originfrom the posterior part of the cord, and is divided intoseveral bundles. The two roots are elevated on a blunthook and drawn gently toward the median line;
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