The practice of surgery . Fig. 440.—Cersical laminectomy: A, A, Saw-cuts through the laminse, justwithin their junction with the articular process; B, Doyen saw in act of dividingthe lamina> at a right angle to their surface, its guard (determining the de|)th of sec-tion) being entirely raised at the beginning of the division; C, knife dividing theligamenta subflava; D, osteotome levering away the muscles of the vertebral grooves,using the spinous processes as fulcra (Bickham). and then on the other. There is sharp bleeding generally. Check itby firm packing. Before going further see that t
The practice of surgery . Fig. 440.—Cersical laminectomy: A, A, Saw-cuts through the laminse, justwithin their junction with the articular process; B, Doyen saw in act of dividingthe lamina> at a right angle to their surface, its guard (determining the de|)th of sec-tion) being entirely raised at the beginning of the division; C, knife dividing theligamenta subflava; D, osteotome levering away the muscles of the vertebral grooves,using the spinous processes as fulcra (Bickham). and then on the other. There is sharp bleeding generally. Check itby firm packing. Before going further see that the bones are widelyexposed and that all bleeding is stopped. The steps so far are tediousand often laborious. Entering through the bones of the canal is not difficult. Dividethe interspinous ligament at the bottom of the proposed bone window,remove with rongeur forceps all the spinous processes in view, and TUMORS OF THE SPINE 693 cut aw;iy part ot the lowest lamina,. Then, with stout cutting forceps 1. A Fig. 441.—Osteoplastic resection of the spine: A, Tenaculum forceps holdingback composite flap; B, B, delicate forceps grasping and elevating membranes andforming a transverse ridge; C, C, tenacula holding apart edges of incised membranes;D, angular scissors used in incising membranes; E, half-button of bone bitten outof lower margin of last lamina in flap by rongeur forceps; F, similar half-buttonbitten out of upper margin of next stationary lamina below, the two half-buttonsforming a circular opening, when in contact, for drainage; G, vascular fatty areolartissue covering membranes. The stump of the excised spine is shos^^l, in impression,through the turned-back flap (drawn from cadaveric operation) (Bickham). (or with chisel, osteotome, or saw), cut away a suitable number oflaminae on either side, and remove the excised sections of bone. 694 THE HEAD AXD SPINE Now we have the dura exposed and may see the nerves emergingfrom it. The remainder of the operation is obvious
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectsurgery, bookyear1910
