. Text-book of operative surgery . Incisiou for osteoplastic laminectomy. The muscles of the back have beeu detaehedIrom the trausverse processes oii the right side, and ciit across above and below. speaks in high terms of the osteoplastic Operation, especially of the method introduced by Cavicchia and performed by Durante, a method which we also regard Avith favour. It is performed as follows : A curved, or preferably an angled incision (see Fig. 96) 1 Cf. detailed accounts by Chipault, Etüde de Chirurgie meduUaire. Paris, 1904, and Marion Chir du Systeme nerveux, Paris, 1905. 2 (^%jy_ ^^^ S
. Text-book of operative surgery . Incisiou for osteoplastic laminectomy. The muscles of the back have beeu detaehedIrom the trausverse processes oii the right side, and ciit across above and below. speaks in high terms of the osteoplastic Operation, especially of the method introduced by Cavicchia and performed by Durante, a method which we also regard Avith favour. It is performed as follows : A curved, or preferably an angled incision (see Fig. 96) 1 Cf. detailed accounts by Chipault, Etüde de Chirurgie meduUaire. Paris, 1904, and Marion Chir du Systeme nerveux, Paris, 1905. 2 (^%jy_ ^^^ Systeme nerveux, Paris, 1905. SURGERV OF THE SPINAL CORD AND ITS CO VE RINGS 205 is made over four or five vertebral spines, dividing skin, fascia, and superficialmuscles (above, the trapezius, and tlie fascia covering the rhomboids, splenius capitisand colli, and the serratus posticus superior; below, the latissimus dorsi and serratusposticus inferior). The large muscles of the back are incised transversely above t\ mt\\ ifW \\t. Fig. 97 âOsteoplastic laminectomy, 2nd stage. The spiuous processes liave been chiselled tlirough attheir bases and turtied over to the left. The laniiuEe have been cut across with bone-forceps,exposing the spinal dura. and below as far as is necessary, namely the longissimus dorsi, with the iliocostalisand the accessorius farther out. The longissimus dorsi is raised and _ retractedtowards the middle line, and, without detachment of the muscles (semi-spinahs,multifidus) which are in direct contact with the arches, a broad chisel is applied 2o6 OPERATIVE SURGERY to the roots of tlie spines, whicli are then divided, and forcibly retracted to tlie otherside with strong hooks. Haämorrhage is considerably lessened by avoiding excessivedissection of muscle ofF the bones. The vertebral arches are now sufficiently exposedand a pair of forceps is inserted under tliem on each side, after Avliich tliey are cutacross and removed. The dura then lies exposed.
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