. Manual of operative surgery. different methods of operating have been devised by varioussurgeons. Tietze and others divide the operation into two stages: first, per- SPASIKITY 769 forming laminectomy and some days later opening the dura and completingthe work. Undoubtedly a two-stage operation facilitates the finding of theposterior roots in that there is less blood to obscure the view, but bleeding canbe well controlled by pressure with pads of hot gauze against the spinal muscles,and by packing narrow strips of gauze between the dura and the lateral portionsof the vertebrae after the spina
. Manual of operative surgery. different methods of operating have been devised by varioussurgeons. Tietze and others divide the operation into two stages: first, per- SPASIKITY 769 forming laminectomy and some days later opening the dura and completingthe work. Undoubtedly a two-stage operation facilitates the finding of theposterior roots in that there is less blood to obscure the view, but bleeding canbe well controlled by pressure with pads of hot gauze against the spinal muscles,and by packing narrow strips of gauze between the dura and the lateral portionsof the vertebrae after the spinal canal has been opened. Danger from infectionis distinctly less in a one-stage than in a two-stage operation. (For Fraziersmethod of exposing the cord see p. 760.) To distinguish the posterior roots itis necessary to have free exposure of the posterior surface of the cord; if bloodobscures the view it ought to be removed by gentle douching with warm saltsolution (Fig. 928). Spinous proc. Epidural space DuraSubarachnoid space. Spinal ganglion Ant. root. {Poirier and Charpy.) After the dura is opened attempts to remove blood by means of spongingare liable to do much damage to the delicate nerve structures exposed. How many and which of the posterior roots ought to be divided? Frazier writes: It is known that the supply of each muscle or group ofmuscles is represented in most instances by three segments of the cord andby as many roots and, according to the observations of Sherrington, the cutane-ous nerve supply of any given area is derived from at least three roots. Theo-retically we plan to break the reflex arc of the muscles involved, by cuttingoff as many peripheral stimuli as possible; we should not, however, removeevery source of sensory stimulation, otherwise we would substitute a conditionof absolute anesthesia and flaccidity for one of spasticity. In selecting theroots to be sacrificed it is necessary obviously to remove at least two of thethree possible sources of senso
Size: 1811px × 1380px
Photo credit: © The Reading Room / Alamy / Afripics
License: Licensed
Model Released: No
Keywords: ., bookcentury1900, bookdecade1920, bookpublisherphila, bookyear1921
