Case of fracture of the spine, in which the operation of trephining was performed : with observations / by Robert M'Donnell.

  • McDonnell, Robert, 1828-1889.
Date:
1865
Catalogue details

Licence: Public Domain Mark

Credit: Case of fracture of the spine, in which the operation of trephining was performed : with observations / by Robert M'Donnell. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    I determined to remove the spinous and inferior articulating pro- cesses of this vertebra, by cutting through the lamin90. After waiting for a time while sponges and cold water were applied to stop bleeding, I first took off a part of the spinous process of the part I was going to remove, and divided the interspinous ligaments above and below. I next, with a strong pair of bone forceps, cut through the lamina on the patients left side (on which side I stood myself). This, owing to the displacement I have already described, was quite easily effected, as, of course the lamina, as well as the articulating process, was raised up somewhat on this side. On the right side, however, the opposite state of things made it much more difficult to succeed in cutting through the lamina. I could not suc- ceed at first with the cutting forceps, but was obliged to use a Hey’s saw guarded, so that it could not go in beyond a certain depth. I was unwilling to use the saw, lest the unavoidable shaking might injure any callus already thrown out, and tend to undo any repair that nature had already commenced. I finally succeeded in dividing the lamina on the right side with the forceps, I then grasped, in a pair of necrosis forceps, the root of the spinous process of t^e portion thus separated, and raising it cautiously, divided, with a scalpel, the ligamentous structures which now alone prevented its removal. On sponging away the blood, the theca vertebralis came into view; a small portion of the arch of the vertebra above was also removed with gouging forceps. The spinal cord was obviously pushed backwards, and had lain very close under the arch of bone taken away. The vertebral theca was •not tense; there was no evidence of either blood clot or fluid being pent up within it; it was therefore not opened, although I had at first intended to do so. Slight venous hemorrhage took place from the veins underneath the bone. The operation lasted about an hour; it was protracted by long rests now and then, waiting until the sponging with cold water and infusion of matico checked oozing of venous blood, as it was necessary to see with great precision what one was doing. I do not think that more than five, or at the most six, ounces of blood was lost. A couple of sutures were put in at the upper part of the wound; the lower part was left^open, a small tent of soft sponge alone being introduced. Notes immediately subsequent to Operation.—^\\o, patient was re- placed upon his back, pads of spongio-piline being placed above and