Removal Of Spinal Cord In Infants

ANTERIOR APPROACH The basic principle is the same as in adults. The incomplete calcification of the spinal column permits the use of a scalpel blade instead of an oscillating saw blade.

Fig. 6-8. Removal of cervical spine. Upper, scalpel blade is used to separate bone block at an intervertebral disk. Lower, bone block to be removed is reflected upward forcefully to break off at high cervical level. This method is faster, but not suitable when examination of the cervical spine (e.g., for fractures or disk protrusion) is necessary. Notice continuity of cervical roots with spinal cord.

Fig. 6-8. Removal of cervical spine. Upper, scalpel blade is used to separate bone block at an intervertebral disk. Lower, bone block to be removed is reflected upward forcefully to break off at high cervical level. This method is faster, but not suitable when examination of the cervical spine (e.g., for fractures or disk protrusion) is necessary. Notice continuity of cervical roots with spinal cord.

COMBINED APPROACH For complete removal of a meningocele, meningomyelocele, or other lesion related to a midline fusion defect, it is best to combine the anterior and posterior approaches. After evisceration, the body is turned over and an incision is made around the meningomyelocele or other defect to allow en bloc removal of the lesion with the entire spinal column and cord. That task can be approached either posteriorly by extending a midline incision over the spin-ous processes, or anteriorly. In either case, the ribs are separated from the spine and the sacral bone is cut away from the rest of the pelvic bones. A transection is made across the upper thoracic spine and the entire block is freed from soft-tissue attachments. For retaining the continuity of the cervical spine, the posterior approach obviously is the method of choice. The method can be used regardless of the position of the midline defect. A similar approach is suitable for the removal of an occipital meningocele or encephalocele. An Arnold-Chiari malformation should be exposed with its posterior aspect within the bony cavity and for this, the posterior portion of the occipital bone is cut off, followed by laminectomy of the upper cervical spine. The skull is opened in a routine fashion.

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