TREATMENT 81 



account of age has a well defined limiting wall. 

 It is often possible in many cases to resect the 

 sac and then heal up the wound under aseptic 

 conditions without drainage. More often, 

 however, the region is invaded with infection 

 of long duration and exhibits necrotic areas 

 which must be removed. For example, if the 

 ligament is found carpeted with undulated 

 granulations and is seen to exhibit necrotic 

 spots or is riddled with pus tracts, it should be 

 entirely removed The resection is effected by 

 cutting it off anteriorly, grasping the end with 

 a tumor forceps and then dissecting it in the 

 backward direction to the posterior commis- 

 sure of the wound. This is done on both sides 

 or only on one side according to the condition 

 in which the ligament is found. When not too 

 firmly fixed into the adjacent connecting tis- 

 sue it can often be torn out with the tumor 

 forceps. 



The bones beneath are left severely alone. 

 Trimming with bone forceps or curette is not 

 recommended. Spontaneous exfoliation is de- 

 pended upon exclusively. We have found that 

 meddling with the spinous processes is a harm- 

 ful practice. The exposed curetted ends be- 

 come open channels for the descent of new and 

 deeper inflammatory processes, when later dur- 

 ing the healing they are constantly soaked in 



