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 
