Part I - Skinning

• Make one midsagittal and several transverse incisions on the back in order to create more manageable skinning areas

• Skin the entirety of the back 

Part II - Superficial Back Musculature

• Identify and clean the superficial back musculature:

  • Trapezius m.

  • Latissimus dorsi m. 

• Clean the thoracolumbar aponeurosis (fascia)

• Reflect the trapezius and latissimus dorsi mm.

Part III - Deep Back

• Reflect all superficial back musculature

• Make two paraspinal incisions, from the external occipital protuberance to the tip of the coccyx

• Retract all deep musculature laterally, exposing the spinous processes and laminae 

• Observe supraspinous and interspinous ligaments running between adjacent spinous processes 

Part IV - Laminectomy 

• Perform a laminectomy from T1 to all inferior vertebrae 

• Identify ligamenta flava 

Part V - Vertebral Canal Contents

• Observe the epidural fat and the posterior internal vertebral venous plexus, then remove them

• Identify the dura mater surrounding the spinal cord, and note the filum terminale externum/coccygeal ligament extending from the termination of the dura mater 

• Incise along the midline of the dura mater and open the dural sac

• View the meninges, spinal cord, and associated structures:

  • Arachnoid mater

  • Pia mater

  • Lumbosacral enlargement 

  • Spinal nn.

  • Denticulate ligaments 

  • Conus medullaris 

  • Cauda equina

  • Filum terminale internum

• Identify the posterior spinal arteries and veins running along the spinal cord

• Make a transverse cut through the spinal cord in the thoracic region and reflect the cord in order to visualize the anterior spinal artery and veins 

• Try to distinguish between the grey and white matter on the cut edge of the spinal cord

• Locate the posterior longitudinal ligament by removing the anterior portion of the dural sac 

Part VI - Spinal Nerves and Associated Structures  

• Follow the dorsal root laterally through the dural root sheath to find the:

  • Dorsal root ganglion

  • Trunk of spinal n.

  • Dorsal and ventral primary rami of spinal n.