Endoscope‐Assisted Thoracolumbar Lateral Corpectomy

Objective: To report an endoscope‐assisted lateral approach to expose the intervertebral foramen and disk and perform lateral corpectomy of thoracolumbar disks in dogs. Study Design: Cadaver study. Animals: Fresh canine cadavers (n=6). Methods: A thoracic (T10–T11) and a lumbar (L3–L4) lateral approach were made on 6 fresh canine mixed breed cadavers. Through a limited skin incision, musculature was dissected and retracted using a neurosurgical self‐retaining retractor and lateral corpectomy performed. The approach and bone removal, both performed under endoscopic control, were assessed. Results: The foramen and intervertebral disk were clearly observed in all specimens without any iatrogenic injury of the ventral and dorsal nerve branches. Access to the foramen was possible in all specimens; in the thoracic area the head of the rib was always partially excised to observe the intervertebral disk medially. Lateral corpectomy was easily performed in all cadavers and spinal cord observation was good. Extension to foraminotomy or mini hemilaminectomy could easily be performed through the same limited approach. Conclusion: Endoscopic exploration provided a good viewing of the intervertebral disk and/or foramen. An endoscope‐assisted thoracolumbar lateral corpectomy could effectively be performed through a limited approach to the thoracolumbar disks and allowed good ventral spinal cord assessment.     

Surgical treatment of lumbosacral foraminal stenosis using a lateral approach in twenty dogs with degenerative lumbosacral stenosis

Objectives— To describe clinical signs, magnetic resonance imaging (MRI) and surgical findings using a lateral approach to the lumbosacral intervertebral foramen and to evaluate clinical outcomes in dogs with or without concurrent dorsal decompression and annulectomy.
Study Design— Retrospective study.
Animals— Dogs (n=20) with degenerative lumbosacral stenosis (DLSS).
Methods— Medical records (2002–2006) of dogs that had lumbosacral lateral foraminotomy alone or in combination with dorsal decompression were reviewed. Degree of dysfunction was assessed separately for each pelvic limb; dogs with unilateral signs were included in group A, those with bilateral signs in group B. Retrieved data were: signalment, history, neurologic status on admission, 3 days, 6 weeks, and 6 months postoperatively, duration of clinical signs, results of MRI, surgical site(s), intraoperative findings, and outcome.
Results— Based on the clinical and MRI findings unilateral foraminotomy was performed in 8 dogs, bilateral foraminotomy in 1 dog, unilateral foraminotomy with concurrent dorsal decompression in 7 dogs, and bilateral foraminotomy with concomitant dorsal decompression in 4 dogs. Surgery confirmed the presence of foraminal stenosis in all dogs, with osteophyte formation and soft tissue proliferations being the most common lesions. Outcome was good to excellent in 19 dogs and poor in 1 dog. Mean follow-up was 15.2 months (range, 6–42 months).
Conclusion— Lateral foraminotomy addresses compressive lesions within exit and middle zones of the lumbosacral foramen.
Clinical Relevance— Successful surgical management of DLSS is dependent on recognition and correction of each of the compressive lesions within the lumbosacral junction.     

Use of a four pin and methylmethacrylate fixation in L7 and the iliac body to stabilize lumbosacral fracture-luxations: a clinical and anatomic study

Objectives— To describe the clinical outcome of a 4 pin lumbosacral fixation technique for lumbosacral fracture–luxations, and to refine placement technique for iliac pins based on canine cadaver studies.
Study Design— Retrospective and anatomic study.
Sample Population— Dogs (n=5) with lumbosacral fracture-luxations and 8 cadaveric canine pelvi.
Methods— Lumbosacral fracture–luxations were stabilized with a 4 pin (positive-profile threaded) and bone cement fixation. Caudal pins were inserted in the iliac body and cranial pins were inserted into the L7 or L6 pedicle and body. Follow-up examinations and radiographs were performed to assess patient outcome. Intramedullary pins were inserted into the iliac bodies of 8 cadaver pelvi. Radiographs were taken to measure pin insertion angles and define ideal insertion angles that would maximize pin purchase in the ilium.
Results— Follow-up neurologic examination was normal in 4 dogs. Radiographic healing of the fracture was evident in 5 dogs. One implant failure occurred but did not require re-operation. For cadaver iliac pins, mean craniocaudal insertion angle was 29° and mean lateromedial insertion angle was 20°.
Conclusions— Four pin and bone cement fixation effectively stabilizes lumbosacral fracture luxations. The iliac body provides ample bone stock, which can be maximized using an average craniocaudal pin trajectory of 29° and an average lateromedial pin trajectory of 20°.
Clinical Relevance— Lumbosacral fracture–luxations can be stabilized with 4 pin and bone cement fixation in the lumbar vertebrae and iliac body, using 29 and 20° as guidelines for the craniocaudal and lateromedial pin insertion angles in the ilium.     

Feasibility and accuracy of ultrasound-guided sacroiliac joint injection in dogs

Frozen cadaver specimens from three dogs were used to create a sectional anatomic atlas of the sacroiliac region. Frozen/thawed cadaver specimens from 12 dogs were used to develop an ultrasound-guided sacroiliac joint injection technique. Accuracy of the technique was tested in 15 additional canine cadaver specimens, using injectate containing blue dye and iodinated contrast medium. Sonoanatomic landmarks for consistently identifying a caudodorsal window into the canine sacroiliac joint space included the L7-S1 articular process joints, ilial wing, sacral wing, sacral lamina, and median sacral crest. Accuracy of ultrasound-guided sacroiliac joint injection was not significantly affected by operator, but was affected by the tissue location targeted and the reference standard used for calculations. Accuracy of the technique was good for placing injectate into either the synchondrosis component, dorsal sacroiliac ligament or ventral sacroiliac ligament; fair to poor for placing injectate into the synovial component; and poor for placing injectate into all four sacroiliac soft tissue structures. Concurrent placement of injectate into extraarticular tissues occurred frequently. We conclude that ultrasound-guided sacroiliac joint injection is feasible for evaluation as a treatment method for lumbosacral region pain in dogs, but is not sufficiently accurate for localizing pain to the sacroiliac joint alone.     

The Surgical Anatomy of the Canine Sacrum for Lag Screw Fixation of the Sacroiliac Joint

One hundred canine sacral bone specimens were examined to identify surgical landmarks that may improve screw placement in sacroiliac repair. A lateral view of the sacral wing was studied, as this structure is most easily identified in the dorsal approach used for sacroiliac repair. The height and length of each sacral wing were measured. Four other features of the canine sacrum were identified and measured in comparison with the sacral wing height and length. The cranial overlap of the sacral wing over the intervertebral space of L₇-S₁ was found to have a mean of 14% of the length of the sacral wing. The ventral overlap of the sacral wing over the pelvic canal was found to be 21% of the height of the sacral wing. The ventral limit of the spinal canal (dorsal limit of the sacral body) was 45% of the sacral wing height. The first pelvic foramen was located at a mean distance of 64% of the sacral wing length and 20% of the sacral wing height. Using these four features, a composite view of the sacral wing is described to illustrate the area of the sacral body where screw placement is optimal.     

COMPARISON BETWEEN COMPUTED TOMOGRAPHIC AND SURGICAL FINDINGS IN NINE LARGE-BREED DOGS WITH LUMBOSACRAL STENOSIS

In a three-year prospective study, computed tomographic (CT) and surgical findings were compared for nine large breed dogs with lumbosacral stenosis. Surgically-excised tissue was examined histologically in seven dogs and additional necropsy evaluation was performed in one dog. The CT abnormalities observed at sites of confirmed cauda equina compression were: loss of epidural fat, increased soft tissue opacity, bulging of the intervertebral disc margin, spondylosis, thecal sac displacement, narrowed intervertebral foramen, narrowed vertebral canal, thickened articular process, articular process subluxation, articular process osteophyte, and telescoped sacral lamina. The CT characteristics of lumbosacral degenerative disease and discospondylitis were similar to those described in humans. In three dogs, CT findings at the site of cauda equina compression were consistent with congenital or developmental spinal stenosis, but the method of surgical exposure precluded confirmation. Epidural fibrosis (eight dogs) and multi-level CT abnormalities (six dogs) were identified but the cause(s) and significance were unknown.     

FEASIBILITY OF ULTRASOUND‐GUIDED EPIDURAL ACCESS AT THE LUMBO‐SACRAL SPACE IN DOGS

Epidural injections are commonly performed blindly in veterinary medicine. The aims of this study were to describe the lumbosacral ultrasonographic anatomy and to assess the feasibility of an ultrasound‐guided epidural injection technique in dogs. A cross sectional anatomic atlas of the lumbosacral region and ex vivo ultrasound images were obtained in two cadavers to describe the ultrasound anatomy and to identify the landmarks. Sixteen normal weight canine cadavers were used to establish two variations of the technique for direct ultrasound‐guided injection, using spinal needles or epidural catheters. The technique was finally performed in two normal weight cadavers, in two overweight cadavers and in five live dogs with radiographic abnormalities resulting of the lumbosacral spine. Contrast medium was injected and CT was used to assess the success of the injection. The anatomic landmarks to carry out the procedure were the seventh lumbar vertebra, the iliac wings, and the first sacral vertebra. The target for directing the needle was the trapezoid‐shaped echogenic zone between the contiguous articular facets of the lumbosacral vertebral canal visualized in a parasagittal plane. The spinal needle or epidural catheter was inserted in a 45° craniodorsal–caudoventral direction through the subcutaneous tissue and the interarcuate ligament until reaching the epidural space. CT examination confirmed the presence of contrast medium in the epidural space in 25/25 dogs, although a variable contamination of the subarachnoid space was also noted. Findings indicated that this ultrasound‐guided epidural injection technique is feasible for normal weight and overweight dogs, with and without radiographic abnormalities of the spine.     

Biomechanical Analysis of Torsion and Shear Forces in Lumbar and Lumbosacral Spine Segments of Nonchondrodystrophic Dogs

Objective— To determine stiffness and load–displacement curves as a biomechanical response to applied torsion and shear forces in cadaveric canine lumbar and lumbosacral specimens.
Study Design— Biomechanical study.
Animals— Caudal lumbar and lumbosacral functional spine units (FSU) of nonchondrodystrophic large-breed dogs (n=31) with radiographically normal spines.
Methods— FSU from dogs without musculoskeletal disease were tested in torsion in a custom-built spine loading simulator with 6 degrees of freedom, which uses orthogonally mounted electric motors to apply pure axial rotation. For shear tests, specimens were mounted to a custom-made shear-testing device, driven by a servo hydraulic testing machine. Load–displacement curves were recorded for torsion and shear.
Results— Left and right torsion stiffness was not different within each FSU level; however, torsional stiffness of L7-S1 was significantly smaller compared with lumbar FSU (L4-5–L6-7).
Ventral/dorsal stiffness was significantly different from lateral stiffness within an individual FSU level for L5-6, L6-7, and L7-S1 but not for L4-5. When the data from 4 tested shear directions from the same specimen were pooled, level L5-6 was significantly stiffer than L7-S1.
Conclusions— Increased range of motion of the lumbosacral joint is reflected by an overall decreased shear and rotational stiffness at the lumbosacral FSU.
Clinical Relevance— Data from dogs with disc degeneration have to be collected, analyzed, and compared with results from our chondrodystrophic large-breed dogs with radiographically normal spines.     

SUBCLINICAL CT ABNORMALITIES IN THE LUMBOSACRAL SPINE OF OLDER LARGE-BREED DOGS

Computed tomography (CT) of the L5-S3 vertebral levels was performed in six, large-breed dogs presented for problems unrelated to the lumbosacral spine. All dogs were asymptomatic for lumbosacral stenosis on neurologic examination. Breeds included German Shepherd, Golden Retriever, Boxermix and Belgian Malinois. Ages ranged from 5-12 years. Five out of six dogs exhibited CT abnormalities. Among the 18 disc levels examined, the most common findings were idiopathic stenosis, loss of vertebral canal epidural fat, and nerve tissue displacement. Less common abnormalities were vertebral canal or foraminal bone proliferation, loss of intervertebral foramen fat, vertebral canal disc bulging, degenerative articular process joint disease, transitional vertebra, dural ossification, foraminal disc bulging, Schmorl's nodes, calcified extruded disc fragment, and sacroiliac joint osteophytes. Vertebral subluxation was absent in all dogs. Findings indicate that some lumbosacral CT abnormalities may be clinically insignificant, especially in older dogs.     

ACCURACY OF RADIOGRAPHIC DETECTION OF THE CRANIAL MARGIN OF THE DORSAL LAMINA OF THE CANINE SACRUM

An elongated sacral lamina has been described as one of the contributing factors for dogs with cauda equina syndrome due to degenerative lumbosacral stenosis (DLSS); however, published evidence is lacking on the accuracy of radiographic screening for the presence of this lesion. Objectives of this prospective, cross‐sectional cadaver study were to describe the accuracy and repeatability of detection of the cranial sacral lamina margin on plain lateral radiographs of the lumbosacral junction in dogs. Twenty‐five medium and large breed canine cadavers were radiographed before and after placement of a radiopaque hook in the cranial margin of the sacral lamina. Three independent evaluators placed digital markers at the perceived margin on preinterventional radiographs. The distance from perceived location to the true location on postinterventional radiographs was recorded for each dog and observer. A discordance threshold (distance between perceived and actual margin) of 1.5 mm was subjectively defined as clinically relevant. The three evaluators demonstrated good repeatability, although the accuracy for margin detection was only fair (mean discordance 1.7 mm). Evaluators demonstrated greater accuracy in identifying the landmark in juveniles (1.4 mm) vs. adults (1.8 mm; P < 0.01). Results of this study indicated that observer repeatability is good and accuracy is fair for correctly identifying the radiographic cranial margin of the sacral lamina in dogs. This should be taken into consideration when interpreting elongation of the sacral lamina in radiographs of dogs with suspected DLSS, especially adults.     

Biomechanical flexion-extension forces in normal canine lumbosacral cadaver specimens before and after dorsal laminectomy-discectomy and pedicle screw-rod fixation

Objective— To determine biomechanical flexion–extension forces in cadaveric canine lumbosacral specimens, before and after dorsal laminectomy with partial discectomy, and after dorsal pedicle screw–rod fixation of L7 and S1.
Study Design— Biomechanical cadaver study.
Animals— Cadaveric spine specimens without lumbosacral pathology from mature, intact Labrador retrievers (n=12).
Methods— Lumbosacral spine segments were subjected to a constant bending moment from L6 to S1 in a hydraulic 4-point bending materials testing machine. Force and displacement were recorded during each loading cycle constituting 1 complete flexion–extension cycle of the spine. Each spine segment had 3 series of recordings of 5 loading cycles each: (1) intact spine, (2) after surgical destabilization by dorsal laminectomy and partial discectomy, and (3) after surgical stabilization using dorsal pedicle screw–rod fixation.
Results— After dorsal laminectomy and partial discectomy, the neutral zone and range of motion were not different from those in the native spine specimen. After pedicle screw–rod fixation, the neutral zone and range of motion of the instrumented specimen significantly ( P <.0001) decreased compared with the native specimen and the specimen after dorsal laminectomy.
Conclusion— Dorsal laminectomy and partial discectomy does not lead to significant spinal instability in flexion and extension whereas pedicle screw and rod fixation effectively stabilizes the lumbosacral spine.
Clinical Relevance— Dorsal laminectomy and partial discectomy does not lead to significant spinal instability. Pedicle screw–rod fixation of L7 and S1 may be used to stabilize an unstable L7–S1 junction in dogs with degenerative lumbosacral stenosis.     

Endoscopic-assisted lumbosacral foraminotomy in the dog

OBJECTIVE: To determine if endoscopic-assisted foraminotomy significantly increased the area of the L7-S1 intervertebral foramen and if, over 12 weeks, stenosis would occur. STUDY DESIGN: Prospective, experimental study. ANIMAL POPULATION: Six clinically normal, 22-29 kg, adult dogs. METHODS: Using endoscopic assistance, unilateral L7-S1 foraminotomy was performed. Computed tomography of L7-S1 was performed preoperatively, immediately postoperatively, and at 12 weeks. Parasagittal foramen area (PFA) measurements were obtained at the entry, middle, and exit zones of the treated and control foramen for each period. Objective and subjective data were compared among dogs by time period and treatment status. RESULTS: Endoscopic-assisted foraminotomy resulted in a significant increase in the mean PFA of the entry and middle zones immediately postoperatively. The exit zone was not significantly larger at any time. The foramen remained significantly larger at 12 weeks only in the middle zone; however, some decrease in the surgically created foramen enlargement occurred at all 3 levels. The procedure was well tolerated but dogs did have transient, mild delay of functional return postoperatively. CONCLUSIONS: Endoscopic-assisted foraminotomy in dogs can be performed for certain foraminal regions, allowing enhanced visibility of the spinal canal. The foramen can be surgically enlarged at the entry and middle zones using this technique; however, some reduction of the foraminal enlargement occurs by 12 weeks. The clinical implications of this reduction cannot be determined from this study. CLINICAL RELEVANCE: Endoscopic-assisted foraminotomy could be used to improve intraoperative visualization in dogs with foraminal stenosis as a component of degenerative lumbosacral stenosis.     

Agreement between computed tomography, magnetic resonance imaging, and surgical findings in dogs with degenerative lumbosacral stenosis

OBJECTIVE: To assess the extent of agreement between computed tomography (CT), magnetic resonance imaging (MRI), and surgical findings in dogs with degenerative lumbosacral stenosis. DESIGN: Observational study. ANIMALS: 35 dogs with degenerative lumbosacral stenosis. PROCEDURES: Results of preoperative CT and MRI were compared with surgical findings with respect to degree and location of disk protrusion, position of the dural sac, amount of epidural fat, and swelling of spinal nerve roots. RESULTS: A lumbosacral step was seen on radiographic images from 22 of 32 (69%) dogs, on CT images from 23 of 35 (66%) dogs, and on MR images from 21 of 35 (60%) dogs. Most dogs had slight or moderate disk protrusion that was centrally located. There was substantial or near perfect agreement between CT and MRI findings in regard to degree of disk protrusion (kappa, 0.88), location of disk protrusion (0.63), position of the dural sac (0.89), amount of epidural fat (0.72), and swelling of spinal nerve roots (0.60). The degree of agreement between CT and surgical findings and between MRI and surgical findings was moderate in regard to degree and location of disk protrusion (kappa, 0.44 to 0.56) and swelling of spinal nerve roots (0.40 and 0.50). CONCLUSIONS AND CLINICAL RELEVANCE: Results indicate that there is a high degree of agreement between CT and MRI findings in dogs with degenerative lumbosacral stenosis but that the degree of agreement between diagnostic imaging findings and surgical findings is lower.     

Facet joint geometry and intervertebral disk degeneration in the L5-S1 region of the vertebral column in German Shepherd dogs

OBJECTIVE: To evaluate the possible association between facet joint geometry and intervertebral disk degeneration in German Shepherd Dogs. ANIMALS: 25 German Shepherd Dogs and 11 control dogs of similar body weight and condition. PROCEDURE: Facet joint angles in the caudal portion of the lumbar region of the vertebral column (L5-S1) were measured by use of computed tomography, and the intervertebral discs were evaluated microscopically. The relationship between facet joint geometry and disk degeneration was evaluated by use of statistical methods. RESULTS: German Shepherd Dogs had significantly more facet joint tropism than control dogs, but an association with disk degeneration was not found. However, German Shepherd Dogs had a different facet joint conformation, with more sagittally oriented facet joints at L5-L6 and L6-L7 and a larger angle difference between the lumbar and lumbosacral facet joints, compared with control dogs. CONCLUSIONS AND CLINICAL RELEVANCE: A large difference between facet joint angles at L6-L7 and L7-S1 in German Shepherd Dogs may be associated with the frequent occurrence of lumbosacral disk degeneration in this breed.     

MR-imaging of lumbosacral intervertebral disc degeneration in clinically sound German shepherd dogs compared to other breeds

German shepherd dogs are overrepresented in the group of dogs with cauda equina compression syndrome due to degenerative lumbosacral stenosis. A congenital predisposition for early degeneration of the lumbosacral intervertebral disc has been suspected. Our aims were to assess the morphologic appearance of the lumbosacral intervertebral disc and the lumbosacral junction in healthy German shepherd dogs compared to other breeds and to evaluate for an early onset of degenerative changes. The lumbosacral spine of 110 clinically sound German shepherd dogs and 47 healthy dogs of other large breeds was examined using magnetic resonance (MR) imaging. The degeneration of every intervertebral disc was graded using an established classification system. Signal intensity of the entire lumbosacral disc and the nucleus pulposus was determined independently. Lumbosacral malalignment was assessed according to a previously described method. The findings for the German shepherd dogs were compared to those of the other breeds. Although most dogs were younger than 18 months at the date of examination, significantly higher grades of degeneration were detected for the lumbosacral intervertebral disc of German shepherd dogs (P < 0.003). Degeneration of the lumbosacral intervertebral disc was independent from findings in the other lumbar discs. We conclude that the German shepherd dog has a predisposition for degenerative changes in the lumbosacral intervertebral disc.     

Cauda equina compression syndrome (CECS): retrospective study of surgical treatment with partial dorsal laminectomy in 86 dogs with lumbosacral stenosis

We report our results of partial lumbosacral laminectomy for treatment of canine Cauda equina Compression Syndrome due to a lumbosacral stenosis. Opposite to conventional techniques of dorsal laminectomy, only widening of the Spatium interarcuale is performed. This is achieved by exstirpation of the Lig. flavum and partial dorsal laminectomy of the first sacral segment. The Proc. spinosi and integrity of facet joints are fully maintained by this technique. In 96.5% of 86 dogs treated with this method relief of dorsal pressure and permanent rapid regression of clinical symptoms was achieved. In two cases recurrence of clinical symptoms was observed during follow up and one case showed no improvement at all. In conclusion partial dorsal laminectomy is a minimal invasive technique for treatment of Cauda equina compression syndrome expressed by pain reaction accompanied by minor neurological deficits caused by lumbosacral stenosis. Maintained spinal stability allows short reconvalescence and the unrestricted use of dogs immediately post operation.     

TRANSOSSEOUS VERTEBRAL VENOGRAPHY: A DIAGNOSTIC AID IN LUMBOSACRAL DISEASE

Transosseous vertebral venography as a technic for investigating disease of the lumbosacral region is described. The technic preferred by the author is an intraosseous injection of contrast medium into the body of L7. Using a caudal needle, 10 ml of contrast medium was injected manually and a radiograph was made as the last milliliter was introduced. Contrast medium filled the lumbar venous sinuses and, by reflux, filled the sacral sinuses caudally to the S2–3 intervertebral foramen. Lumbosacral disease caused an obstruction to contrast medium flow and narrowed or deviated the vertebral venous sinus. Complications of transosseous vertebral venography were extravasation of contrast medium into the epidural space and surrounding soft tissue, and trauma to the sixth lumbar nerve in one dog. The procedure was contraindicated in the presence of local infection and when anesthesia was an undue risk.     

Comparison of the width of the intervertebral disk space and radiographic changes before and after intervertebral disk fenestration in dogs

Intervertebral disk space widths were measured on lateral radiographs of 73 anesthetized dogs. Weight was found to have a significant (P less than 0.01) effect on disk space width. Using weight-adjusted disk space width measurements for all subsequent studies, older (7- to 16-year-old) dogs and males had consistently, but not significantly, wider, disk spaces than did alternative groups. Cervical and lumbar intervertebral disk spaces tended to be wider than those in the caudal thoracic region. The widest cervical intervertebral disk spaces were C4-5 and C5-6 and the narrowest was C2-3. In the lumbar region, L2-3 was the widest disk space and L4-5 was the narrowest. Dachshunds generally had greater mean intervertebral disk space width than did other breeds of dogs. Cervical (n = 6 dogs) and thoracolumbar (n = 6 dogs) disk fenestration resulted in narrow intervertebral disk spaces, regardless of breed. When a ventral approach was used in thoracolumbar fenestration, the mean intervertebral disk space was narrower than that resulting from use of a dorsolateral approach. Spondylosis was found radiographically 1 to 4 years after intervertebral disk fenestration in 3 of 6 dogs that had cervical fenestrations and in 5 of 6 dogs that underwent thoracolumbar fenestration.     

Direct cutaneous arterial supply to the tail in dogs.

Cutaneous arterial blood supply to the tail was evaluated in 12 dogs. Subtraction radiography of internal iliac artery and distal aorta angiography in 3 of these dogs was used to determine arterial blood supply to the tail from the median sacral and lateral caudal arteries. Dissection of the tail in 8 canine cadavers revealed bilateral subcutaneous location of lateral caudal arteries following tail amputation. An axial pattern flap based on the lateral caudal arteries contributed to the reconstruction of a large caudodorsal cutaneous defect in a dog. An axial pattern flap based on the lateral caudal arteries following tail amputation may be indicated to aid reconstruction of large caudodorsal cutaneous defects of the trunk in dogs.