A comparison of hemilaminectomy (with concomitant disc fenestration) and dorsal laminectomy for the treatment of thoracolumbar disc protrusion in dogs.

The techniques of hemilaminectomy (with concomitant disc fenestration) and dorsal laminectomy were compared statistically in two groups of 30 dogs with thoracolumbar disc disease. On presentation all the dogs were unable to walk and were graded 1 to 3 according to their degree of neurological dysfunction. Nineteen had a previous history of thoracolumbar pain or hindlimb paresis. Radiography showed a narrowed disc space or extruded calcified disc material in 52 of the dogs and lumbar myelography revealed an extradural mass in 57; 24 of the dogs had clinical or myelographic lateralisation of signs. Hemilaminectomy significantly improved the ability to retrieve protruded disc material compared with dorsal laminectomy, and the removal of protruded disc material significantly improved the degree of recovery. Fenestration significantly reduced the recurrence of thoracolumbar disc disease.     

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.     

Modified deep dorsal laminectomy in the dog.

Spinal cord compression subsequent to radical laminectomy was investigated. A modified deep dorsal laminectomy technique was devised to allow extensive exposure and decompression of the canine spinal cord without undue hazard of postoperative fibrotic spinal cord compression. A previously described laminectomy technique was modified by the addition of spinal plating to avoid the occurrence of constrictive fibrosis.     

Intraoperative use of ultrasonography during continuous dorsal laminectomy in two dogs with caudal cervical vertebral instability and malformation ("Wobbler syndrome")

OBJECTIVE: To describe an intraoperative ultrasound imaging technique during dorsal laminectomy in 2 dogs with caudal cervical vertebral instability and malformation (CCVIM, "Wobbler syndrome"). STUDY DESIGN: Clinical case report. SAMPLE POPULATION: Two dogs with CCVIM. RESULTS: On neurologic examination there was tetraparesis with upper motor neuron signs in the thoracic limbs and lower motor neuron signs in the pelvic limbs in dog 1, and hyperreflexia of the rear limbs, normoreflexia of the right front limb, and hyporeflexia of the left front limb of dog 2. Both dogs had signs of marked cervical pain and radiographic signs of cervical spinal cord compression. Intraoperative ultrasonography of the spinal cord revealed protruding intervertebral disc at C5-6 (dog 1) and C6-7 (dog 2), and the parallel borders of the spinal cord and central canal after decompression. Continuous dorsal laminectomy (CDL) resulted in improvement over 16 months (dog 1) and 20 months (dog 2). CONCLUSIONS: Intraoperative ultrasonographic imaging of the cervical spinal cord after CDL was helpful in determining adequate decompression (postlaminectomy) of the spinal cord in relation to the ventral and lateral compressive component(s) and to image the protruding intervertebral disc. CLINICAL RELEVANCE: Intraoperative ultrasonography can be used to provide valuable information on the spinal cord and surrounding soft tissues for the neurosurgeon.     

Magnetic Resonance Imaging in the Diagnosis of Degenerative Lumbosacral Stenosis in Four Dogs

Magnetic resonance imaging was used to diagnose degenerative lumbosacral stenosis in four dogs that had physical and neurologic signs consistent with a cauda equina lesion. Nerve root displacement by protruding disc material and loss of epidural fat were identified. In all dogs, the diagnosis was confirmed by dorsal laminectomy of the lumbosacral area.     

Spinal decompressive procedures and dorsal compartment injuries: comparative biomechanical study in canine cadavers

Effects of decompressive procedures or dorsal injuries on flexion-extension, 4-point bending properties of the L-3 and L-4 motion segment in dogs were quantitated and compared. Hemilaminectomy did not significantly (P less than 0.05) affect mechanical properties of the spine. Bilateral facetectomy caused a small increase in the range of motion and a 56% decrease in ultimate bending strength. Excision of the supraspinous and interspinous ligaments decreased the flexural stiffness of the spine, increased the range of motion of the interspace, and decreased ultimate flexion bending strength 62%. Dorsal laminectomy caused a marked decrease in spine stiffness in all phases of flexion and extension, increased the range of motion, and decreased ultimate flexion bending strength 75%. Seemingly, a hemilaminectomy was preferable to the dorsal laminectomy if adequate decompression and exploration were achieved with the hemilaminectomy.     

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.     

Asymmetric lumbosacral transitional vertebra and subsequent disc protrusion in a cocker spaniel

A 10-year-old cocker spaniel bitch presented with severe lumbosacral pain and acute onset left pelvic limb lameness. A diagnosis of asymmetric lumbosacral transitional vertebra with disc protrusion at L6-L7 was made by computed tomography. The cauda equina and left L6 nerve root were surgically decompressed with a dorsal laminectomy and lateral foraminotomy, which led to rapid resolution of the clinical signs.     

Cervical vertebral instability (wobbler syndrome) in the dog.

Observations on a series of 38 cases (35 Doberman Pinschers and three Great Danes) of the canine wobbler syndrome are described. Radiographic examinations suggested that the primary lesion is an intervertebral instability at C6/7, but with time, secondary changes of the disc degeneration and prolapse and vertebral body malformation causing stenosis of the vertebral canal occur. Cases detected at a young age and showing only the primary lesion were treated successfully, by disc fenestration alone or by disc fenestration and intervertebral screwing. The success rate in older cases with secondary lesions was poor and in this type of case, cord decompression by dorsal laminectomy appears necessary.     

Spinal trauma. Pathophysiology and management of traumatic spinal injuries.

Spinal trauma can originate from internal or external sources. Injuries to the spinal cord can be classified as either concussive or compressive and concussive. The pathophysiologic events surrounding spinal cord injury include the primary injury (compression, concussion) and numerous secondary injury mechanisms (vascular, biochemical, electrolyte), which are mediated by excessive oxygen free radicles, neurotransmitter and electrolyte alterations in cell membrane permeability, excitotoxic amino acids, and various other biochemical factors that collectively result in reduced SCBF, ischemia, and eventual necrosis of the gray and white matter. Management of acute spinal cord injuries includes the use of a high-dose corticosteroid regimen within the initial 8 hours after trauma. Sodium prednisolone and methylprednisolone, at recommended doses, act as oxygen radical scavengers and are anti-inflammatory. Additional considerations are the stability of the vertebral column, other conditions associated with trauma (i.e., pneumothorax), and the presence or absence of spinal cord compression, which may warrant surgical therapy. Vertebral fractures or luxations can occur in any area of the spine but most commonly occur at the junction of mobile and immobile segments. Dorsal and dorsolateral surgical approaches are applicable to the lumbosacral and thoracolumbar spine and dorsal and ventral approaches to the cervical spine. Indications for surgical intervention include spinal cord compression and vertebral instability. Instability can be determined from the type of fracture, how many of the three compartments of the vertebrae are disrupted, and on occasion, by carefully positioned stress studies of fluoroscopy. Decompression (dorsal laminectomy, hemilaminectomy, or ventral cervical slot) is employed when compression of the spinal cord exists. The hemilaminectomy (unilateral or bilateral) causes less instability than dorsal laminectomy and therefore should be used when practical. The preferred approach for atlantoaxial subluxation is ventral, and the cross pinning, vertebral fusion technique is used for stabilization. Fracture luxations of C-2 are repaired with small plates on the ventral vertebral body. The thoracic and upper lumbar spine is stabilized with dorsal fixation techniques or combined dorsal spinal plate/vertebral body plate fixation. Several methods of fixation can be used with lower lumbar or lumbosacral fractures, including the modified segmental technique and the combined dorsal spinal plate/Kirschner-Ehmer technique.     

Lumbosacral intervertebral disk disease in six cats

Medical records of six cats diagnosed with lumbosacral intervertebral disk disease were reviewed. Clinical signs included reluctance to jump, low tail carriage, elimination outside the litter box, reluctance to ambulate, pelvic-limb paresis, urinary incontinence, and constipation. All cats had lumbosacral hyperpathia on palpation. Computed tomography in four cats revealed evidence of extradural spinal cord compression at the seventh lumbar (L(7)) to first sacral (S(1)) vertebral interspace. Compression was confirmed via myelography in three of these four cats, with confirmation in the fourth cat at the time of decompressive laminectomy. Each of the six cats underwent dorsal decompressive laminectomy at the L(7) to S(1) interspace. Postoperative clinical follow-up lasted 3 to 35 months, with most cats having excellent outcomes.     

Usefulness of hemilaminectomy for cervical intervertebral disk disease in small dogs

Hemilaminectomy was performed to treat cervical disc disease in 18 small dogs. Cervical spinal cord compression was characterized by ventral and/or lateral compression on myelograms. The duration of follow-up examinations ranged from 2 to 72 months. The optimal response time after surgery ranged from 2 days to 3 months. The outcome was determined to be excellent if clinical signs resolved and the dog had completely improved. The outcome was determined to be good if the dog improved, but was not clinically normal or if the degree of the owner's satisfaction was insufficient. Fourteen dogs achieved complete neurologic recovery without complications. One dog was initially neurologically worse after surgery, but ultimately improved to normal neurologic status. These outcomes were judged to be excellent. In the remaining 3 dogs, 2 dogs had relapse of neck pain and one dog remained mildly ataxic. These outcomes were judged to be good. These results suggest that hemilaminectomy is an effective option for surgical treatment of spinal cord compression secondary to cervical disc disease in small dogs.     

Continuous lumbar hemilaminectomy for intervertebral disc disease in an Amur tiger (Panthera tigris altaica)

A 13-yr-old Amur tiger (Panthera tigris altaica) was presented for an acute onset of paraplegia. Spinal imaging that included plain radiographs, myelography, and computed tomography performed under general anesthesia revealed lateralized spinal cord compression at the intervertebral disc space L4-5 caused by intervertebral disc extrusion. This extrusion was accompanied by an extensive epidural hemorrhage from L3 to L6. Therefore, a continuous hemilaminectomy from L3 to L6 was performed, resulting in complete decompression of the spinal cord. The tiger was ambulatory again 10 days after the surgery. This case suggests that the potential benefit of complete spinal cord decompression may outweigh the risk of causing clinically significant spinal instability after extensive decompression.     

Traumatic Intervertebral Disc Herniation with Paraplegia in a Black-Tailed Prairie Dog (Cynomys ludovicianus)

A 2-year-old castrated male black-tailed prairie dog (Cynomys ludovicianus) was presented 48 hours after peracute onset of rear limb paraplegia secondary to a traumatic incident. The prairie dog was nonambulatory in the rear legs with absent deep pain; hematuria and pollakiuria were also observed. Diagnostic imaging revealed intervertebral disc herniation with compression of the spinal cord at the L1-L2 disc spaces. Hemilaminectomy at the L1-L2 disc space was performed. After 48 hours, the prairie dog regained anal tone, and a deep pain response was noted. Azotemia developed during the course of hospitalization likely secondary to neuromuscular damage causing an obstruction in the lower urinary tract but resolved with supportive care. The prairie dog recovered complete use of its hind legs and had normal excretory function at a 3-month recheck. Practitioners should consider intervertebral disc herniation secondary to trauma as a differential diagnosis for neurologic deficits affecting the rear limbs of prairie dogs. Surgical management of intervertebral disc herniation is a viable treatment option in appropriate cases.     

Degenerative lumbosacral stenosis in 18 dogs

Eighteen dogs with degenerative lumbosacral stenosis were presented to the University of Queensland Small Animal Clinic (UQSAC) over a three-year period. Presenting clinical signs included lumbosacral pain (89 per cent), hindlimb paresis and proprioceptive deficits (56 per cent), lameness (49 per cent), flaccid tails (22 per cent), and urinary dysfunction (16 per cent). All 18 dogs were treated by decompressive laminectomy. Two dogs were also treated by a pin fixation-fusion technique. The major compressive lesion was a type II disc protrusion (72 per cent). Seventeen dogs (94 per cent) showed improvement postoperatively with minimal complications. Confirmation of diagnosis is difficult in that many aged dogs without clinical signs show radiographic signs compatible with stenosis.     

Diagnosis of lumbosacral intervertebral disc disease and protrusion in a horse using ultrasonographic evaluation and computed tomography

This case report describes the clinical presentation, diagnostic imaging modalities, treatment and post mortem evaluation of lumbosacral intervertebral disc protrusion in a mature Quarter Horse gelding 10 days after initial signs were noted. Grade 3 hindlimb ataxia, conscious proprioceptive deficits, urinary and faecal incontinence were present, which did not improve with anti‐inflammatories, antimicrobial therapy, corticosteroids, antioxidant therapy, cold‐laser therapy or electroacupuncture. Imaging modalities utilised ante mortem were computed radiography, transcutaneous and transrectal ultrasonography. Transrectal ultrasonography yielded findings highly suggestive of lumbosacral intervertebral disc protrusion and due to the lack of improvement and a poor prognosis, the horse was humanely subjected to euthanasia. Post mortem computed tomography, necropsy and histopathological evaluation confirmed lumbosacral intervertebral disc disease and protrusion into the spinal canal with subsequent impingement of the spinal nerve roots. Lumbosacral intervertebral disc protrusion as a clinical disease in the horse has not been previously described and should be included as a differential diagnosis in cases with acute hindlimb ataxia, proprioceptive deficits, and urinary and faecal incontinence.     

Treatment of a prolapsed lumbar intervertebral disc in a ferret

A seven-month-old, male ferret had acute paraplegia and radiographs showed signs of disc prolapse between the second and third lumbar vertebrae (L2/3). Hemilaminectomy was performed to decompress the spinal cord. Histological examination revealed that the extradural material was consistent with annulus fibrosus and the L2/3 articular facets were enlarged as a result of bone remodelling. The ferret became ambulatory one month postoperatively. Five months postoperatively, the ferret had normal posture with mild proprioceptive deficits in the pelvic limbs, and fusion of the L2 and L3 vertebral bodies.     

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.     

Thoracolumbar dorsolateral laminectomy with osteotomy of the spinous process in fourteen dogs

Objective— To describe outcome after an alternative unilateral approach to the thoracolumbar spine for dorsal laminectomy.
Study Design— Retrospective clinical study.
Animals— Dogs (n=14) with thoracolumbar spinal cord compression.
Methods— Thoracolumbar spinal cord compression was lateral (6 dogs), dorsal (4), and dorsolateral (4) caused by subarachnoid (7) and synovial cysts (2) and intradural-extramedullary neoplasia (5). All dogs were treated by dorsal laminectomy with osteotomy of the spinous process using a unilateral paramedian approach. The contralateral paraspinal muscles were not stripped from the spinous process and the osteoligamentous complexes were preserved. Retraction of the spinous process and muscles to the contralateral side resulted in complete visualization of the dorsal vertebral arch thereby allowing dorsal laminectomy to be performed.
Results— No technique complications occurred. Approximately 75% exposure of the spinal cord (dorsal and lateral compartments) was achieved providing adequate visualization and treatment of the lesions. Transient deterioration of neurologic state occurred in 5 dogs because of extensive spinal cord manipulation. At long-term follow-up, 6 dogs were normal, 6 had clinical improvement, and 2 were unchanged.
Conclusion— Dorsal laminectomy after osteotomy and retraction of the spinous process may be considered in canine patients with dorsal, dorsolateral, or lateral compression to facilitate adequate decompression of the spinal cord.
Clinical Significance— This surgical technique offers an alternative approach to the thoracolumbar spine and spinal cord by a modified dorsal laminectomy that preserves the paraspinal muscle integrity on the contralateral side.     

Management of spinal trauma in 69 cats

This study sought to evaluate a series of clinical and radiological findings on spinal trauma in cats and the outcome that emerged from conservative or surgical treatment using 2 types of spinal stapling: stabilization using a Steinmann pin and coated polypropylene. Case records were reviewed for their diagnostic approaches on the basis of physical and neurological conditions, and concurrent disorders in addition to spinal trauma. Radiological examinations of the vertebral column were carried out using survey radiography, myelography and epidurography. All cases were classified according to etiopathogenesis of the disease. Surgical treatment consisted of decompression (laminectomy, hemilaminectomy and durotomy), or decompression with stabilization which was performed by one of two methods. The first one was the employment of translaminar stapling at the base of a spinous process and the other involved spinal stapling at the spinous process. The spinal lesions were identified as cervical (n = 2), thoracic (n = 35), lumbar (n = 22), sacral and caudal (n = 10). While 19 out of 30 conservatively managed cases recovered, the rest had persistent residual paresis and ataxia. Complete recovery was seen in 4 cats that underwent hemilaminectomy and 3 subjected to laminectomy. Partial recovery was observed in 5 cases involving laminectomy; however, there was no improvement observed in another 2 cases. Each animal was followed for at least a 3-month period to evaluate the clinical assessment of the results following treatment. The results of conservative and operative management of spinal trauma indicated that the type and degree of spinal cord degradation strongly influenced any prognosis. The results emerging from decompressive procedures seemed satisfactory for those cases where instability was not an issue. Both stabilization techniques were not ideal in terms of their methodological versatility or regarding weaknesses of bone structure observed in intra- and postoperative periods. However, translaminar stapling at the base of a spinous process was deemed to be the superior technique.