Influence of intervertebral disc fenestration at the herniation site in association with hemilaminectomy on recurrence in chondrodystrophic dogs with thoracolumbar disc disease: a prospective MRI study

Objective— To describe the influence of fenestration at the disc herniation site on recurrence in thoracolumbar disc disease of chondrodystrophoid dogs.
Study Design— Prospective clinical study.
Animals— Chondrodystrophic dogs (n=19).
Methods— Dogs were divided into 2 groups: group 1 (9 dogs) had thoracolumbar disc extrusion (Hansen type I) treated by hemilaminectomy and concomitant fenestration of the affected intervertebral disc and group 2 (10 dogs) had hemilaminectomy without fenestration. All dogs had 3 magnetic resonance imaging (MRI) examinations: preoperatively, immediately postoperatively to assess removal of herniated disc material, and again 6 weeks after surgery.
Results— There were 13 male and 6 female dogs; mean age, 7.1 years. Thoracolumbar disc herniation was confirmed with MRI. Immediate post surgical MRI revealed that the herniated disc removal was complete in all but 1 dog and that fenestration did not lead to complete removal of nucleus pulposus within the intervertebral disc space. On the 3rd MRI examination, none of the group 1 dogs had further disc material herniation at the fenestrated site. Six of the 10 group 2 dogs had a recurrence of herniation leading to clinical signs in 3 dogs (pain in 2 dogs, paresis in 1 dog).
Conclusion— In thoracolumbar disc herniation, fenestration of the affected intervertebral disc space prevents further extrusion of disc material.
Clinical Relevance— Fenestration reduces the risk of early recurrence of disc herniation and associated postoperative complications.     

A Comparison of Manual and Power-Assisted Thoracolumbar Disc Fenestration in Dogs

Thoracolumbar disc fenestration was performed in eight canine cadavers. A hole was cut in the anulus fibrosus with a scalpel in four dogs, and with a high speed drill and burr in four dogs. A curette was used to remove as much of the nucleus pulposus as possible. Sixty-five percent of the nucleus pulposus was removed with the power-assisted technique and 41% was removed by manual fenestration. Manual and power-assisted disc fenestration were performed on alternate intervertebral discs from T11-12 to L5-6 in four dogs. Six months after surgery, results of high-detail radiographic and histologic evaluation of the vertebral bodies and discs showed minimal difference in the sequelae of the two techniques. A retrospective medical records analysis and follow-up of 60 clinical cases treated with prophylactic, power-assisted disc fenestration failed to identify any cases with postoperative recurrence of neurologic deficits. Ten percent of the dogs had periodic back pain of unknown etiology, without other signs of intervertebral disc disease. The findings of this study indicate that power-assisted disc fenestration permits more complete evacuation of the nucleus than manual fenestration, causes no more postoperative complications, and results in a low recurrence rate of neurologic deficits.     

Structural Changes in Thoracolumbar Disks Following Lateral Fenestration A Study of the Radiographic, Histologic, and Histochemical Changes in the Chondrodystrophoid Dog

Lateral fenestrations of intervertebral disks T12–13 through L2–3 were performed on 16 1-year-old chondrodystrophoid dogs. The disks of five dogs were fenestrated by removing the core of disk material with a 20 gauge spinal needle, six were fenestrated in the same manner with a 14 gauge spinal needle, and five were fenestrated with a 14 gauge spinal needle and a tartar scraper. Forty-two of 48 disks had radiographic evidence of narrowing following surgery. Microscopic examination of the disks indicated that the nucleus pulposus was nonreactive tissue and that fenestration did not incite an inflammatory response that resulted in dissolution of the nucleus pulposus. Results of histochemical analyses of the fenestrated disks were not different from those of control disks. The only effects observed during a 24 week period following fenestration were disruption of the annulus fibrosus and nucleus pulposus by the fenestration device, removal of varying amounts of the nucleus pulposus, and vascular and fibrous tissue invasion of the lateral annulus fibrosus. These findings suggest that the effectiveness of fenestration is governed by the amount of nucleus pulposus removed.     

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.     

Enhanced type X collagen expression in the extruded nucleus pulposus of the chondrodystrophoid dog

The causes of early degeneration and calcification of the nucleus pulposus in the chondrodystrophoid dog are poorly understood, and the underlying molecular mechanism of this process has not yet been clearly defined. Type X collagen is one of the key molecules in endochondral bone growth and development, especially matrix calcification. The relationship between type X collagen and disc degeneration and calcification in chondrodystrophoid dogs has not yet been studied. We analyzed the expression of type X collagen in degeneration and calcification of the intervertebral disc in chondrodystrophoid dogs, using type X collagen immunohistochemistry. Control intervertebral discs were collected from five dogs (4 female, 1 male, average age 1.3 years, beagle breed). Degenerated intervertebral discs were surgically removed from 11 canine patients with intervertebral disc extrusion (1 female, 10 male, average age 5.1 years, dachshund breed) in Nippon Veterinary and Animal Science University. All extruded disc samples showed hypertrophic changes and clustering of cells, typical features observed in the degenerated nucleus pulposus. The relative expression of type X collagen in the degenerated nucleus pulposus (84.3 +/- 11.0%) was significantly increased compared to the control nucleus pulposus (5.4 +/- 5.4%). Our findings suggest that type X collagen might contribute to the development of degeneration or calcification in the nucleus pulposus of the chondrodystrophoid dog.     

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.     

Clinical and magnetic resonance imaging features of canine compressive cervical myelopathy with suspected hydrated nucleus pulposus extrusion

Objective : To describe clinical and magnetic resonance imaging features in dogs with compressive cervical myelopathy due to acute suspected hydrated nucleus pulposus extrusion. Design : Retrospective case series. Animals : Ten dogs with compressive cervical myelopathy caused by acute suspected hydrated nucleus pulposus extrusion. Materials and Methods : Medical records and magnetic resonance images of dogs evaluated from 2005 through 2010 were reviewed. The inclusion criteria were clinical signs compatible with cervical myelopathy, magnetic resonance imaging of the spine performed within 48 hours after onset, magnetic resonance imaging findings consistent with compressive suspected hydrated nucleus pulposus extrusion, complete medical records and follow‐up information. Results : Six dogs were presented with acute onset tetraplegia and four dogs with acute onset of nonambulatory tetraparesis. Compromised respiratory function was present in three dogs. Compressive suspected hydrated nucleus pulposus extrusion was found on magnetic resonance imaging at the C4‐C5 (n=6), C3‐C4 (n=3) and C5‐C6 (n=1) intervertebral disc spaces. Seven dogs underwent surgical treatment and three dogs were treated conservatively. All dogs except one regained ambulatory status within two weeks after the onset, and had a favourable outcome. Clinical Significance : Compressive myelopathy caused by acute suspected hydrated nucleus pulposus extrusion has not been reported previously and, even though neurological deficits can be severe on presentation, outcome is favourable.     

Partial percutaneous discectomy for treatment of thoracolumbar disc protrusion: retrospective study of 331 dogs

OBJECTIVES: To determine retrospectively the prognosis and outcome for dogs diagnosed with thoracolumbar intervertebral disc disease treated with partial percutaneous discectomy (PPD). METHODS: Three hundred and thirty-one dogs presenting with symptoms of thoracolumbar intervertebral disc disease from 1998 to 2003 were treated with PPD. Diagnosis and location of intervertebral disc disease was confirmed by clinical examination, radiography, myelography and magnetic resonance imaging. PPD was performed via fluoroscopy-guided removal of a 5 mm bore cylinder out of the central intervertebral space. RESULTS: Clinical success after surgery was achieved in 159 (88.8 per cent) grade II to IV patients and 58 (38.2 per cent) grade V patients. The mean (sd) time from percutaneous discectomy to first improvement was 8.3 (13.2) days. CLINICAL SIGNIFICANCE: The PPD approach to the thoracolumbar spine involves minor trauma (yielding rapid recovery) and less pain, and produces results comparable with open fenestration. Consequently, this simple minimal invasive technique can be recommended as an alternative to the technique of fenestration and can be easily performed in addition to open surgical decompression techniques or prophylactically. However, it is not a replacement for surgical treatment in dogs with thoracolumbar disc disease that require removal of disc fragments causing spinal cord or nerve root compression.     

THORACOLUMBAR INTRADURAL DISC HERNIATION IN EIGHT DOGS: CLINICAL,LOW‐FIELD MAGNETIC RESONANCE IMAGING,AND COMPUTED TOMOGRAPHIC MYELOGRAPHY FINDINGS

Intradural disc herniation is a rarely reported cause of neurologic deficits in dogs and few published studies have described comparative imaging characteristics. The purpose of this retrospective cross sectional study was to describe clinical and imaging findings in a group of dogs with confirmed thoracolumbar intradural disc herniation. Included dogs were referred to one of four clinics, had acute mono/paraparesis or paraplegia, had low field magnetic resonance imaging (MRI) and/or computed tomographic myelography, and were diagnosed with thoracolumbar intradural disc herniation during surgery. Eight dogs met inclusion criteria. The prevalence of thoracolumbar intradural disc herniation amongst the total population of dogs that developed a thoracolumbar intervertebral disc herniation and that were treated with a surgical procedure was 0.5%. Five dogs were examined using low‐field MRI. Lesions that were suspected to be intervertebral disc herniations were observed; however, there were no specific findings indicating that the nucleus pulposus had penetrated into the subarachnoid space or into the spinal cord parenchyma. Thus, the dogs were misdiagnosed as having a conventional intervertebral disc herniation. An intradural extramedullary disc herniation (three cases) or intramedullary disc herniation (two cases) was confirmed during surgery. By using computed tomographic myelography (CTM) for the remaining three dogs, an intradural extramedullary mass surrounded by an accumulation of contrast medium was observed and confirmed during surgery. Findings from this small sample of eight dogs indicated that CTM may be more sensitive for diagnosing canine thoracolumbar intradural disc herniation than low‐field MRI.     

Cervical Chemonucleolysis in the Dog A Surgical Technique

Cervical chemonucleolysis performed surgically in 16 clinically normal 4 and 10 year old Beagle dogs was well tolerated. The dosage of chymopapain per intervertebral disc was 200 or 500 U. Disc space narrowing was radiographically visible by day 1. By gross and histologic examination, there was lysis of the nucleus pulposus (NP) and perinuclear annulus fibrosus (AF). No observable differences due to ages of the dogs or doses of the enzyme were seen.     

Investigations of the Therapeutig and Prophylactic Effects of Disc Evacuation in Cases of Thoraco-Lumbar Herniated Discs in Dogs

The author describes a method for the fenestration and evacuation of degenerated discs in the thoraco-lumbar region of the dog using a lateral approach. This lateral approach makes it possible to reach the entire area of the nucleus pulposus. With the method described, all of the discs in the region of T₉/T₁₀—L₅/L₆ can be evacuated at the same time. The author presents 88 operated cases which showed light or moderate signs of thoraco-lumbar disc herniation, i.e. dogs which displayed pain and/or varying grades of paresis, but retained the ability to walk on their hind legs. The author compares the results of this surgical treatment with the results of the conservative treatment of 128 cases. No significant difference in respect to the mean recovery time was seen between the 2 groups, but the progression of the attack into paraplegia did not occur in the surgically treated material, while such a progression was seen in 4 cases in the conservative material. The greatest value of the disc evacuation, according to the author''s investigations, seems to be its prophylactic effect against recurrence. If all of the radiologically degenerated discs in the affected area are evacuated, it appears that one achieves almost complete prophylaxis for some years.     

The assessment of ventral cervical decompression in the treatment of prolapse of the nucleus pulposus in dogs

The aim of the study is the assessment of treatment effectiveness of disc extrusion with the method of ventral cervical decompression (ventral slot). Surgical procedure was performed on 15 dogs--10 chondrodystrophoid and 5 achondrodystrophoid. Clinical signs and localization of lesions were similar to those reported earlier. All of the dogs, but one which died during the operation, were cured. Percentage of dogs which recovered within 7 days since the surgery is slightly higher than in the previous reports. Atypical mass of nucleus pulposus displaced to the vertebral canal is described and the observation of atypical course of worsening after fenestration is presented.     

Presence of residual material following mini-hemilaminectomy in dogs with thoracolumbar intervertebral disc extrusion

Presence of residual material following mini-hemilaminectomy in dogs (n = 9) with spontaneous thoracolumbar intervertebral disc extrusion was prospectively investigated. Volume of extruded disc material within the vertebral canal and the proportion of residual material were determined using pre- and post-operative magnetic resonance imaging. The degree of spinal cord compression, proportion of extradural material considered hemorrhage, and invasion of the articular facets were also determined. Residual material was identified in 44% of the mini-hemilaminectomies. The median percentage of residual material calculated was 7.7% of the preoperative volume. No observed effect of surgical side or site, proportion of extradural material considered hemorrhage, patient weight, and duration of clinical signs was detected.     

Lateral spinal decompression in the dog

As an adjunct to the thoracolumbar surgical management of intervertebral disc prolapse in the dog, a lateral decompressive technique is described which permits removal of the prolapsed intervertebral disc material and prophylactic disc fenestration at the same time.     

Assessment of the usefulness of the fenestration method in cases of disc extrusion in the cervical and thoraco-lumbar spine in chondrodystrophic dogs

The aim of this paper was to assess the effectiveness of treatment of Type I (according to Hansen) intervertebral disc extrusion using the fenestration method. The evaluated clinical material included 37 chondrodystrophic dogs in which multiple fenestration (from 2 to 6 intervertebral spaces) was performed. Dachshunds comprised 86.5% of patients. All dogs were administered corticosteroids during the operation. A mass similar to a slightly jelly-like yogurt, cottage cheese or plaster-like consistency was extracted. In one case a post-surgical pyogenic infection of the wound occured. In two cases, a deterioration in the neurological state followed the fenestration procedure of the cervical spine. In one case of thoraco-lumbar spine fenestration, a deterioration of clinical state was found. Recovery was observed after disc extrusion from the cervical spine in 8 out of 11 dogs, from the thoraco-lumbar spine in 12 out of 14 dogs with the 2nd grade clinical signs and in 11 out of 12 dogs with the 3rd grade clinical sings. In 6 dogs, recurrence of first or second grade clinical signs occurred, but only half of them had to undergo treatment. The probability of dog recovery did not depend on the degree of symptom intensity in a statistically significant way (p=0.11) or on the duration of the disease before the surgical treatment (p=0.87).     

Evaluation of Fenestration for Treatment of Degenerative Disc Disease in the Caudal Cervical Region of Large Dogs

Seventeen large dogs (15 Doberman pinschers, one Labrador retriever, and one German short-haired pointer) with pain and gait abnormalities resulting from caudal cervical intervertebral disc degeneration were treated by disc fenestration. Four dogs recovered completely, two dogs appeared to have recovered but nerve root compression and pain returned 3 years later, five did not recover completely or did not improve, and six became progressively worse. In the dogs that recovered, preoperative myelograms showed that traction on or flexing the neck relieved the spinal cord compression. Such manipulation did not relieve slight persistent compression in the dogs that did not improve nor did it relieve severe compression by disc herniation or spinal canal stenosis in the dogs that became progressively worse. The return of nerve root compression after 3 years in two dogs was attributed to incomplete removal of dorsal anulus fibrosus. It was concluded that disc fenestration alone provided inadequate treatment of caudal cervical degenerative disc disease in large dogs.     

Chemonucleolysis with Collagenase A Radiographic and Pathologic Study in Dogs

Collagenase, a proteolytic enzyme, was injected intradiscally in nine clinically normal, middle-aged beagles. Calcium chloride diluent solution (control), 100 ABC units of collagenase, and 250 ABC units of collagenase, were injected in randomly selected intervertebral discs (T13-L1 to L5-L6). On day 11, the discs injected with collagenase were narrowed radiographically, but there was no significant change in myelograms. Grossly and histologically, there was dissolution of the intervertebral discs, mainly nucleus pulposus, and protrusion of nucleus material in the vertebral body through bony end-plates in discs injected with collagenase. Collagenase chemonucleolysis may be an alternative to spinal surgery for intervertebral disc protrusion in dogs.