Results of surgical treatment for thoracolumbar disc protrusion

Ninety-nine dogs were treated by hemilaminectomy for thoracolumbar intervertebral disc protrusion. Most animals were 4–7 years old and chondrodystrophoid. The incidence of protrusion was higher at the thoracolumbar junction. Animals with paresis, pain, or pain and paresis had a greater recovery rate than dogs with paralysis. Résumé. La protrusion du disque intervertébral thoracolombaire a été traitée par hémi-laminectomie chez 99 chiens, la plupart âgés de 4 à 7 ans et atteints de chondrodystrophie. Les protrusions étaient plus fréquentes à la jonction thoraco-lombaire. Les animaux qui manifes-taient de la parésie ou de la douleur, ou de la parésie et de la douleur, se rétablissaient plus vite et mieux que les animaux paralysés. Zusammenfassung. Neunundneunzig Hunde wurden mit Hemilaminektomie bei thoraco-lumbaren Zwischenwirbelscheibenvorfall behandelt. Die meisten Tiere waren 4–7 Jahre alt und chondrodystrophoid. Die Häufigkeit von Diskushernien war höher am thoracolumbarem Über-gangsabschnitt. Tiere mit Parese, Schmerzen oder Schmerzen und Parese wurden häufiger wiederhergestellt als Hunde mit Paralyse.     

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.     

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.     

Hemilaminectomy for the treatment of thoracolumbar disc disease in the dog: a follow-uo studv of 40 cases

A study was made of dogs with Hansen type I thoracolumbar disc extrusions that had been treated by hemilaminectomy and fenestration of the affected disc. Follow-up information was available for 40 dogs undergoing treatment over a five-year period. The follow-up period ranged from 12 to 72 months (mean 34 months). The case details and the results of treatment of these 40 dogs are presented. All dogs were graded according to the degree of neurological dysfunction at the time of initial presentation and at the conclusion of the study period. Twenty-seven dogs (68 per cent) had no detectable signs of neurological dysfunction or thoracolumbar pain at the final assessment and a further eight dogs (20 per cent) had mild ambulatory paraparesis but were regarded by their owners as functional pets. Recurrence of neurological signs consistent with thoracolumbar disc disease was seen in five dogs (13 per cent) and was successfully resolved completely in one of three dogs that were treated.     

犬椎间盘病防治

椎间盘病是犬的常见病,临床上表现疼痛、运动机能障碍、瘫痪、大小便失禁等不同症状。一般遇到上述症状容易被当作缺钙或风湿,实际上犬椎间盘病的主要原因是遗传性因素,其他诸如运动不当、外力、气温变化、营养失调也可以诱发该病。犬椎间盘病通常包括颈椎、胸椎、腰椎和腰荐的椎间盘病,临床表现因发病部位而异,以胸腰部最为常发,这点和人的椎间盘病有较大的不同需要区别认识。从犬种来看最易发生该病的是腊肠犬、其次是京叭、贵宾、可卡和比格犬。在北京尤以京叭犬最为常见。椎间盘是连接椎体的致密结缔组织,由中央的髓核和以同心圆状包裹…     

Vertebral stabilisation and selective decompression for the management of triple thoracolumbar disc protrusions

Triple adjacent thoracolumbar disc protrusions causing moderate to severe spinal cord compression were diagnosed by magnetic resonance imaging in two German shepherd dogs with marked paraparesis and pelvic limb ataxia. Both cases were managed by selective hemilaminectomy, partial annulectomy and bilateral quadruple vertebral body stabilisation using novel canine locking fixation plates (SOP). The stabilisation of multiple vertebrae in the thoracolumbar spine was possible because the plates could be contoured with six degrees of freedom. Spinal pain resolved and neurological function improved in both dogs. Screw breakage was evident in one dog five months following surgery.     

Reoperative neurosurgery in dogs with thoracolumbar disc disease

OBJECTIVE: To characterize the subset of dogs in our neurosurgical practice that underwent spinal surgery for thoracolumbar (TL) disc herniation and subsequently underwent additional decompressive TL surgery. STUDY DESIGN: A retrospective case series. SAMPLE POPULATION: Thirty dogs that underwent reoperation for TL disc herniation. A comparison group of Dachshunds that underwent only one decompressive TL disc surgery was also studied. METHODS: Dogs that underwent reoperation were divided into two groups based on the interval between their first and second surgery. The early reoperation group included those dogs having a second surgery less than 4 weeks after the initial operation. The late reoperation group included those dogs having a second surgery more than 4 weeks after the initial operation. For each Dachshund in the late reoperation group, two Dachshunds that underwent only one decompressive TL disc surgery were selected and formed the comparison group. Dogs in the comparison group were matched with reoperated cases based on the severity of preoperative neurologic deficit and site of disc herniation. These two groups were compared to determine: (1) if age and body weight were risk factors for reoperation, and (2) if dogs had a poorer functional outcome after their second decompressive surgery than did those in the comparison group after their first (and only) decompressive surgery. RESULTS: A total of 30 of 467 (6.4%) dogs that underwent decompressive TL disc surgery were reoperated. In the early reoperative cases (n = 5 dogs), the inciting cause in all cases was residual compression from disc material at the site of the initial surgery. In the late reoperation group, 22 of 25 (88%) cases had a second disc herniation at a site distinct from the initial lesion. Dachshunds had a significantly higher risk for late reoperation (odds ratio and 95% CI = 3.67, 1.46 to 10.03); other small and medium-sized breeds (<20 kg) were underrepresented. Age and body weight were not significant predictors for reoperation. A total of 21 of 23 (91%) dogs had functional recovery after late reoperation. Complete sensorimotor loss was a significant negative predictor of functional recovery in the late reoperative cases (P = .01). Likelihood of functional recovery in dogs after their second decompressive surgery was identical to the functional recovery of dogs in the comparison group. CONCLUSIONS AND CLINICAL RELEVANCE: Our results show that a second disc herniation occurring at a site distinct from the initial lesion is the most common cause for reoperation and that Dachshunds have a significantly greater risk than other breeds.     

Analgesic effects of acupuncture in thoracolumbar disc disease in dogs

The analgesic effects of acupuncture were studied in 38 dogs affected by acute thoracolumbar disc disease, type I to IV. Steel acupuncture needles were inserted into selected acupuncture points. Stimulation time was 20 minutes. Electrical stimulation of needles, ear-acupuncture, vitamins B and C and antibiotics were occasionally used in some dogs of types I and II and in the majority of types III and IV. Pain relief was observed in 62.5 per cent of dogs of type I (back-pain), in 70.5 per cent of dogs of type II (hindlimb paresis, backpain) and in 39 per cent of dogs of types III and IV (hindlimb paralysis, backpain) after the first acupuncture treatment. Dogs of type I and II responded significantly better (P<0.01) than dogs of type III and IV at the fourth treatment (100 per cent and 61.5 per cent, respectively).     

Modified lateral spinal decompression in 61 dogs with thoracolurnbar disc protrusion

A modified lateral spinal decompression technique was performed in 61 dogs with thoracolumbar disc protrusion. Myelography combined with plain radiography and neurological examination determined the side of greatest compression in 93 per cent of the dogs. Disc material was retrieved in 98 per cent of the cases. Of the 35 non-ambulatory dogs, 95 per cent regained the ability to walk. The recovery time was three weeks.     

Re‐opening the window on fenestration as a treatment for acute thoracolumbar intervertebral disc herniation in dogs

Acute thoracolumbar intervertebral disc herniation in dogs is a common cause of “back” pain, pelvic limb paresis or paralysis and incontinence. Treatment of this condition has long been a source of controversy, especially since the introduction of surgical interventions in the 1950s. Unfortunately, formal clinical trials to compare efficacy of conservative and surgical interventions have never been carried out and the current lack of clinical equipoise on this subject now precludes such a trial on ethical grounds. In this article we re‐examine and discuss earlier published data on recovery associated with the various therapies, focusing on evidence suggesting that decompressive surgery and fenestration may be equally efficacious.     

Computed tomographic characteristics of acute thoracolumbar intervertebral disc disease in dogs

Forty canine patients with a presumptive diagnosis of the intervertebral disc herniation at the thoracolumbar region were imaged. A neurological examination was performed and all patients were classified under four grades by the examination. The degrees of attenuation of the herniated disc material were measured in Housefield units (HU) in each image. The ratio of the area to herniated disc material and the height to disc material were measured. The clinical grade was correlated with the area ratio of the herniated disc material to the spinal cord, but not correlated with the height ratio of that. In the patients with epidural hemorrhage at surgery, HUs of the herniated disc material was lower than those with no epidural hemorrhage at surgery. Non-contrast computed tomography scans of the spine can be useful in diagnosing acute intervertebral disc disease in chondrodystrophoid breeds, evaluating patient status and identifying concurrent epidural hemorrhage.     

The assessment of the usefulness of hemilaminectomy without fenestration in the treatment of thoracolumbar disc disease in chondrodystrophic dogs

The aim of the publication is to assess the effectiveness of the treatment of type I disc extrusion according to Hansen by using the method of hemilaminectomy without fenestration. The evaluated clinical material comprised 36 chondrodystrophic dogs in which 38 surgical procedures were performed. All dogs were administered corticosteroid during the operation. Dachshunds made up to 79% of patients. In 34 cases grainy mass was extracted from the vertebral canal. In two cases it was plaster-like mass and in other two--granulo-chondral. Most often (12 cases) the prolapse of the nucleus pulposus was observed between the first and second lumbar vertebra. There was one case of the postoperative pyogenic infection of the wound. Recovery was observed in all dogs with 3rd grade clinical signs, 17 out of 18 dogs with 4th grade and 8 out of 13 dogs with 5th grade of dysfunction severity. The recovery time of the dog depended in the statistically significant way on the severity of symptoms and the grade of the present disease (p<0.00005). There did not appear to be any statistically significat relationship between the recovery time and the duration of symptoms pre operatively (p=0.42), the time of non-ambulatory status (p=0.27) and the breed of the dog (p=0.81).     

Laminectomy for 34 dogs with thoracolumbar intervertebral disc disease and loss of deep pain perception

The case details and the results of treatment of 34 dogs with thoracolumbar intervertebral disc disease, without deep pain perception, that had been treated by laminectomy and fenestration, are presented. The association of a number of potential prognostic factors with the neurological outcome is examined. Twenty-one dogs (62 per cent) recovered neurological function, seven (21 per cent) failed to recover neurological function and three (9 per cent) developed progressive myelomalacia postoperatively, while three dogs (9 per cent) were euthanized intraoperatively because of diffuse myelomalacia. Twenty of the dogs that recovered neurological function showed a return of deep pain perception within two weeks of decompressive surgery. Statistical analysis showed significant differences in the outcome between dogs that took less than one hour to lose the ability to ambulate and dogs with a longer duration of onset of inability to ambulate. The extent of spinal cord swelling determined by myelography was not found to be a useful prognostic indicator.     

Evaluation of electroacupuncture treatment for thoracolumbar intervertebral disk disease in dogs

OBJECTIVE: To evaluate use of electroacupuncture combined with standard Western medical treatment versus Western medical treatment alone for treatment of thoracolumbar intervertebral disk disease in dogs. DESIGN: Prospective controlled study. ANIMALS: 50 dogs with signs of thoracolumbar intervertebral disk disease. PROCEDURES: Dogs were randomly allocated to 1 of 2 treatment groups and classified as having grade 1 to 5 neurologic dysfunction. Dogs in group 1 received electroacupuncture stimulation combined with standard Western medical treatment; those in group 2 received only standard Western medical treatment. A numeric score for neurologic function was evaluated at 4 time points to evaluate effects of treatments. RESULTS: Time (mean +/- SD) to recover ambulation in dogs with grade 3 and 4 dysfunction in group 1 (10.10 +/- 6.49 days) was significantly lower than in group 2 (20.83 +/- 11.99 days). Success (able to walk without assistance) rate for dogs with grade 3 and 4 dysfunction in group 1 (10/10 dogs) was significantly higher than that of similarly affected dogs in group 2 (6/9 dogs). Dogs without deep pain perception (grade 5 dysfunction) had a success (recovery of pain sensation) rate of 3 of 6 and 1 of 8 in groups 1 and 2, respectively, but the difference was not significant. Overall success rate (all dysfunction grades) for group 1 (23/26; 88.5%) was significantly higher than for group 2 (14/24; 58.3%). CONCLUSIONS AND CLINICAL RELEVANCE: Electroacupuncture combined with standard Western medical treatment was effective and resulted in shorter time to recover ambulation and deep pain perception than did use of Western treatment alone in dogs with signs of thoracolumbar intervertebral disk disease.     

A comparison of conservative treatment and fenestration for thoracolumbar intervertebral disc disease in the dog

Many dogs will recover after a thoracolumbar disc protrusion whether they are treated conservatively or surgically. Two statistically similar groups of dogs submitted to the Department of Surgery, Royal Veterinary College (RVC) and to the Department of Surgery, University of Glasgow Veterinary School (UGVS) were reviewed. At the RVC an aggressive surgical policy was adopted and at the UGVS a conservative regime was followed. A comparison has been made between the two groups to evaluate the advantages of each regime. This comparison has provided the basis for a treatment protocol for cases of thoracolumbar intervertebral disc disease in the dog.