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Tabbì M, Barillaro G, Interlandi CD, Di Pietro S, Fugazzotto D, Costa GL, Iannelli NM, Macrì D, Ferrantelli V, Macrì F. Treatment of Canine Disc-Associated Cervical Spondylomyelopathy with a Cervical Distraction-Stabilization Technique (C-LOX Combined with LCP Plate) and Clinical Outcomes. Animals (Basel) 2023; 13:2549. [PMID: 37627343 PMCID: PMC10451975 DOI: 10.3390/ani13162549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/23/2023] [Accepted: 08/06/2023] [Indexed: 08/27/2023] Open
Abstract
Canine disc-associated cervical spondylomyelopathy (DA-CSM) is a form of caudal CSM, characterized by the compression of the spinal cord and nerve roots due to an intervertebral disc protrusion. It is more frequent in large canine breeds. A variety of surgical techniques has been proposed for DA-CSM. The aim of the study was to evaluate the outcomes of a cervical distraction-stabilization technique using an intervertebral anchored fusion device (C-LOX) combined with a locking compression plate (LCP plate) for the treatment of DA-CSM in dogs, based on clinical and radiographical follow-up data. Thirteen dogs affected by DA-CSM were included in the study. After the surgical procedure, an improvement in neurological status was documented in 9/13 cases. This cervical distraction-stabilization technique seems to be a valuable surgical alternative to treat this canine pathology.
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Affiliation(s)
- Marco Tabbì
- Department of Veterinary Sciences, University of Messina, 98168 Messina, ME, Italy; (M.T.); (S.D.P.); (G.L.C.); (N.M.I.); (F.M.)
| | - Giuseppe Barillaro
- CVSG (Clinica Veterinaria San Giorgio), Via Vecchia Pentimele, 63, 89121 Reggio Calabria, RC, Italy;
| | - Claudia Dina Interlandi
- Department of Veterinary Sciences, University of Messina, 98168 Messina, ME, Italy; (M.T.); (S.D.P.); (G.L.C.); (N.M.I.); (F.M.)
| | - Simona Di Pietro
- Department of Veterinary Sciences, University of Messina, 98168 Messina, ME, Italy; (M.T.); (S.D.P.); (G.L.C.); (N.M.I.); (F.M.)
| | - Domenico Fugazzotto
- Ospedale Veterinario San Francesco Trevisovet s.r.l., Strada Feltrina 29, 31038 Castagnole, TV, Italy;
| | - Giovanna Lucrezia Costa
- Department of Veterinary Sciences, University of Messina, 98168 Messina, ME, Italy; (M.T.); (S.D.P.); (G.L.C.); (N.M.I.); (F.M.)
| | - Nicola Maria Iannelli
- Department of Veterinary Sciences, University of Messina, 98168 Messina, ME, Italy; (M.T.); (S.D.P.); (G.L.C.); (N.M.I.); (F.M.)
| | - Daniele Macrì
- Institute Zooprofilattico Sperimentale of Sicily, Via G. Marinuzzi, 3, 90129 Palermo, PA, Italy; (D.M.); (V.F.)
| | - Vincenzo Ferrantelli
- Institute Zooprofilattico Sperimentale of Sicily, Via G. Marinuzzi, 3, 90129 Palermo, PA, Italy; (D.M.); (V.F.)
| | - Francesco Macrì
- Department of Veterinary Sciences, University of Messina, 98168 Messina, ME, Italy; (M.T.); (S.D.P.); (G.L.C.); (N.M.I.); (F.M.)
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Driver CJ, Lopez V, Walton B, Jones D, Fentem R, Tomlinson A, Rose J. Instrumented cervical fusion using patient specific end-plate conforming interbody devices with a micro-porous structure in nine dogs with disk-associated cervical spondylomyelopathy. Front Vet Sci 2023; 10:1208593. [PMID: 37434865 PMCID: PMC10331472 DOI: 10.3389/fvets.2023.1208593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/05/2023] [Indexed: 07/13/2023] Open
Abstract
Objective To report the medium and long-term outcome of nine dogs with disk-associated cervical spondylomyelopathy (DA-CSM), treated by instrumented interbody fusion using patient specific end-plate conforming device that features a micro-porous structure to facilitate bone in-growth. Study design A retrospective clinical study. Animals Nine medium and large breed dogs. Methods Medical records at two institutions were reviewed between January 2020 and 2023. Following magnetic resonance imaging (MRI) diagnosis of DA-CSM, pre-operative computed tomography (CT) scans were exported to computer software for in-silico surgical planning. Interbody devices were 3D-manufactured by selecting laser melting in titanium alloy. These were surgically implanted at 13 segments alongside mono-or bi-cortical vertebral stabilization systems. Follow-up included neurologic scoring and CT scans post-operative, at medium-term follow up and at long-term follow-up where possible. Interbody fusion and implant subsidence were evaluated from follow-up CT scans. Results Nine dogs were diagnosed with DA-CSM between C5-C7 at a total of 13 operated segments. Medium-term follow up was obtained between 2 and 8 months post-operative (3.00 ± 1.82 months). Neurologic scoring improved (p = 0.009) in eight of nine dogs. Distraction was significant (p < 0.001) at all segments. Fusion was evident at 12/13 segments. Subsidence was evident at 3/13 operated segments but was only considered clinically relevant in one dog that did not improve; as clinical signs were mild, revision surgery was not recommended. Long-term follow up was obtained between 9 and 33 months (14.23 ± 8.24 months); improvement was sustained in 8 dogs. The dog that suffered worsened thoracic limb paresis at medium-term follow up was also diagnosed with immune-mediated polyarthropathy (IMPA) and was euthanased 9 months post-operative due to unacceptable side-effects of corticosteroid therapy. Conclusion End-plate conforming interbody devices with a micro-porous structure were designed, manufactured, and successfully implanted in dog with DA-CSM. This resulted in CT-determined fusion with minimal subsidence in the majority of operated segments. Clinical significance The technique described can be used to distract and fuse cervical vertebrae in dogs with DA-CSM, with favorable medium-and long-term outcomes.
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Affiliation(s)
- Colin J. Driver
- Lumbry Park Veterinary Specialists, CVS Referrals, Alton, United Kingdom
| | - Victor Lopez
- School of Engineering, University of Liverpool, Liverpool, United Kingdom
- Fusion Implants, Liverpool, United Kingdom
| | - Ben Walton
- Fusion Implants, Liverpool, United Kingdom
- Movement Referrals, Preston Brook, United Kingdom
| | - Dan Jones
- Fusion Implants, Liverpool, United Kingdom
| | - Rory Fentem
- Small Animal Teaching Hospital, University of Liverpool, Neston, United Kingdom
| | - Andrew Tomlinson
- Small Animal Teaching Hospital, University of Liverpool, Neston, United Kingdom
| | - Jeremy Rose
- Lumbry Park Veterinary Specialists, CVS Referrals, Alton, United Kingdom
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Marinho PVT, Ferrigno CRA, Costa RCD, Pereira CAM, Rego MAF, Bregadioli T, Paes F. Comparison of Cervical Stabilization with Transpedicular Pins and Polymethylmethacrylate versus Transvertebral Body Polyaxial Screws with or without an Interbody Distractor in Dogs. Vet Comp Orthop Traumatol 2022; 35:289-297. [PMID: 35772728 DOI: 10.1055/s-0042-1744490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The main aim of this study was to compare the biomechanical properties of caudal cervical vertebral stabilization using bicortical transpedicular pins with polymethylmethacrylate (PMMA) versus transvertebral body polyaxial screws and connecting rods with or without an interbody distractor. STUDY DESIGN Ten canine cervical vertebral columns (C2-T3) were used. Four models (intact, transvertebral body polyaxial screw with interbody distractor [polyaxial + distractor], transvertebral body polyaxial screw without interbody distractor [polyaxial - distractor] and bicortical transpedicular pins/polymethylmethacrylate [pin-PMMA]) were applied to C6-7 sequentially on the same specimens. Angular range of motion (AROM) in the form of flexion and extension was measured at C4-5, C5-6 and C6-7 in all groups. RESULTS Treated vertebral specimens had significantly less AROM than unaltered specimens. There was no significant difference in AROM between the experimental groups at C6 and C7. Angular range of motion ratio in flexion-extension was 80.8, 72.7 and 78.3% for polyaxial + distractor, polyaxial - distractor and pin-PMMA groups, respectively, which were less than the intact group. There was no significant increase in the range of motion of the adjacent vertebrae after stabilization. CONCLUSION Stabilization obtained with transvertebral body polyaxial screws was comparable to that from the well-established bicortical pins/PMMA construct. Association of an intervertebral distractor did not change AROM of the polyaxial screw constructs.
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Affiliation(s)
- Paulo V T Marinho
- Department of Veterinary Medicine, Federal Institute of Education, Science, and Technology of Southern Minas Gerais, IFSULDEMINAS, Muzambinho, MG, Brazil
| | - Cassio R A Ferrigno
- Small Animal Clinical Science, University of Tennessee, Knoxville, United States
| | - Ronaldo C da Costa
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, Ohio, United States
| | - César A M Pereira
- Biomechanics Laboratory LIM-41/HC-FMUSP, Hospital das Clínicas, College of Medicine, University of São Paulo, São Paulo, Brazil
| | - Mário A F Rego
- Department of Surgery, University of São Paulo, São Paulo, Brazil
| | | | - Fernanda Paes
- Department of Surgery, University of São Paulo, São Paulo, Brazil
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Falzone C, Tranquillo V, Gasparinetti N. Comparison of Two Surgical Techniques for the Treatment of Canine Disc Associated-Cervical Spondylomyelopathy. Front Vet Sci 2022; 9:880018. [PMID: 35795784 PMCID: PMC9251543 DOI: 10.3389/fvets.2022.880018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 05/16/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To compare prosthetic disc and vertebral distraction stabilization in dogs with disc-associated cervical spondylomyelopathy (DA-CSM). Study Design A retrospective clinical study. Animals 25 dogs. Methods Dogs presenting with clinical signs and MRI findings compatible with DA-CSM underwent surgery. Implantation of the Adamo's prosthetic disc (PD) or vertebral distraction-stabilization (DS) with intervertebral cage, ventral locking plates, and dorsal transarticular screws was performed. All dogs were followed-up and evaluated clinically for a minimum of 1 year and radiographically for at least 3 months. In particular, we focused on the evaluation of subsidence (the degree of vertebral collapse). Results Twenty-five dogs were enrolled: 12 with PD implantation and 13 with DS implantation. Of these, 24 dogs were followed-up at 1 year. Overall, 12 dogs improved (4 PD and 8 DS), eight were stable (4 PD and 4 DS), and four deteriorated (3 PD and 1 DS). Deterioration was more common in PD cases, especially soon after surgery. In a few PD cases, a second surgery was necessary. The most common complication in dogs with DS was discospondylitis. Subsidence was detected in 11 PD and 7 DS dogs. Subsidence was more severe and occurred sooner after surgery in PD cases compared to DS cases. DS cases were more prone to clinical improvement and less prone to subsidence than PD cases in this study. However, the statistical evidence was weak owing to the small sample size. Conclusion The preliminary results suggest that prosthetic disc implantation is more prone to clinical and radiographic failures than distraction stabilization. Clinical Relevance The DS technique is a valuable surgical option for treating dogs with DA-CSM, with favorable short- and long-term clinical and radiographic outcomes.
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Affiliation(s)
- Cristian Falzone
- Department of Neurology-Neurosurgery, Diagnostica Piccoli Animali, Zugliano, Italy
- *Correspondence: Cristian Falzone
| | - Vito Tranquillo
- Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna, Bergamo, Italy
| | - Nicola Gasparinetti
- Department of Neurology-Neurosurgery, Diagnostica Piccoli Animali, Zugliano, Italy
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Knell SC, Park B, Voumard B, Pozzi A. Ex vivo study of the intradiskal pressure in the C6-7 intervertebral disk after experimental destabilization and distraction-fusion of the C5-C6 vertebrae in canine cadaveric specimens. Am J Vet Res 2021; 82:1003-1012. [PMID: 34714770 DOI: 10.2460/ajvr.20.12.0218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate intradiskal pressure (IDP) in the C6-7 intervertebral disk (IVD) after destabilization and distraction-fusion of the C5-C6 vertebrae. SAMPLE 7 cadaveric C4-T1 vertebral specimens with no evidence of IVD disease from large-breed dogs. PROCEDURES Specimens were mounted in a custom-made 6 degrees of freedom spinal loading simulator so the C5-C6 and C6-C7 segments remained mobile. One specimen remained untreated and was used to assess the repeatability of the IDP measurement protocol. Six specimens underwent 3 sequential configurations (untreated, partial diskectomy of the C5-6 IVD, and distraction-fusion of the C5-C6 vertebrae). Each construct was biomechanically tested under neutral, flexion, extension, and right-lateral bending loads. The IDP was measured with a pressure transducer inserted into the C6-7 IVD and compared between the nucleus pulposus and annulus fibrosus and across all 3 constructs and 4 loads. RESULTS Compared with untreated constructs, partial diskectomy and distraction-fusion of C5-C6 decreased the mean ± SD IDP in the C6-7 IVD by 1.3 ± 1.3% and 0.8 ± 1.3%, respectively. During motion, the IDP remained fairly constant in the annulus fibrosus and increased by 3.8 ± 3.0% in the nucleus pulposus. The increase in IDP within the nucleus pulposus was numerically greatest during flexion but did not differ significantly among loading conditions. CONCLUSIONS AND CLINICAL RELEVANCE Distraction-fusion of C5-C6 did not significantly alter the IDP of healthy C6-7 IVDs. Effects of vertebral distraction-fusion on the IDP of adjacent IVDs with degenerative changes, such as those in dogs with caudal cervical spondylomyelopathy, warrant investigation.
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Affiliation(s)
- Sebastian C Knell
- From the Clinic for Small Animal Surgery, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland
| | - Brian Park
- From the Clinic for Small Animal Surgery, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland
| | - Benjamin Voumard
- Musculoskeletal Biomechanics, ARTORG Center for Biomedical Engineering Research, University of Bern, CH-3010 Bern, Switzerland
| | - Antonio Pozzi
- From the Clinic for Small Animal Surgery, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland
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Beishuizen R, Reints Bok TE, Teunissen M, van der Veen AJ, Emanuel KS, Tryfonidou MA, Meij BP. Biomechanical effects of a titanium intervertebral cage as a stand-alone device, and in combination with locking plates in the canine caudal cervical spine. Vet Surg 2021; 50:1087-1097. [PMID: 33955033 PMCID: PMC8360106 DOI: 10.1111/vsu.13657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/07/2021] [Accepted: 04/24/2021] [Indexed: 11/28/2022]
Abstract
Objective To evaluate the change in ex vivo biomechanical properties of the canine cervical spine, due to an intervertebral cage, both as a stand‐alone device and in combination with plates. Study Design Experimental ex vivo study. Animals Cervical spinal segments (C5‐C7) from eight canine cadavers. Methods The range of motion (ROM) and elastic zone stiffness (EZS) of the spines were determined with a four‐point bending device in flexion/extension, lateral bending, and axial rotation for four conditions: native, discectomy, cage (at C6‐C7), and cage with plates (at C6‐C7). The disc height index (DHI) for each condition was determined using radiography. Results Discectomy resulted in overall increased ROM (p < .01) and EZS (p < .05) and decreased DHI (p < .005) when compared to the native condition. Placement of the cage increased DHI (p < .001) and restored total ROM during flexion/extension, lateral bending and axial rotation, and EZS during flexion/extension to the level of the native spine. Application of the plates further reduced the total ROM during flexion/extension (p < .001) and lateral bending (p < .001), but restored ROM in extension and EZS during lateral bending. No implant failure, subsidence, or significant cage migration occurred during loading. Conclusion An anchorless intervertebral cage used as a stand‐alone device was able to restore the disc height and spinal stability to the level of the native cervical spine, whereas the addition of plates further reduced the spinal unit mobility. Clinical Significance This study implies that the intervertebral cage may be used as a stand‐alone device in the spinal unit fixation in the canine cervical spine.
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Affiliation(s)
- Rick Beishuizen
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Tjarda E Reints Bok
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Michelle Teunissen
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Albert J van der Veen
- Department of Orthopedic Surgery, Amsterdam UMC, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Kaj S Emanuel
- Department of Orthopedic Surgery, Amsterdam UMC, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Department of Orthopedic Surgery, Maastricht UMC+, Maastricht, The Netherlands
| | - Marianna A Tryfonidou
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Bjorn P Meij
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
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Zindl C, Fitzpatrick N, Litsky AS, Allen MJ. Kinematics of a Novel Canine Cervical Fusion System. Vet Comp Orthop Traumatol 2021; 34:257-267. [PMID: 33860511 DOI: 10.1055/s-0041-1725016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim of this study was to determine the biomechanical behaviour of a novel distraction-fusion system, consisting of an intervertebral distraction screw, pedicle locking screws and connecting rods, in the canine caudal cervical spine. STUDY DESIGN Biomechanical study in cadaveric canine cervicothoracic (C3-T3) spines (n = 6). Cadaveric spines were harvested, stripped of musculature, mounted on a four-point bending jig, and tested using non-destructive four-point bending loads in extension (0-100 N), flexion (0-60 N) and lateral bending (0-40 N). Angular displacement was recorded from reflective optical trackers rigidly secured to C5, C6 and C7. Data for primary and coupled motions were collected from intact spines and following surgical stabilization (after ventral annulotomy and nucleotomy) with the new implant system. RESULTS As compared with the intact spine, instrumentation significantly reduced motion at the operated level (C5-C6) with a concomitant non-significant increase at the adjacent level (C6-C7). CONCLUSION The combination of a locking pedicle screw-rod system and intervertebral spacer provides an alternative solution for surgical distraction-stabilization in the canine caudal cervical spine and supports the feasibility of using this new implant system in the management of disc-associated cervical spondylomyelopathy in dogs. The increase in motion at C6-C7 may suggest the potential for adjacent level effects and clinical trials should be designed to address this.
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Affiliation(s)
- Claudia Zindl
- Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | | | - Alan S Litsky
- Departments of Orthopaedics and Biomedical Engineering, The Ohio State University, Columbus, Ohio, United States
| | - Matthew J Allen
- Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
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Selz J, Voumard B, Forterre F. Comparison of the biomechanical performance of a customized unilateral locking compression plate with and without an intervertebral spacer applied to the first and second lumbar vertebrae after intervertebral diskectomy in canine cadaveric specimens. Am J Vet Res 2020; 81:915-921. [PMID: 33251837 DOI: 10.2460/ajvr.81.12.915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine whether a customized unilateral intervertebral anchored fusion device combined with (vs without) an intervertebral spacer would increase the stability of the L1-L2 motion segment following complete intervertebral diskectomy in canine cadaveric specimens. SAMPLE Vertebral columns from T13 through L3 harvested from 16 skeletally mature Beagles without thoracolumbar disease. PROCEDURES Complete diskectomy of the L1-2 disk was performed in each specimen. Unilateral stabilization of the L1-L2 motion segment was performed with the first of 2 implants: a unilateral intervertebral anchored fusion device that consisted of a locking compression plate with or without an intervertebral spacer. The resulting construct was biomechanically tested; then, the first implant was removed, and the second implant was applied to the contralateral side and tested. Range of motion in flexion and extension, lateral bending, and torsion was compared among intact specimens (prior to diskectomy) and constructs. RESULTS Compared with intact specimens, constructs stabilized with either implant were as stable in flexion and extension, significantly more stable in lateral bending, and significantly less stable in axial rotation. Constructs stabilized with the fusion device plus intervertebral spacer were significantly stiffer in lateral bending than those stabilized with the fusion device alone. No significant differences in flexion and extension and rotation were noted between implants. CONCLUSIONS AND CLINICAL RELEVANCE Findings did not support the use of this customized unilateral intervertebral anchored fusion device with an intervertebral spacer to improve unilateral stabilization of the L1-L2 motion segment after complete L1-2 diskectomy in dogs.
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Toni C, Oxley B, Behr S. Atlanto-axial ventral stabilisation using 3D-printed patient-specific drill guides for placement of bicortical screws in dogs. J Small Anim Pract 2020; 61:609-616. [PMID: 32783206 DOI: 10.1111/jsap.13188] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 11/29/2022]
Affiliation(s)
- C Toni
- Neurology-Neurosurgery Service, Willows Veterinary Centre and Referral Service, Solihull, West Midlands, B90 4NH, UK
| | - B Oxley
- Vet 3D, Coventry, West Midlands, UK
| | - S Behr
- Neurology-Neurosurgery Service, Willows Veterinary Centre and Referral Service, Solihull, West Midlands, B90 4NH, UK
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King JC, Corfield GS, Mouatt JG, Kan CY, Moses PA. Surgical management and long-term outcome of dogs with cervical spondylomyelopathy with an anchored intervertebral titanium device. Aust Vet J 2020; 98:156-163. [PMID: 32037520 DOI: 10.1111/avj.12910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 12/11/2019] [Accepted: 12/13/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the short- and long-term outcome of an anchored intervertebral titanium device (C-LOX) for the treatment of 10 dogs with disc-associated cervical spondylomyelopathy (DACSM) and 1 dog with osseous-associated cervical spondylomyelopathy. DESIGN Retrospective case series. METHODS Dogs were included if they were diagnosed with either DACSM or osseous-associated cervical spondylomyelopathy via myelography with or without advanced imaging and underwent surgical distraction and stabilisation of the affected intervertebral disc with a C-LOX implant. Assessment included short-term neurological outcome, radiography immediately and 6 weeks' postsurgery, owner questionnaire and veterinary clinical assessment. RESULTS The mean follow-up time was 12 months. Improvement in neurological status was noted in 10 of 11 dogs. Screw loosening or subsidence occurred in five dogs. Revision surgery was performed in two dogs due to implant fracture (n = 1) and recurrence of spinal cord compression due to endplate subsidence around the implant (n = 1). Adjacent segment disease occurred in three dogs (30%) with DACSM at a mean of 11 months postsurgery. CONCLUSION The use of the C-LOX implant for dogs with cervical spondylomyelopathy resulted in a high rate of initial neurological improvement; however, there is a moderate incidence of minor and major complications that is comparable to previously described distraction-stabilisation techniques.
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Affiliation(s)
- J C King
- Veterinary Specialist Services - Small Animal Surgery Department, Gold Coast, Queensland, Australia
| | - G S Corfield
- Veterinary Specialist Services - Small Animal Surgery Department, Gold Coast, Queensland, Australia
| | - J G Mouatt
- Veterinary Specialist Services - Small Animal Surgery Department, Gold Coast, Queensland, Australia
| | - C Y Kan
- Veterinary Specialist Services - Small Animal Surgery Department, Gold Coast, Queensland, Australia
| | - P A Moses
- Veterinary Specialist Services - Small Animal Surgery Department, Gold Coast, Queensland, Australia
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Reints Bok TE, Willemsen K, van Rijen MHP, Grinwis GCM, Tryfonidou MA, Meij BP. Instrumented cervical fusion in nine dogs with caudal cervical spondylomyelopathy. Vet Surg 2019; 48:1287-1298. [PMID: 31441092 PMCID: PMC6790691 DOI: 10.1111/vsu.13312] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 07/01/2019] [Accepted: 07/28/2019] [Indexed: 11/30/2022]
Abstract
Objective To report the long‐term outcome of nine dogs treated for caudal cervical spondylomyelopathy (CCSM) with surgical spinal fusion. Study design Short case series. Animals Nine large‐breed dogs. Methods Medical records of dogs treated for disc‐associated CCSM (2013‐2016) were reviewed. The surgery objective was spinal distraction by implantation of a SynCage and fixation with two Unilock plates. Follow‐up included the Helsinki pain score questionnaire, neurological grading, radiography, computed tomography (CT), and micro‐CT (μCT) with subsequent histopathology (two dogs). Results Clinical follow‐up was obtained between 9 and 51 months (27.4 ± 13.4 months). The Helsinki pain score and neurological Griffith score improved (P < .01) in all dogs and in eight of nine dogs, respectively. According to CT, the volume of bone (mean ± SD) through the cage was 79.5% ± 14.3%, including compact bone (53.0% ± 23.4%). Subsidence was seen in one of nine dogs. Implant failure was evident in four dogs, and plates were removed in two dogs. In seven of nine dogs, infraclinical pathology was observed in adjacent segment, associated with implants engaging adjacent intervertebral discs. Radiographic evidence of bony fusion between vertebral bodies was noted in all dogs. Spinal fusion was confirmed by μCT and histopathology in two cervical spine segments that became available at 22 and 40 months postoperatively. Conclusion Instrumented spinal fusion in dogs with disc‐associated CCSM resulted in owner satisfaction and radiographic evidence of interbody spinal fusion in all dogs. Clinical significance The fusion distraction technique reported here can be used to achieve spinal fusion with a good long‐term outcome.
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Affiliation(s)
- Tjarda E Reints Bok
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Koen Willemsen
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mattie H P van Rijen
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Guy C M Grinwis
- Department of Pathobiology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Marianna A Tryfonidou
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Björn P Meij
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
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Snyder CJ, Bleedorn JA, Soukup JW. Successful Treatment of Mandibular Nonunion With Cortical Allograft, Cancellous Autograft, and Locking Titanium Miniplates in a Dog. J Vet Dent 2018; 33:160-169. [PMID: 28327074 DOI: 10.1177/0898756416671060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Discontinuities of the mandible can occur for a variety of reasons including primary pathology of bone, pathologic fracture secondary to periodontal disease, and segmental resection for the treatment of neoplasia. Surgical intervention is necessary in many cases to establish normal occlusion and normal mandibular function. Rigid stabilization and treatment of these defects can be challenging due to the limited availability of bone for fixation as well as limited soft tissue coverage. This case report describes successful treatment of a nonunion fracture using cortical allograft and locking titanium miniplates. Complete osseointegration and bone healing were achieved, allowing for complete return to normal occlusion and function.
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Affiliation(s)
- Christopher J Snyder
- 1 Veterinary Dentistry and Oral Surgery, Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Jason A Bleedorn
- 2 Department of Surgery, Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Jason W Soukup
- 1 Veterinary Dentistry and Oral Surgery, Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
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Figueiredo NEO, Luna SPL, Joaquim JGF, Coutinho HD. AVALIAÇÃO DO EFEITO DA ACUPUNTURA E TÉCNICAS AFINS E PERFIL CLÍNICO E EPIDEMIOLÓGICO DE CÃES COM DOENÇAS NEUROLÓGICAS E OSTEOMUSCULARES ATENDIDOS EM SERVIÇO DE REABILITAÇÃO VETERINÁRIA. CIÊNCIA ANIMAL BRASILEIRA 2018. [DOI: 10.1590/1809-6891v19e-44570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Este estudo retrospectivo avaliou 181 cães com doenças neurológicas e osteomusculares atendidos em um serviço de reabilitação e dor crônica, durante o período de 2013 a 2015. Objetivou-se caracterizar o perfil epidemiológico e clínico dos animais e analisar a eficácia da acupuntura (AP) e terapias afins e respectiva evolução clínica. O diagnóstico baseou-se no exame físico, neurológico, ortopédico e de imagem. As afecções mais prevalentes foram as do sistema nervoso central, sobretudo doença do disco toracolombar e traumas vertebromedulares agudos. Nas enfermidades neurológicas, o tratamento foi considerado eficaz quando os pacientes foram capazes de recuperar a deambulação e para as lesões medulares, quando houve melhora clínica do quadro neurológico avaliado por meio de escores. O sucesso obtido nos quatro segmentos medulares foi de 69,5%. Nas enfermidades osteomusculares, 47% dos cães apresentavam lesões no joelho e 44% displasia coxofemoral (DCF). Adotou-se a escala analógica visual (EAV) de locomoção para definir o sucesso do tratamento nestas doenças, que foi de 52,8%. As técnicas que mais se associaram à AP manual foram, por ordem decrescente, a eletroacupuntura, a ozonioterapia e o LASER. O número de sessões de AP foi em média de 7,6±3,5. Conclui-se que a AP e técnicas afins melhoraram o escore de déficit neurológico nas doenças neurológicas avaliadas quando usadas de forma isolada e quando associadas à medicina convencional.
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Treatment of spinal fractures using Lubra plates. Vet Comp Orthop Traumatol 2017; 25:326-31. [DOI: 10.3415/vcot-11-07-0096] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Accepted: 03/21/2012] [Indexed: 11/17/2022]
Abstract
SummaryThe purpose of this retrospective study was to review the clinical use along with the shortand long-term outcome in patients treated with Lubra plates to stabilize spinal fracture and dislocations that were considered unstable at time of surgery according to the ‘three compartment theory’. The data that were collected included breed, age, gender, body weight of the patients, cause of injury, neurological grade (pre- and postoperative), radiographic findings, surgical treatment, and clinical and radiological outcome. Thirteen dogs and two cats were included with thoracic (1 case), thoracolumbar (3 cases), midlumbar (5 cases) and caudal lumbar (6 cases) vertebral fractures. For stabilization, the small-sized (3 cases), medium-sized (6 cases), and large-sized (6 cases) Lubra plates were used. The clinical outcome was excellent in 10/15 patients, functional in 2/15 and poor in 3/15 with a median follow-up period of nine years (range 2 months to 12 years). The fractures eventually stabilized by ventral spondylosis. No implant failure was seen, however demineralization of the spinous processes necessitated implant removal in one case. Our results suggest that Lubra plating is an appropriate technique for thoracolumbar and lumbar vertebral fractures as well as luxations in dogs and cats. The prognosis for neurological recovery was excellent when the animal had a neurological grade of 3 and was not paralyzed.
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15
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Cement plug technique for the management of disc-associated cervical spondylopathy in 52 Dobermann Pinscher dogs. Vet Comp Orthop Traumatol 2017; 29:195-201. [DOI: 10.3415/vcot-15-09-0160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 01/22/2016] [Indexed: 11/17/2022]
Abstract
SummaryObjectives: To report the radiographic and clinical outcome of an intervertebral bone cement plug technique for the management of disc-associated cervical spondylopathy in Dobermann Pinscher dogs.Methods: Retrospective study of 52 Dobermann Pinscher dogs.Results: A variable degree of cement plug subsidence with loss of vertebral distraction was evident in all dogs (n = 40) that were radiographed >6 weeks postoperatively. In no case was there definitive evidence of vertebral body fusion. Eight dogs had a sudden deterioration in neurological status, cervical hyperaesthesia, or both between three days and 12 weeks following surgery that was considered to be implant-associated; six of these dogs were euthanatized. Following surgery, 43/52 dogs were considered to be neurologically normal or to have improved, however, nine of 43 subsequently deteriorated due to adjacent segment disease. At the long-term follow-up, 34 dogs were considered to be neurologically normal or to have improved. Twenty-nine dogs were dead by the end of the study period.Clinical significance: Intervertebral bone cement plug surgery results in an initial improvement in clinical signs in the majority of Dobermann Pinschers with disc-associated cervical spondylopathy. However, it fails to maintain vertebral distraction or achieve vertebral body fusion, and is associated with acute implant complications, additional cervical disc protrusions or mortality in a significant proportion of cases.Online Supplementary Material: Please note that online supplementary material for this paper is available at: http://dx.doi.org/10.3415/VCOT-15-09-0160.
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16
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Hamilton-Bennett SE, Oxley B, Behr S. Accuracy of a patient-specific 3D printed drill guide for placement of cervical transpedicular screws. Vet Surg 2017; 47:236-242. [PMID: 29064584 DOI: 10.1111/vsu.12734] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 05/03/2017] [Accepted: 05/20/2017] [Indexed: 11/30/2022]
Affiliation(s)
| | - Bill Oxley
- Willows Veterinary Centre and Referral Service; Solihull West Midlands United Kingdom
| | - Sebastien Behr
- Willows Veterinary Centre and Referral Service; Solihull West Midlands United Kingdom
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17
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Hakozaki T, Ichinohe T, Kanno N, Yogo T, Harada Y, Inaba T, Kasai Y, Hara Y. Biomechanical assessment of the effects of vertebral distraction-fusion techniques on the adjacent segment of canine cervical vertebrae. Am J Vet Res 2017; 77:1194-1199. [PMID: 27805449 DOI: 10.2460/ajvr.77.11.1194] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess effects of vertebral distraction-fusion techniques at a treated segment (C5-C6) and an adjacent segment (C4-C5) of canine cervical vertebrae. SAMPLE Cervical vertebrae harvested from cadavers of 10 skeletally mature Beagles. PROCEDURES Three models (intact, titanium plate, and polymethylmethacrylate [PM MA]) for stabilization of the caudal region of the cervical vertebrae (C4 through C7) were applied to the C5-C6 vertebral segment sequentially on the same specimens. Biomechanical assessments with flexion-extension, lateral bending, and axial rotational tests were conducted after each procedure. Range of motion (ROM) for a torque load applied with a 6-axis material tester was measured at C4-5 and C5-6 and calculated by use of a 3-D video measurement system. RESULTS In both the plate and PMMA models, ROM significantly increased at C4-5 and significantly decreased at C5-6, compared with results for the intact model. The ROM at C5-6 was significantly lower for the plate model versus the PMMA model in lateral bending and for the PMMA model versus the plate model in axial rotation. Conversely, ROM at C4-5 was significantly higher in axial rotation for the PMMA model versus the plate model. No significant differences were identified in flexion-extension between the PMMA and plate models at either site. CONCLUSIONS AND CLINICAL RELEVANCE Results of this study suggested that vertebral distraction and fusion of canine vertebrae can change the mechanical environment at, and may cause disorders in, the adjacent segment. Additionally, findings suggested that effects on the adjacent segment differed on the basis of the fusion method used.
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Hettlich BF, Fosgate GT, Litsky AS. Biomechanical Comparison of 2 Veterinary Locking Plates to Monocortical Screw/Polymethylmethacrylate Fixation in Canine Cadaveric Cervical Vertebral Column. Vet Surg 2016; 46:95-102. [DOI: 10.1111/vsu.12581] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 08/11/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Bianca F. Hettlich
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine; The Ohio State University; Columbus Ohio
| | - Geoffrey T. Fosgate
- Department of Production Animal Studies, Faculty of Veterinary Science; University of Pretoria; Pretoria South Africa
| | - Alan S. Litsky
- Department of Orthopaedics, College of Medicine; The Ohio State University; Columbus Ohio
- Department of Biomedical Engineering, College of Engineering; The Ohio State University; Columbus Ohio
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19
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Morrison EJ, Litsky AS, Allen MJ, Fosgate GT, Hettlich BF. Evaluation of Three Human Cervical Fusion Implants for Use in the Canine Cervical Vertebral Column. Vet Surg 2016; 45:901-908. [DOI: 10.1111/vsu.12536] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 04/21/2016] [Accepted: 06/13/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Emily J. Morrison
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine, Ohio State University; Columbus Ohio
| | - Alan S. Litsky
- Department of Orthopaedics; College of Medicine, Ohio State University; Columbus Ohio
- Department of Biomedical Engineering; College of Engineering, Ohio State University; Columbus Ohio
| | - Matthew J. Allen
- Department of Veterinary Medicine; University of Cambridge; United Kingdom
| | - Geoffrey T. Fosgate
- Department of Production Animal Studies; Faculty of Veterinary Science, University of Pretoria; South Africa
| | - Bianca F. Hettlich
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine, Ohio State University; Columbus Ohio
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20
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Stout Steele MW, Hodshon AW, Hopkins AL, Tracy GM, Cohen ND, Kerwin SC, Boudreau CE, Thomas WB, Mankin JM, Levine JM. Multi-Center Retrospective Evaluation of Screw and Polymethylmethacrylate Constructs for Atlantoaxial Fixation in Dogs. Vet Surg 2016; 45:909-915. [PMID: 27580972 DOI: 10.1111/vsu.12533] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate outcome and adverse events following ventral stabilization of the atlantoaxial (AA) joint in dogs with clinical AA subluxation using screw/polymethymethacrylate (PMMA) constructs in a retrospective, multi-center cohort study. STUDY DESIGN Historical cohort study. ANIMALS 35 client-owned dogs. METHODS Medical records from 3 institutions were reviewed to identify dogs with AA subluxation treated with ventral screw and PMMA constructs. Data on signalment, pre- and postoperative neurologic status, imaging performed, and adverse events were retrieved. Neurologic examination data were abstracted to generate a modified Frankel score at admission, discharge, and re-examination. Telephone interview of owners >180 days postoperative was conducted. RESULTS Thirty-five dogs with AA subluxation treated with ventral screw/PMMA constructs were included. Most dogs were young (median age 1 year), small breed dogs with acute onset of neurologic signs (median duration 22.5 hours). Most dogs were non-ambulatory at the time of admission (median modified Frankel score 3). Adverse events were identified in 15/35 dogs including 9 dogs with major adverse events. Four dogs required a second surgery due to vertebral canal violation (n = 2) or implant failure (n = 2). Re-examination at 4-6 weeks postoperative reported 15/28 dogs with improved neurologic status and 19/28 dogs were ambulatory. Telephone follow-up was available for 23/35 dogs with 23/23 reported as ambulatory (median follow-up 390 days). CONCLUSIONS Ventral application of screw and PMMA constructs for AA subluxation, as described here, is associated with clinical improvement in the majority of dog. Major adverse events are infrequent and the technique is considered relatively safe.
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Affiliation(s)
- Megan W Stout Steele
- Department of Veterinary Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas
| | - Amy W Hodshon
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, Tennessee
| | | | | | - Noah D Cohen
- Department of Veterinary Large Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas
| | - Sharon C Kerwin
- Department of Veterinary Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas
| | - C Elizabeth Boudreau
- Department of Veterinary Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas
| | - William B Thomas
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, Tennessee
| | - Joseph M Mankin
- Department of Veterinary Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas
| | - Jonathan M Levine
- Department of Veterinary Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas
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21
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Solano MA, Fitzpatrick N, Bertran J. Cervical Distraction-Stabilization Using an Intervertebral Spacer Screw and String-of Pearl (SOP™) Plates in 16 Dogs With Disc-Associated Wobbler Syndrome. Vet Surg 2015; 44:627-41. [DOI: 10.1111/vsu.12325] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 08/01/2014] [Indexed: 11/29/2022]
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22
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Hettlich BF, Allen MJ, Glucksman GS, Fosgate GT, Litsky AS. Effect of an Intervertebral Disk Spacer on Stiffness After Monocortical Screw/Polymethylmethacrylate Fixation in Simulated and Cadaveric Canine Cervical Vertebral Columns. Vet Surg 2014; 43:988-94. [DOI: 10.1111/j.1532-950x.2014.12165.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 10/01/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Bianca F. Hettlich
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine; Ohio State University; Columbus Ohio
| | - Matthew J. Allen
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine; Ohio State University; Columbus Ohio
| | - Gabriela S. Glucksman
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine; Ohio State University; Columbus Ohio
| | - Geoffrey T. Fosgate
- Faculty of Veterinary Science; Department of Production Animal Studies; University of Pretoria; South Africa
| | - Alan S. Litsky
- Department of Orthopaedics; College of Medicine; Ohio State University; Columbus Ohio
- Department of Biomedical Engineering; College of Engineering; Ohio State University; Columbus Ohio
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23
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Schöllhorn B, Bürki A, Stahl C, Howard J, Forterre F. Comparison of the biomechanical properties of a ventral cervical intervertebral anchored fusion device with locking plate fixation applied to cadaveric canine cervical spines. Vet Surg 2013; 42:825-31. [PMID: 24033669 DOI: 10.1111/j.1532-950x.2013.12044.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Accepted: 04/01/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate fixation properties of a new intervertebral anchored fusion device and compare these with ventral locking plate fixation. STUDY DESIGN In vitro biomechanical evaluation. ANIMALS Cadaveric canine C4-C7 cervical spines (n = 9). METHODS Cervical spines were nondestructively loaded with pure moments in a nonconstraining testing apparatus to induce flexion/extension while angular motion was measured. Range of motion (ROM) and neutral zone (NZ) were calculated for (1) intact specimens, (2) specimens after discectomy and fixation with a purpose-built intervertebral fusion cage with integrated ventral fixation, and (3) after removal of the device and fixation with a ventral locking plate. RESULTS Both fixation techniques resulted in a decrease in ROM and NZ (P < .001) compared with the intact segments. There were no significant differences between the anchored spacer and locking plate fixation. CONCLUSION An anchored spacer appears to provide similar biomechanical stability to that of locking plate fixation.
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Affiliation(s)
- Bernhard Schöllhorn
- Department of Small Animal Surgery, Vetsuisse Faculty of Berne, Berne, Switzerland
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Lewis M, Olby NJ, Sharp NJH, Early P. Long-term effect of cervical distraction and stabilization on neurological status and imaging findings in giant breed dogs with cervical stenotic myelopathy. Vet Surg 2013; 42:701-9. [PMID: 23889830 DOI: 10.1111/j.1532-950x.2013.12034.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 06/15/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To assess long-term clinical and imaging outcomes in giant breed dogs with cervical stenotic myelopathy treated surgically. STUDY DESIGN Retrospective case series. ANIMALS Dogs (n = 7). METHODS All dogs had lateral or dorsolateral cord compression at 1 or more sites and were treated with cervical distraction and stabilization using PMMA plugs. Four dogs had follow-up CT or CT/myelography performed at least 6 months postoperatively. Spinal canal stenosis measurements were compared between pre- and postoperative CT images. Long-term clinical neurologic re-evaluation ranged from 4 to 7 years. Outcome was considered positive, satisfactory, or negative. Recurrence was defined as signs of a cervical myelopathy in dogs that initially improved or had stable disease postoperatively. RESULTS All dogs had immediate postoperative improvement. Recurrence (4 months to 4 years postoperatively) occurred in 3 dogs that had multiple sites of compression. Long-term outcome was positive in 4 of 7 dogs. Postoperative imaging revealed subjective regression of bony proliferation at surgical sites in 2 of 4 dogs that improved clinically but morphometric data showed no change in canal measurements. An adjacent site lesion was confirmed in 1 dog. CONCLUSIONS Distraction and stabilization with PMMA plugs and bone grafts is a safe surgical option for giant breed dogs with CSM with a single site of lateral or dorsolateral compression. Long-term recurrence was common among dogs with multiple sites of compression. Follow-up of 4 years or more among a larger population is indicated to fully assess implications of surgical intervention and determine recurrence rates.
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Affiliation(s)
- Melissa Lewis
- College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
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Hettlich BF, Allen MJ, Pascetta D, Fosgate GT, Litsky AS. Biomechanical Comparison Between Bicortical Pin and Monocortical Screw/Polymethylmethacrylate Constructs in the Cadaveric Canine Cervical Vertebral Column. Vet Surg 2013; 42:693-700. [DOI: 10.1111/j.1532-950x.2013.12040.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Accepted: 09/16/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Bianca F. Hettlich
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine; Ohio State University; Columbus; OH
| | - Matthew J. Allen
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine; Ohio State University; Columbus; OH
| | - Daniel Pascetta
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine; Ohio State University; Columbus; OH
| | - Geoffrey T. Fosgate
- Department of Production Animal Studies, Faculty of Veterinary Science; University of Pretoria; South Africa
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De Decker S, da Costa RC, Volk HA, Van Ham LML. Current insights and controversies in the pathogenesis and diagnosis of disc-associated cervical spondylomyelopathy in dogs. Vet Rec 2012. [DOI: 10.1136/vr.e7952] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- S. De Decker
- Department of Veterinary Clinical Sciences; Royal Veterinary College; Hawkshead Lane, North Mymms Hatfield Hertfordshire AL9 7TA UK
| | - R. C. da Costa
- College of Veterinary Medicine; The Ohio State University; 1900 Coffey Road Columbus OH 43210 USA
| | - H. A. Volk
- Department of Veterinary Clinical Sciences; Royal Veterinary College; Hawkshead Lane, North Mymms Hatfield Hertfordshire AL9 7TA UK
| | - L. M. L. Van Ham
- Faculty of Veterinary Medicine; Ghent University; Salisbrylaan, 133 B-9820 Merelbeke Belgium
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da Costa RC, Echandi RL, Beauchamp D. Computed tomography myelographic findings in dogs with cervical spondylomyelopathy. Vet Radiol Ultrasound 2012; 53:64-70. [PMID: 22093094 DOI: 10.1111/j.1740-8261.2011.01869.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Computed tomography (CT) myelography is used occasionally in the diagnosis of cervical spondylomyelopathy, but the type of lesion found in large- versus giant-breed dogs using this modality has not been characterized. Our purpose was to report the frequency of compressive lesions in large- and giant-breed dogs with cervical spondylomyelopathy and imaged using CT myelography. Fifty-eight dogs were retrospectively studied, 23 large-breed and 35 giant-breed dogs. Multiple sites of compression were found in 12 large-breed dogs (52.2%) compared to 30 (85.8%) giant-breed dogs. The main site of compression was at C5-6 and C6-7 in both large-breed (91.3%) and giant-breed (72.4%) dogs. The main cause and direction of compression was disc-associated and ventral in 19 (82.6%) of the large-breed dogs while osseous changes were the primary cause of compression in 27 (77.2%) of the giant-breed dogs, with most compressions being lateral (51.4%), followed by dorsolateral (14.2%). Osseous compression was observed at C7-T1 in eight giant-breed dogs (22.8%), and at T1-T2 or T2 only in five dogs (14.3%). Four of 23 large-breed dogs (17.4%), and seven (20%) of 35 giant-breed dogs had spinal cord atrophy. Therefore, giant-breed dogs often have multiple compressions, usually caused by osseous changes causing lateralized compressions. In large-breed dogs most compressions are disc-associated and located ventrally. Considering the number of giant-breed dogs with compressions at C7-T1, T1-2, and T2, it is important to include the cranial thoracic region when imaging dogs suspected of having cervical spondylomyelopathy.
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Affiliation(s)
- Ronaldo C da Costa
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210, USA.
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28
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De Decker S, Gielen IMVL, Duchateau L, Oevermann A, Polis I, Van Soens I, van Bree HJJ, Van Ham LML. Evolution of clinical signs and predictors of outcome after conservative medical treatment for disk-associated cervical spondylomyelopathy in dogs. J Am Vet Med Assoc 2012; 240:848-57. [DOI: 10.2460/javma.240.7.848] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Adamo PF. Cervical arthroplasty in two dogs with disk-associated cervical spondylomyelopathy. J Am Vet Med Assoc 2011; 239:808-17. [DOI: 10.2460/javma.239.6.808] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Steffen F, Voss K, Morgan JP. Distraction-fusion for caudal cervical spondylomyelopathy using an intervertebral cage and locking plates in 14 dogs. Vet Surg 2011; 40:743-52. [PMID: 21770976 DOI: 10.1111/j.1532-950x.2011.00850.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate clinical and radiographic outcome in dogs with caudal cervical spondylomyelopathy (CCSM) treated with an intervertebral fusion cage and locking plates. STUDY DESIGN Prospective clinical study. ANIMALS Large breed dogs (n=14) with CCSM. METHODS Dogs had single level cervical spine distraction/fusion performed using an intervertebral cage with a hollow center filled with cancellous autograft and 2 ventrally applied locking plates. Outcome was measured using neurologic scores and radiographic interpretation 6 weeks, 6 months, and 12 months postoperatively. RESULTS The surgical procedure was well tolerated in all dogs. Final outcome at 12 months was available in 9 dogs. Five dogs were judged excellent, 1 dog was good, 2 dogs were satisfactory, and 2 dogs were poor because of adjacent segment disease. Four dogs died for reasons unrelated to the procedure. Radiographically, implants remained stable over the entire follow-up period. The disc space continued to fill with an immature pattern of new bone, which showed progressive increase in opacity and quantity. Subsidence of the cage (median 2 m) was detected in 9 dogs at 6 weeks and remained unchanged in those that could be followed further. CONCLUSION Distraction-fusion of single level CCSM in dogs with a combination of intervertebral cage and ventral locking plates is clinically effective and results in successful bony fusion.
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Affiliation(s)
- Frank Steffen
- Section of Small Animal Surgery/Neurology, Vetsuisse Faculty of the University of Zurich, Zurich, Switzerland.
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31
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De Decker S, Caemaert J, Tshamala MC, Gielen IMVL, Van Bree HJJ, Bosmans T, Wegge B, Van Ham LML. Surgical treatment of disk-associated wobbler syndrome by a distractable vertebral titanium cage in seven dogs. Vet Surg 2011; 40:544-54. [PMID: 21539580 DOI: 10.1111/j.1532-950x.2011.00839.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate a distractable titanium cage for the treatment of disk-associated wobbler syndrome (DAWS). STUDY DESIGN Prospective study. ANIMALS Dogs (n = 7) with DAWS. METHODS After total discectomy of C5-C6 and C6-C7, the median part of the vertebral body of C6 was removed with preservation of the lateral walls and dorsal cortex. The removed cancellous bone was collected. The implant was placed in the bony defect of C6. After placement, the titanium cage was distracted and affixed by 4 screws. Finally, the implant was filled and covered with cancellous bone. Dogs had follow-up examinations at 1, 3, 6, 12, and 24 months. Six months after surgery, cervical radiographs and computed tomography (CT) were performed. RESULTS Although no intraoperative complications occurred, correct placement of the cage was technically challenging. Revision surgery was necessary in 2 dogs because of implant loosening and aggravation of vertebral tilting. All dogs improved after discharge from the hospital. In 1 dog, recurrence of clinical signs caused by articular facet proliferation at an adjacent intervertebral disk space occurred. Radiographs at 6 months demonstrated cage subsidence in 4 dogs. In all dogs, CT was suggestive for fusion of the bone graft with the vertebral body. CONCLUSIONS Although results are promising, technical adaptations will be necessary to make this specific surgical technique, designed for humans, suitable for routine use in dogs.
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Affiliation(s)
- Steven De Decker
- Faculty of Veterinary Medicine Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
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Agnello KA, Kapatkin AS, Garcia TC, Hayashi K, Welihozkiy AT, Stover SM. Intervertebral Biomechanics of Locking Compression Plate Monocortical Fixation of the Canine Cervical Spine. Vet Surg 2010; 39:991-1000. [DOI: 10.1111/j.1532-950x.2010.00755.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hettlich BF, Fosgate GT, Levine JM, Young BD, Kerwin SC, Walker M, Griffin J, Maierl J. Accuracy of conventional radiography and computed tomography in predicting implant position in relation to the vertebral canal in dogs. Vet Surg 2010; 39:680-7. [PMID: 20459486 DOI: 10.1111/j.1532-950x.2010.00697.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the accuracy of radiography and computed tomography (CT) in predicting implant position in relation to the vertebral canal in the cervical and thoracolumbar vertebral column. STUDY DESIGN In vitro imaging and anatomic study. ANIMALS Medium-sized canine cadaver vertebral columns (n=12). METHODS Steinmann pins were inserted into cervical and thoracolumbar vertebrae based on established landmarks but without predetermination of vertebral canal violation. Radiographs and CT images were obtained and evaluated by 6 individuals. A random subset of pins was evaluated for ability to distinguish left from right pins on radiographs. The ability to correctly identify vertebral canal penetration for all pins was assessed both on radiographs and CT. Spines were then anatomically prepared and visual examination of pin penetration into the canal served as the gold standard. RESULTS Left/right accuracy was 93.1%. Overall sensitivity of radiographs and CT to detect vertebral canal penetration by an implant were significantly different and estimated as 50.7% and 93.4%, respectively (P<.0001). Sensitivity was significantly higher for complete versus partial penetration and for radiologists compared with nonradiologists for both imaging modalities. Overall specificity of radiographs and CT to detect vertebral canal penetration was 82.9% and 86.4%, respectively (P=.049). CONCLUSIONS CT was superior to radiographic assessment and is the recommended imaging modality to assess penetration into the vertebral canal. CLINICAL RELEVANCE CT is significantly more accurate in identifying vertebral canal violation by Steinmann pins and should be performed postoperatively to assess implant position.
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Affiliation(s)
- Bianca F Hettlich
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA.
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