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Kramer V, Böttcher P. Mapping Subchondral Bone Density Distribution in the Canine C6-C7 Vertebral Endplates: A CT-OAM Study. Animals (Basel) 2023; 13:3432. [PMID: 38003050 PMCID: PMC10668868 DOI: 10.3390/ani13223432] [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: 09/21/2023] [Revised: 11/01/2023] [Accepted: 11/04/2023] [Indexed: 11/26/2023] Open
Abstract
Intervertebral cage subsidence is a common complication in treating disc-associated cervical spondylomyelopathy in dogs. The mechanical stability of the vertebral endplate in contact with the cage is crucial to preventing subsidence. This study aims to assess subchondral bone mineral density (sBMD) in the canine vertebral endplate (specifically, the C6-C7 vertebral motion unit) as a measure of its mechanical stability. The sBMD distribution was mapped for the C6 caudal and C7 cranial vertebral endplates in 15 middle- to large-breed dogs using computed tomography osteoabsorptiometry. The sBMD distribution in the canine C6 and C7 vertebral endplates exhibited a heterogeneous pattern, with lower density observed in the central and dorsal contact areas of the nucleus pulposus, where common subsidence occurs. Our results suggest a potential need to redesign intervertebral cages to ensure that contact areas align with regions of higher bone density. A broad-based design extending toward the lateral and dorsal aspects of the annulus fibrosus contact area may enhance stability.
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Affiliation(s)
- Vincenz Kramer
- Small Animal Clinic, Freie Universität Berlin, 14163 Berlin, Germany;
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2
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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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Bonelli MDA, da Costa RC. Magnetic resonance imaging and neurologic characterization of combined osseous- and disc-associated cervical spondylomyelopathy in dogs. J Vet Intern Med 2023; 37:1418-1427. [PMID: 37314024 PMCID: PMC10365061 DOI: 10.1111/jvim.16792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 05/26/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Although both disc- or osseous-associated forms of cervical spondylomyelopathy (CSM) are observed in the same dogs, this combined form has not been thoroughly evaluated. OBJECTIVES To describe imaging characteristics of dogs with concurrent disc- and osseous CSM and investigate an association between findings on neurological examination and imaging. ANIMALS Sixty dogs with disc and osseous-associated CSM from 232 CSM-affected dogs. METHODS Retrospective study. Dogs diagnosed via high-field MRI with a combination of intervertebral disc (IVD) protrusion and osseous proliferation of articular processes, dorsal lamina, or both were identified. Large and giant breed dogs were grouped according to whether combined compressions were at the same site or different sites. Statistical methods were used to investigate the association and relationship between variables. RESULTS Thirty-five out of 60 (58%) were large breeds and 22/60 (37%) were giant breeds. Mean and median age was 6.6 and 7 years respectively (range, 0.75-11 years). Forty of the 60 dogs (67%) had concurrent osseous and disc-associated spinal cord compression in the same location. This was considered the main compression site in 32/40 (80%) dogs. Dogs with osseous- and disc-associated compressions at the same site were more likely to have a higher neurologic grade (P = .04). CONCLUSIONS AND CLINICAL IMPORTANCE A substantial percentage of dogs with CSM present with concomitant IVD protrusion and osseous proliferations, most at the same site. Characterizing this combined form is important in the management of dogs with CSM because it could affect treatment choices.
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Affiliation(s)
| | - Ronaldo Casimiro da Costa
- Department of Veterinary Clinical Sciences, College of Veterinary MedicineThe Ohio State UniversityColumbusOhioUSA
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4
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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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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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Kimura S, Nakata K, Nakano Y, Nozue Y, Konno N, Sugawara T, Maeda S, Kamishina H. Case Report: Spinal Stabilization Surgery Using a Novel Custom-Made Titanium Fixation System for the Spinal Instability Caused by Vertebral Malformation in a Dog. Front Vet Sci 2021; 8:755572. [PMID: 34859088 PMCID: PMC8631319 DOI: 10.3389/fvets.2021.755572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/19/2021] [Indexed: 11/17/2022] Open
Abstract
A 2-year-old Maltese was presented with wobbly gait of the pelvic limbs. Based on imaging examinations, a diagnosis of congenital malformation at T5–T8 and severe kyphosis causing spinal cord compression at T6–T7 was made. Dorsal laminectomy and stabilization of T6 and T7 vertebrae were performed. As the size of the vertebrae was small and they were severely deformed, novel custom-made titanium implants were used for spinal stabilization. Clinical signs were resolved 2 weeks after surgery. Although radiographic examination 373 days after surgery showed slight loosening of implants, post-operative course remained uneventful. This report describes the use of novel custom-made titanium implants for spinal fixation surgery in a dog.
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Affiliation(s)
- Shintaro Kimura
- The United Graduate School of Veterinary Sciences, Gifu University, Gifu, Japan.,The Animal Medical Center of Gifu University, Gifu University, Gifu, Japan
| | - Kohei Nakata
- The Animal Medical Center of Gifu University, Gifu University, Gifu, Japan
| | - Yukiko Nakano
- The Animal Medical Center of Gifu University, Gifu University, Gifu, Japan
| | - Yuta Nozue
- The Animal Medical Center of Gifu University, Gifu University, Gifu, Japan
| | | | - Taku Sugawara
- Department of Spinal Surgery, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan
| | - Sadatoshi Maeda
- The United Graduate School of Veterinary Sciences, Gifu University, Gifu, Japan.,The Animal Medical Center of Gifu University, Gifu University, Gifu, Japan
| | - Hiroaki Kamishina
- The United Graduate School of Veterinary Sciences, Gifu University, Gifu, Japan.,The Animal Medical Center of Gifu University, Gifu University, Gifu, Japan
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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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8
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Knell SC, Smolders LA, Pozzi A. Ex vivo Evaluation of the Dynamic Morphometry of the Caudal Cervical Intervertebral Disc Spaces of Small Dogs and Cats. Front Vet Sci 2021; 8:706452. [PMID: 34485434 PMCID: PMC8415525 DOI: 10.3389/fvets.2021.706452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/15/2021] [Indexed: 11/30/2022] Open
Abstract
The objective of this study was to provide a morphometric description of the caudal cervical intervertebral disc (IVD) spaces of small-breed dogs and cats. Specimens consisting of C4 through C7 from five small-breed dogs and six cats were positioned in neutral, flexion, extension, and lateral bending positions; and CT images were acquired. Height and width of the cranial and caudal vertebral endplates (VEPs), angle between the VEPs (IVD wedge angle), and craniocaudal distance (IVD width) between VEPs for the four loading positions were measured and compared for three segments (C4-C5, C5-C6, and C6-C7). VEP size normalized to body weight from medium-sized dogs was retrieved from a previous study and compared with data from small dogs and cats. A linear mixed model was used to compare outcome measures. Significance was set to p < 0.05. VEP size normalized to body weight was the largest in small dogs compared with cats (p = 0.0422) and medium-sized dogs (p = 0.0064). Cats and medium-sized dogs were similar (p = 0.2763) in this regard. Flexion and extension induced a reduction of IVD width in the ventral portion of the IVD and the area of the nucleus. The dorsal part of the IVD remained unchanged throughout loading conditions. Unique morphometric characteristics of the caudal cervical IVD space of small dogs and cats were detected that are different from those described in sizes of dogs (medium-sized) typically affected by caudal cervical spondylomyelopathy (CSM). These findings may help to understand the different pathomechanisms in cervical spinal disease between small- and medium-sized dogs, including caudal CSM.
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Affiliation(s)
- Sebastian C. Knell
- Clinic for Small Animal Surgery, Vetsuisse Faculty University of Zurich, Zurich, Switzerland
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9
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Bonelli MDA, da Costa LBDSBC, da Costa RC. Association of neurologic signs with high-field MRI findings in 100 dogs with osseous-associated cervical spondylomyelopathy. Vet Radiol Ultrasound 2021; 62:678-686. [PMID: 34370359 DOI: 10.1111/vru.13014] [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: 12/30/2020] [Revised: 05/22/2021] [Accepted: 05/24/2021] [Indexed: 11/29/2022] Open
Abstract
Although osseous-associated cervical spondylomyelopathy (OA-CSM) findings have been well described using magnetic resonance imaging (MRI), there are no large-scale published studies on the associations between dog size, age, high-field MRI and neurologic findings. Using a retrospective, observational study design, we aimed to investigate an association between neurologic and high-field MRI characteristics in OA-CSM. Records were reviewed for dogs diagnosed with OA-CSM using high-field MRI. One-hundred dogs were included: 73/100 (73%) were giant breeds, 27/100 (27%) large breeds. Mean and median ages were, respectively, 3.1 and 2 years (0.3-9.75 years), with 2.6 and 2 years for giant-breed; and 4.4 and 4 years for large-breed dogs. The majority of dogs were male (75%) with chronic presentation (89%), more than one site of spinal cord compression (78%) and foraminal stenosis (91%). Dogs with multiples sites of spinal cord compression were more likely to have severe spinal cord compression (p < 0.001), severe foraminal stenosis (p < 0.001) and ligamentum flavum/soft tissue proliferation (p = 0.03) than those with a single compressive site. There was a weak correlation between neurologic grade and severity of spinal cord compression (r = 0.27; p = 0.007), number of affected sites (r = 0.24; p = 0.0183) and spinal cord T2W hyperintensity (r = 0.24; p = 0.0152). Intervertebral disc degeneration was seen in 80% of dogs. Age did not appear to have a prominent role in the manifestation of OA-CSM. This study showed that OA-CSM affects a sizeable proportion of young large-breed, in addition to giant-breed dogs.
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Affiliation(s)
- Marília de Albuquerque Bonelli
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA
| | | | - Ronaldo Casimiro da Costa
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA
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Samer ES, Forterre F, Rathmann JMK, Stein VM, Precht CM, Guevar J. Accuracy and Safety of Image-Guided Freehand Pin Placement in Canine Cadaveric Vertebrae. Vet Comp Orthop Traumatol 2021; 34:338-345. [PMID: 34298579 DOI: 10.1055/s-0041-1731808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of this study was to validate an imaging technique for evaluation of spinal surgery accuracy and to establish accuracy and safety of freehand technique in the thoracolumbar spine of large breed dogs. STUDY DESIGN After thoracolumbar spine computed tomography (CT), 26 drilling corridors were planned then drilled to receive 3.2 mm positive profile pins using a freehand technique. After pin removal, CT was repeated. All entry points, exit points and angles of the preoperative planned trajectories were compared with postoperative ones using an image registration and fusion technique by three observers. Corridor coordinates for entry and exit points were evaluated in three dimensions and angles were measured in one plane. Intraclass correlation coefficient (ICC) was used to establish the imaging technique reliability and descriptive statistics were used to report on the freehand technique accuracy. Safety was evaluated using a vertebral cortical breach grading scheme. RESULTS Intraclass correlation coefficient for the entry points, exit points and angle were 0.79, 0.96 and 0.92 respectively. Mean deviations for the entry points, exit points and angle were 3.1 mm, 6.3 mm and 7.6 degrees respectively. Maximum deviations were 6.3 mm, 11.0 mm and 16.4 degrees. Most deviations were lateral and caudal. All corridors were judged as safe. CONCLUSION The imaging technique reliability was good to excellent to study spinal surgery accuracy. Implant deviations should be anticipated when planning stabilization surgery in large breed dogs using the freehand-guided technique.
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Affiliation(s)
- Eva S Samer
- Department of Clinical Veterinary Medicine, Division of Clinical Neurology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Franck Forterre
- Department of Clinical Veterinary Medicine, Division of Small Animal Surgery, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | | | - Veronika M Stein
- Department of Clinical Veterinary Medicine, Division of Clinical Neurology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Christina M Precht
- Department of Clinical Veterinary Medicine, Division of Clinical Radiology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Julien Guevar
- Department of Clinical Veterinary Medicine, Division of Clinical Neurology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
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11
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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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Bonelli MDA, da Costa LBDSBC, da Costa RC. Magnetic resonance imaging and neurological findings in dogs with disc-associated cervical spondylomyelopathy: a case series. BMC Vet Res 2021; 17:145. [PMID: 33827551 PMCID: PMC8025371 DOI: 10.1186/s12917-021-02846-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 03/22/2021] [Indexed: 11/10/2022] Open
Abstract
Background Canine cervical spondylomyelopathy can be separated into osseous and disc-associated (DA-CSM) forms. Our aim was to describe the magnetic resonance imaging (using a high-field scanner) and neurological findings in dogs with DA-CSM and investigate a relationship between these findings. Results Sixty-three dogs were included: 60/63 (95 %) were large breeds, with Doberman Pinschers and males over-represented (70 %). Mean and median age at the time of diagnosis was 7.25 and 7.2 years (range 0.41–12 years). Chronic signs were noted in 52/63 (83 %) dogs, with proprioceptive ataxia the most common. Main site of spinal cord compression was commonly C6-7 or C5-6. Thirty-six (57 %) dogs had various sites of spinal cord compression. Most dogs younger than 6 years of age had a single affected site. Foraminal stenosis was present in 51/63 dogs (81 %). T2-weighted hyperintensity was present in 40/63 dogs (63 %). 88 % of the articular processes showed degenerative changes, which correlated strongly with intervertebral disc degeneration. Ligamentum flavum hypertrophy was seen in 38 % of dogs. No correlation was observed between neurologic signs and number of affected sites. A moderate positive correlation was observed between severity of spinal cord compression and neurologic grade (r 0.48; p < 0.001). Conclusions DA-CSM was predominantly observed in older, male Dobermans, with lesions located in the caudal cervical vertebral region. It was also seen in dogs 3 years of age or even younger (8 %). Single compressive lesions were more common in dogs younger than 6 years of age. Many dogs had concomitant changes (e.g.: ligamentum flavum hypertrophy and foraminal stenosis). Most dogs with ligamentum flavum hypertrophy were 6 years or older. A positive correlation was observed between severity of spinal cord compression and neurologic grade, but multilevel compression was not associated with more severe neurologic signs. A very high percentage of dogs had articular process degenerative changes. Possible biomechanical or genetic relationships between degenerative changes in articular processes, ligamentum flavum, and intervertebral discs warrants further investigation.
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Affiliation(s)
- Marília de Albuquerque Bonelli
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, 601 Vernon Tharp St, OH, 43210, Columbus, USA
| | | | - Ronaldo Casimiro da Costa
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, 601 Vernon Tharp St, OH, 43210, Columbus, USA.
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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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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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Vansteenkiste DP, Fenger JM, Fadda P, Martin‐Vaquero P, da Costa RC. MicroRNA expression in the cerebrospinal fluid of dogs with and without cervical spondylomyelopathy. J Vet Intern Med 2019; 33:2685-2692. [PMID: 31639228 PMCID: PMC6872614 DOI: 10.1111/jvim.15636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 09/24/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Osseous-associated cervical spondylomyelopathy (OA-CSM) is a common condition of the cervical vertebral column that affects giant dog breeds. MicroRNAs (miRNAs) are small RNAs that regulate gene expression, and recent data suggest that circulating miRNAs present in biological fluids may serve as potential biomarkers for disease. The miRNA profiles of cerebrospinal fluid (CSF) from healthy dogs and dogs clinically affected by OA-CSM have not been described. OBJECTIVE To characterize the expression levels of miRNAs present in the CSF of normal Great Danes and identify differentially expressed miRNAs in the CSF of Great Danes clinically affected with OA-CSM. ANIMALS Client-owned dogs: 12 control, 12 OA-CSM affected. METHODS Cerebrospinal fluid samples were collected prospectively. MicroRNA expression was evaluated using the NanoString nCounter platform and quantitative real-time PCR. RESULTS We identified 8 miRNAs with significant differential expression. MiR-299-5p and miR-765 had increased expression levels in the CSF of OA-CSM-affected dogs, whereas miR-494, miR-612, miR-302-d, miR-4531, miR-4455, and miR-6721-5p had decreased expression levels in OA-CSM affected dogs compared to clinically normal dogs. Quantitative real-time PCR was performed to validate the expression levels of 2 miRNAs (miR-494 and miR-612), and we found a 1.5-fold increase in miR-494 expression and a 1.2-fold decrease in miR-612 in the CSF of the OA-CSM affected group (P = .41 and .89, respectively). CONCLUSIONS AND CLINICAL IMPORTANCE Data generated from our study represent an initial characterization of the miRNA profile of normal canine CSF and suggest that a distinct CSF miRNA expression profile is associated with OA-CSM.
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Affiliation(s)
- Daniella P. Vansteenkiste
- Department of Veterinary Clinical SciencesThe Ohio State University, College of Veterinary MedicineColumbusOhio
| | - Joelle M. Fenger
- Department of Veterinary Clinical SciencesThe Ohio State University, College of Veterinary MedicineColumbusOhio
| | - Paolo Fadda
- Comprehensive Cancer Center, Genomics Shared ResourceThe Ohio State UniversityColumbusOhio
| | | | - Ronaldo C. da Costa
- Department of Veterinary Clinical SciencesThe Ohio State University, College of Veterinary MedicineColumbusOhio
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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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Tuan J, Solano MA, Fitzpatrick N. Ventral distraction-stabilization in 5 continuous sites for the treatment of cervical spondylomyelopathy in a Great Dane. Vet Surg 2019; 48:607-614. [PMID: 30828843 DOI: 10.1111/vsu.13189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 10/01/2018] [Accepted: 02/12/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To report the combined use of novel and commercially available implants for ventral distraction-stabilization of 5 continuous compressive sites in a Great Dane with cervical spondylomyelopathy (CSM). STUDY DESIGN Case report. ANIMALS One 4-year-old male Great Dane weighing 78 kg. METHODS A tetraparetic 4-year-old Great Dane with osseous-associated CSM (OA-CSM) with 5 sites of dorsolateral compression was presented for surgical intervention. Custom designed Fitz intervertebral traction screws (FITS) and a commercially available polyaxial spinal system were used for ventral distraction-stabilization of all lesions. Multiple neurological reevaluations were performed, with the final evaluation at 27 months postoperatively. Preoperative, immediate-postoperative, and 27 month-postoperative computed tomography (CT) images were retrospectively reviewed to compare the vertebral canal dimensions at the affected sites. RESULTS Multilevel distraction-stabilization technique resulted in improvement of the dog's neurological function by 10 days postoperatively. The vertebral canal measurements were revealed to have improved in over half of the measured variables when the 27-month-postoperative images were compared with the preoperative CT images. Increased vertebral canal dimensions were observed immediately after surgery, and some of these measurements continued to improve by 27 months postoperatively. CONCLUSION Ventral distraction-stabilization technique with custom-designed FITS and a polyaxial spinal system resulted in both clinical improvement and objective improvement in spinal canal measurements in an OA-CSM-affected Great Dane. CLINICAL SIGNIFICANCE An indirect decompression technique can eliminate dynamic movements and result in regression of vertebral canal bony proliferation in dogs with OA-CSM.
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Affiliation(s)
- Jayson Tuan
- Fitzpatrick Referrals, Eashing, Godalming, Surrey, United Kingdom
| | - Miguel A Solano
- Fitzpatrick Referrals, Eashing, Godalming, Surrey, United Kingdom
| | - Noel Fitzpatrick
- Fitzpatrick Referrals, Eashing, Godalming, Surrey, United Kingdom
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Knell SC, Smolders LA, Steffen T, Pozzi A. Ex vivo computed tomography evaluation of loading position on morphometry of the caudal cervical intervertebral disk spaces of dogs. Am J Vet Res 2019; 80:235-245. [PMID: 30801208 DOI: 10.2460/ajvr.80.3.235] [Citation(s) in RCA: 3] [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 provide an objective, quantitative morphometric description of the caudal cervical intervertebral disk (IVD) spaces of dogs. SAMPLE Vertebral specimens consisting of C4 through C7 from 5 medium-sized dogs. PROCEDURES CT images were obtained with the specimens positioned in neutral, flexion, extension, and lateral bending positions. Size and shape of the cranial and caudal end plates, angle between the end plates (IVD wedge angle), and craniocaudal distance (IVD width) between end plates for the 4 loading positions were measured and compared for the 3 segments (C4-5, C5-6, and C6-7). RESULTS End plate size and shape, IVD wedge angle, and IVD width were not significantly different among the 3 segments. Caudal cervical end plates were consistently larger than cranial cervical end plates. The IVD wedge angle ranged from -4.8° to 15.2°. Flexion induced a reduction in IVD width in the ventral portion of the IVD, whereas extension induced a decrease in width in the dorsal portion of the IVD. Central IVD width remained unchanged among the loading positions. CONCLUSIONS AND CLINICAL RELEVANCE Unique morphometric and dynamic characteristics of the caudal cervical IVD space of dogs were detected. These findings may help investigators when designing IVD prostheses for dogs with cervical spondylomyelopathy.
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Fujioka T, Nakata K, Nishida H, Sugawara T, Konno N, Maeda S, Kamishina H. A novel patient‐specific drill guide template for stabilization of thoracolumbar vertebrae of dogs: cadaveric study and clinical cases. Vet Surg 2018; 48:336-342. [DOI: 10.1111/vsu.13140] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 10/16/2018] [Accepted: 11/06/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Toru Fujioka
- The United Graduate School of Veterinary Sciences, Gifu University Gifu Japan
- Ivy Animal Clinic Okayama Japan
| | - Kohei Nakata
- The United Graduate School of Veterinary Sciences, Gifu University Gifu Japan
- The Animal Medical Center of Gifu University, Gifu University Gifu Japan
| | - Hidetaka Nishida
- The United Graduate School of Veterinary Sciences, Gifu University Gifu Japan
- The Animal Medical Center of Gifu University, Gifu University Gifu Japan
| | - Taku Sugawara
- Department of Spinal SurgeryResearch Institute for Brain and Blood Vessels‐Akita Akita Japan
| | | | - Sadatoshi Maeda
- The United Graduate School of Veterinary Sciences, Gifu University Gifu Japan
- The Animal Medical Center of Gifu University, Gifu University Gifu Japan
| | - Hiroaki Kamishina
- The United Graduate School of Veterinary Sciences, Gifu University Gifu Japan
- The Animal Medical Center of Gifu University, Gifu University Gifu Japan
- Center for Highly Advanced Integration of Nano and Life SciencesGifu University Gifu Japan
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Marinho P, Macedo A, Ferrigno C, Dal-Bó I, Paes F, Bregadioli T. Placement of vertebral screws for spinal stabilization and distraction in a dog with disc-associate cervical spondylomyelopathy: case report. ARQ BRAS MED VET ZOO 2018. [DOI: 10.1590/1678-4162-9538] [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
ABSTRACT A 10-year-old male Rottweiler was evaluated for a 2-month history of recurrent forelimb weakness. Neurologic examination revealed proprioceptive ataxia, tetraparesis and moderate cervical pain. Disk-associated cervical spondylomyelopathy (CSM) with static lesion at C3-4 was diagnosed based on magnetic resonance imaging (MRI). The dog was surgically treated by a ventral slot procedure and distraction-stabilization of the vertebral bodies through insertion of vertebral screws with transverse connective bars. The patient had favorable clinical outcome. Neurologic assessment performed 120 days after surgery showed absence of neurologic defects. Radiographic assessment performed at the same time indicated adequate spinal cord decompression although vertebral fusion was not achieved. To the authors’ knowledge, this is the first case of distraction-stabilization with vertebral (pedicle) screws to treat CSM in a dog. The treatment was well tolerated with no complications and excellent outcome and can be a viable option for this condition.
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Affiliation(s)
- P.V.T. Marinho
- Instituto Federal de Educação, Ciência e Tecnologia do Sul de Minas Gerais, Brazil
| | | | | | | | - F. Paes
- Universidade de São Paulo, Brazil
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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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Teunissen M, van der Veen A, Smit T, Tryfonidou M, Meij B. Effect of a titanium cage as a stand-alone device on biomechanical stability in the lumbosacral spine of canine cadavers. Vet J 2017; 220:17-23. [DOI: 10.1016/j.tvjl.2016.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 11/21/2016] [Accepted: 12/11/2016] [Indexed: 10/20/2022]
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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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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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Tellegen AR, Willems N, Tryfonidou MA, Meij BP. Pedicle screw-rod fixation: a feasible treatment for dogs with severe degenerative lumbosacral stenosis. BMC Vet Res 2015; 11:299. [PMID: 26642756 PMCID: PMC4672470 DOI: 10.1186/s12917-015-0614-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 12/02/2015] [Indexed: 11/21/2022] Open
Abstract
Background Degenerative lumbosacral stenosis is a common problem in large breed dogs. For severe degenerative lumbosacral stenosis, conservative treatment is often not effective and surgical intervention remains as the last treatment option. The objective of this retrospective study was to assess the middle to long term outcome of treatment of severe degenerative lumbosacral stenosis with pedicle screw-rod fixation with or without evidence of radiological discospondylitis. Results Twelve client-owned dogs with severe degenerative lumbosacral stenosis underwent pedicle screw-rod fixation of the lumbosacral junction. During long term follow-up, dogs were monitored by clinical evaluation, diagnostic imaging, force plate analysis, and by using questionnaires to owners. Clinical evaluation, force plate data, and responses to questionnaires completed by the owners showed resolution (n = 8) or improvement (n = 4) of clinical signs after pedicle screw-rod fixation in 12 dogs. There were no implant failures, however, no interbody vertebral bone fusion of the lumbosacral junction was observed in the follow-up period. Four dogs developed mild recurrent low back pain that could easily be controlled by pain medication and an altered exercise regime. Conclusions Pedicle screw-rod fixation offers a surgical treatment option for large breed dogs with severe degenerative lumbosacral stenosis with or without evidence of radiological discospondylitis in which no other treatment is available. Pedicle screw-rod fixation alone does not result in interbody vertebral bone fusion between L7 and S1.
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Affiliation(s)
- Anna R Tellegen
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM, Utrecht, The Netherlands.
| | - Nicole Willems
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM, Utrecht, The Netherlands.
| | - Marianna A Tryfonidou
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM, Utrecht, The Netherlands.
| | - Björn P Meij
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM, Utrecht, The Netherlands.
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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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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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30
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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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Epstein NE. Iliac crest autograft versus alternative constructs for anterior cervical spine surgery: Pros, cons, and costs. Surg Neurol Int 2012; 3:S143-56. [PMID: 22905321 PMCID: PMC3422096 DOI: 10.4103/2152-7806.98575] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Accepted: 04/04/2012] [Indexed: 12/21/2022] Open
Abstract
Background: Grafting choices available for performing anterior cervical diskectomy/fusion (ACDF) procedures have become a major concern for spinal surgeons, and their institutions. The “gold standard”, iliac crest autograft, may still be the best and least expensive grafting option; it deserves to be reassessed along with the pros, cons, and costs for alternative grafts/spacers. Methods: Although single or multilevel ACDF have utilized iliac crest autograft for decades, the implant industry now offers multiple alternative grafting and spacer devices; (allografts, cages, polyether-etherketone (PEEK) amongst others). While most studies have focused on fusion rates and clinical outcomes following ACDF, few have analyzed the “value-added” of these various constructs (e.g. safety/efficacy, risks/complications, costs). Results: The majority of studies document 95%-100% fusion rates when iliac crest autograft is utilized to perform single level ACDF (X-ray or CT confirmed at 6-12 postoperative months). Although many allograft studies similarly quote 90%-100% fusion rates (X-ray alone confirmed at 6-12 postoperative months), a recent “post hoc analysis of data from a prospective multicenter trial” (Riew KD et. al., CSRS Abstract Dec. 2011; unpublished) revealed a much higher delayed fusion rate using allografts at one year 55.7%, 2 years 87%, and four years 92%. Conclusion: Iliac crest autograft utilized for single or multilevel ACDF is associated with the highest fusion, lowest complication rates, and significantly lower costs compared with allograft, cages, PEEK, or other grafts. As spinal surgeons and institutions become more cost conscious, we will have to account for the “value added” of these increasingly expensive graft constructs.
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Affiliation(s)
- Nancy E Epstein
- Clinical Professor of Neurosurgery, The Albert Einstein College of Medicine, Bronx, N.Y. 10451, and Chief of Neurosurgical Spine and Education, Winthrop University Hospital, Mineola, N.Y. 11501
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