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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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Poleschinski JM, Eley N, Enderlein D, Kramer M, Lierz M, Fischer D. A Novel Dipotassium Hydrogen Phosphate Phantom for Calibrating Computed Tomographic Bone Density Measurements in Birds. J Avian Med Surg 2022; 36:28-38. [DOI: 10.1647/20-00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Computed Tomography Osteodensitometry for Assessment of Bone Mineral Density of the Canine Head-Preliminary Results. Animals (Basel) 2021; 11:ani11051413. [PMID: 34069215 PMCID: PMC8156747 DOI: 10.3390/ani11051413] [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: 03/22/2021] [Revised: 04/22/2021] [Accepted: 05/10/2021] [Indexed: 12/13/2022] Open
Abstract
Simple Summary Metabolic bone disease can have disastrous consequences on canine health. Unlike in human medicine where awareness of osteoporosis and bone mineral density (BMD) disorders have led to the holistic application of osteodensitometry, application of osteodensitometry in dogs is limited. We aimed to assess the utility of quantitative computed tomography (qCT) bone mineral density (BMD) measurement of the canine calvarium using semiautomated osteodensitometry software and define host factors associated with canine BMD in a skeletally healthy population. Calvarium qCT can be used to rapidly obtain BMD measurement of dogs. Canine BMD was negatively associated with weight, whereas there was no relationship between BMD and age or sex. Many chronic canine diseases can significantly affect bone health via a variety of pathophysiological mechanisms. This efficient qCT method could facilitate rapid BMD screening in dogs undergoing CT evaluation and ultimately encourage further BMD investigation. Abstract Despite bone mineral density (BMD) being regularly measured in human patients, BMD studies in clinical cohorts of dogs is lacking. In order to facilitate BMD assessment and in turn better identify dogs suffering from metabolic bone disease, rapid, easy and precise computed tomography (qCT) techniques are required. In this study we aimed to assess the utility of quantitative computed tomography (qCT) bone mineral density (BMD) measurement of the canine calvarium using a semiautomated osteodensitometry software and define host factors associated with canine bone mineral density in a skeletally healthy population. Calvarial qCT at the level of the temporomandibular joints was performed on 323 dogs using a dedicated osteodensitometry calibration phantom during a clinically indicated head computed tomography (CT). Calvarial BMD was analyzed using a dedicated semiautomatic osteodensitometry software for contouring of the calvarial lamellar bone margins and BMD calculation. The mean duration of the calvarial qCT scanning was 64.6 s, and the mean duration of BMD analysis was 34 s, with a mean of two manual adjustments required for the bone margin tracing. The median BMD of all dogs in our study was 659 mg Calcium hydroxyapatite/mL. There was a negative linear correlation between BMD and body weight, but no correlation with age, sex or neutered status. Canine BMD assessment using qCT of the calvarium is a practical and fast technique that can be added to a clinical CT examination with minimal extra time requirements. Canine BMD host-dependent factors exhibit different relationships from that of humans; however, further investigation is warranted.
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Kwon D, Kim J, Lee H, Kim B, Han H, Oh H, Kim M, Yoon H, Lee B, Eom K. Quantitative computed tomographic evaluation of bone mineral density in beagle dogs: comparison with dual-energy x-ray absorptiometry as a gold standard. J Vet Med Sci 2018; 80:620-628. [PMID: 29415919 PMCID: PMC5938190 DOI: 10.1292/jvms.17-0428] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
This study aimed to demonstrate the higher accuracy and reproducibility of quantitative computed tomography (QCT) compared with dual-energy X-ray absorptiometry (DXA) as a gold standard for measuring canine bone mineral density (BMD). Seven middle-aged beagle dogs underwent lumbar vertebral and bilateral femoral DXA and QCT scans. BMD (mg/cm2) was measured at the vertebral body from L2 to L6, femoral neck, and proximal and distal femoral diaphyses. The BMD values were measured 3 times and compared. The BMD value on QCT was higher than that on DXA for femoral BMD but not for vertebral BMD. The correlation was strong for the lumbar vertebrae (r=0.66) and was strongest for L3 (r=0.85). No correlation was found for the femoral neck (P=0.35), and only moderate correlations were found for the proximal and distal femoral diaphyses (r=0.43 and r=0.40, respectively). The limits of agreement were narrower for vertebral BMD than for femoral BMD, and L3 had the narrowest limits of agreement. The intraclass correlation (ICC) was higher for DXA than for QCT at all lumbar and femoral sites measured, but the ICC of QCT was higher than 0.7. In conclusion, L3 can be used to monitor changes in BMD, and relative values and sequential monitoring of femoral BMD can also be useful because of the high reproducibility of QCT measurements. QCT would be a useful technique for evaluation of BMD in veterinary practice.
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Affiliation(s)
- Danbee Kwon
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, 120, Neungdong-ro, Gwangjin-gu, Seoul 05029, South Korea
| | - Jaehwan Kim
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, 120, Neungdong-ro, Gwangjin-gu, Seoul 05029, South Korea
| | - Hyeeun Lee
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, 120, Neungdong-ro, Gwangjin-gu, Seoul 05029, South Korea
| | - Byeol Kim
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, 120, Neungdong-ro, Gwangjin-gu, Seoul 05029, South Korea
| | - HyunHee Han
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, 120, Neungdong-ro, Gwangjin-gu, Seoul 05029, South Korea
| | - HyunJu Oh
- Department of Theriogenology and Biotechnology, College of Veterinary Medicine, Seoul National University, Seoul 08826, South Korea
| | - MinJung Kim
- Department of Theriogenology and Biotechnology, College of Veterinary Medicine, Seoul National University, Seoul 08826, South Korea
| | - Hakyoung Yoon
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, 120, Neungdong-ro, Gwangjin-gu, Seoul 05029, South Korea
| | - ByeongChun Lee
- Department of Theriogenology and Biotechnology, College of Veterinary Medicine, Seoul National University, Seoul 08826, South Korea
| | - Kidong Eom
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, 120, Neungdong-ro, Gwangjin-gu, Seoul 05029, South Korea
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Lucas K, Behrens BA, Nolte I, Galindo-Zamora V, Betancur S, Almohallami A, Bouguecha A, Mostafa A, Lerch M, Stukenborg-Colsman C, Wefstaedt P. Comparative investigation of bone mineral density using CT and DEXA in a canine femoral model. J Orthop Res 2017; 35:2667-2672. [PMID: 28387962 DOI: 10.1002/jor.23574] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 03/28/2017] [Indexed: 02/04/2023]
Abstract
Bone density measurements using computed tomography (CT) instead of dual-energy X-ray absorptiometry (DEXA) are currently of great interest in human and veterinary medical research as it would be beneficial to use CT scans obtained for other indications also for determining bone density. For Hounsfield units (HU) measured with CT in specific regions of interests (ROIs) in one or several slice/s a correlation with bone mineral density (BMD) measured by DEXA in humans and dogs of between 0.44 and 0.77 is reported in the literature. In the present study, instead certain volumes of interest (VOIs) obtained by CT scan and the corresponding HU to the respective VOIs were compared with the bone mineral density of the corresponding areas measured by DEXA. The aim of the study was to investigate whether this procedure gives more accurate information about bone density of the bones as three-dimensional objects of the respective patient. Correlation between measured HU in the respective VOI and BMD measured with DEXA in the corresponding ROI showed a very good correlation of 0.93. Linear regression with R2 = 0.85 (p = 0.0262) was calculated. Except for VOI5, similar distribution of values and significant differences (p < 0.0001-0.0087) between ROIs/VOIs were detected. Determining HU for assessing bone mineral density in a certain volume provides more accurate results than those previously reported from two-dimensional (2D) CT measurements. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2667-2672, 2017.
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Affiliation(s)
- Karin Lucas
- Small Animal Clinic, University of Veterinary Medicine Hannover, Foundation, Bünteweg 9, Hannover, 30559, Germany
| | - Bernd-Arno Behrens
- Institute of Forming Technology and Machines, Leibniz University Hannover, Hannover, Germany
| | - Ingo Nolte
- Small Animal Clinic, University of Veterinary Medicine Hannover, Foundation, Bünteweg 9, Hannover, 30559, Germany
| | - Vladimir Galindo-Zamora
- Small Animal Clinic, Faculty of Veterinary Medicine, National University of Colombia, Bogotá, Colombia
| | - Stefanie Betancur
- Institute of Forming Technology and Machines, Leibniz University Hannover, Hannover, Germany
| | - Amer Almohallami
- Institute of Forming Technology and Machines, Leibniz University Hannover, Hannover, Germany
| | - Anas Bouguecha
- Institute of Forming Technology and Machines, Leibniz University Hannover, Hannover, Germany
| | - Ayman Mostafa
- Faculty of Veterinary Medicine, Department of Surgery, Cairo University, Giza, 12211, Egypt
| | - Matthias Lerch
- Department of Orthopaedic Surgery, Hannover Medical School, Hannover, Germany
| | | | - Patrick Wefstaedt
- Small Animal Clinic, University of Veterinary Medicine Hannover, Foundation, Bünteweg 9, Hannover, 30559, Germany
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