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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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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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Fugazzotto D, Devoti CC, Cassano IA, Teani C, Berti E, Brusati M, Zeira O. Clinical and diagnostic imaging findings in a bengal tiger ( Panthera tigris tigris) with cervical spondylomyelopathy: A case report. BRAZILIAN JOURNAL OF VETERINARY MEDICINE 2022; 44:e003921. [PMID: 35749102 PMCID: PMC9179195 DOI: 10.29374/2527-2179.bjvm003921] [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: 10/04/2021] [Accepted: 01/31/2022] [Indexed: 11/25/2022] Open
Abstract
An adult neutered male Bengal tiger (Panthera tigris tigris) presented with abnormal gait. Neurological examination showed poor left ambulatory hemiparesis, spontaneous proprioceptive deficit in the left anterior limb, and decreased flexor reflex in the forelimbs. The neurological symptoms suggested a caudal cervical spinal cord lesion. Pathological findings included increased cholinesterase and protein levels in the cerebrospinal fluid. Computed tomography examination revealed C2-C3 intervertebral disc herniation, C5-C6 intervertebral disc herniation associated with a reduction of the intervertebral space, and mild ventral dislocation of the C6 vertebra compared to C5. In addition, severe bilateral shoulder osteoarthritis and a hypoattenuating nodule in the left thyroid gland with an open etiology were observed. These findings were interpreted as indicating cervical spondylomyelopathy (CSM). Treatment included analgesic and steroidal anti-inflammatory therapy as well as movement restriction. Follow-up at 4 weeks showed modest improvement. Thus, CSM should be included in the differential diagnosis of tigers with neurological cervical signs.
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Affiliation(s)
- Domenico Fugazzotto
- Veterinarian, Ospedale Veterinario San Michele, Tavazzano con Villavesco, LO, Italy
- Correspondence Domenico Fugazzotto Ospedale Veterinario San Michele Via Primo Maggio 37 26838 Tavazzano con Villavesco, (LO), Italy E-mail:
| | - Chiara Costa Devoti
- Veterinarian, MSc, Ospedale Veterinario San Michele, Tavazzano con Villavesco, LO, Italy
| | - Ilaria Anna Cassano
- Veterinarian, Ospedale Veterinario San Michele, Tavazzano con Villavesco, LO, Italy
| | - Chiara Teani
- Veterinarian, MSc, Ospedale Veterinario San Michele, Tavazzano con Villavesco, LO, Italy
| | - Elisa Berti
- Head of Centro Tutela e Ricerca Fauna Esotica e Selvatica Sasso Marconi, (BO), Italy
| | - Marta Brusati
- Veterinarian, Ospedale Veterinario San Michele, Tavazzano con Villavesco, LO, Italy
| | - Offer Zeira
- Veterinarian, PhD, Head of Opsedale Veterinario San Michele, Tavazzano con Villavesco, (LO), Italy
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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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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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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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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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Scott H, Shihab N, Raimondi F. Canine wobbler syndrome study. Vet Rec 2013; 173:428. [PMID: 24187000 DOI: 10.1136/vr.f6532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- H Scott
- Neurology Referral Service, Southern Counties Veterinary Specialists, Unit 6, Forest Corner Farm, Hangersley, Ringwood, Hampshire BH24 3JW
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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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Myelographic diagnosis and results of surgical treatment of caudal cervical spondylomyelopathy in dogs: a retrospective study (2000–2010). ACTA VET BRNO 2013. [DOI: 10.2754/avb201281040415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The outcomes of six different surgical techniques of caudal cervical spondylomyelopathy treatment in dogs with static and dynamic spinal cord compressions were assessed. Out of 425 dogs with cervical spine diseases, caudal cervical spondylomyelopathy was diagnosed in 69 dogs. Dynamic myelographic study was performed in 48 of them as a diagnostic method necessary for choosing the appropriate technique of surgical treatment. Twenty-five out of the 48 dogs underwent surgery. The best results of the surgical treatment of static compression were achieved with a ventral slot (89% of the nine surgical interventions) with partial improvement 48 h after surgery and marked improvement 8 weeks after surgery. For dynamic compressions, vertebral traction and stabilization with intervertebral washer plus vertebral body screws and polymethylmethacrylate bridge was found to be the most successful surgical treatment with significant improvement in 62% of the thirteen surgical interventions 8 weeks after surgery. In 5 dogs (20%), two intervertebral spaces with caudal cervical spondylomyelopathy were surgically treated. Recurrence was observed in 6 dogs (24%) after the mean period of 20 months (5 to 44 months) after surgery. Direct ventral slot decompression could be recommended for clinical cases of the caudal cervical spondylomyelopathy with static compression, and intervertebral washer plus vertebral body screws and polymethylmethacrylate bridge for dogs with dynamic compression, respectively. Our findings refer to the results of surgical treatment in a relatively large number of dogs with caudal cervical spondylomyelopathy and can help surgeons to choose an effective surgical method of treatment in dogs with wobbler syndrome based on dynamic myelographic study findings.
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Abstract
Total joint replacement is now considered a routine surgical option for small animals with advanced joint disease. This review highlights the current state of the art in total hip, elbow and knee replacement in small animals, as well as the potential for application to other joints such as the intervertebral discs, hock and shoulder. Advances in cementless fixation, the use of less-invasive, bone-sparing procedures, and the development of custom implant options for revision surgery and oncologic reconstruction will be discussed. As growth in this field continues, it is important that future developments in total joint replacement are built on a foundation of detailed laboratory evaluation of new implant designs and surgical techniques, objective assessment of clinical outcomes, and a comprehensive, coordinated retrieval program that evaluates both well-functioning and failed joint replacements.
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Affiliation(s)
- M J Allen
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH 43210, USA
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