Ventral surgical approach to the lumbosacral joint in the dog.

OBJECTIVE: To describe a ventral surgical approach to the lumbosacral (LS) junction, access to L7 and S1, and access to the LS disc. STUDY DESIGN: Cadaveric descriptive study. ANIMALS: Canine cadavers (n = 6). METHODS: A ventral surgical approach to the LS junction was made and local anatomic structures documented. Accessible ventral L7 and S1 vertebral bodies and LS disc were marked with India ink. Total and marked surface areas were calculated. The potential for bicortical and unicortical implant placement was determined in transverse slices of L7 and S1. Exposed ventral disc annulus relative to vertebral canal diameters were measured. RESULTS: Portions of L7 and S1 were accessible in all dogs, but shape and dimensions varied. Ventral access for implant placement was available in both L7 and S1 in every dog. The median sacral artery and vein were in contact with the ventral LS disc annulus in every dog. Accessible ventral annulus were greater than vertebral canal in all dogs. CONCLUSIONS: Ventral approach to the LS junction is possible, with LS discectomy, and implant placement in L7 and S1 vertebral bodies possible from this approach. Injury to, or sacrifice of, the median sacral artery and/or vein may occur in this approach.

Treatment of incomplete ossification of the humeral condyle with autogenous bone grafting techniques.

OBJECTIVE: To report clinical experience with autogenous bone grafting, with and without metallic implants, for treatment of lameness attributed to incomplete ossification of the humeral condyle (IOHC). STUDY DESIGN: Case series. ANIMALS: Dogs (n=8; 9 elbows) with IOHC. METHODS: A transcondylar humeral bone core was removed and the resultant socket grafted using autogenous bone harvested as either free cancellous bone or a corticocancellous dowel using an osteochondral autograph transfer system. In 8 elbows, additional support for the humeral condyle was provided with metallic implants. Postoperative outcome was assessed by clinical, radiographic, computed tomographic (CT) and owner questionnaire examinations in the short and medium term. RESULTS: Eight dogs (9 elbows) were treated surgically for IOHC. Graft types were free cancellous graft (n=2) or corticocancellous dowel (7). Condylar augmentation was performed using epicondylar cross pins (1); transcondylar Acutrak (AT) screw and epicondylar cortical screw (1); and a single transcondylar AT screw (7). Lameness resolved in 1-12 weeks. Bone bridging was documented in 7 of 8 elbows assessed by CT examination. Owner questionnaires (6 dogs) assessing daily functions were available for 7 of 9 elbows (follow-up, 6-45 months). Relevant follow-up function scores were significantly improved compared with preoperative values. One dog was intermittently lame and was administered nonsteroidal antiinflammatory medication. CONCLUSION: Use of autogenous bone grafting techniques leads to resolution of lameness attributed to IOHC. Augmentation of grafts with implants like the AT screw is recommended. CLINICAL RELEVANCE: Autogenous bone grafting techniques represent a viable alternative or adjunct to existing techniques for clinical management of IOHC in the dog.

Subtotal coronoid ostectomy for treatment of medial coronoid disease in 263 dogs.

OBJECTIVE: To document clinical outcomes after subtotal coronoid ostectomy (SCO) for treatment of medial coronoid disease (MCD). STUDY DESIGN: Prospective clinical study. ANIMALS: Dogs (n=263) with MCD. METHODS: MCD was treated by a combination of SCO via mini-arthrotomy, cage confinement (6 weeks), leash restricted exercise (12 weeks) and pentosan polysulfate administration. Outcomes were assessed by clinical examination in the short-term (324 elbows), owner questionnaires (146 dogs), clinical examination (90 dogs), subjective assessment of gait (110 elbows) and radiographic examination (180 elbows), 4 months to 7 years 7 months after surgery. RESULTS: One intraoperative complication occurred (1 elbow with fissuring of the ulna) and 8.2% elbows had immediate postoperative complications, the most common being wound infection (7%). Improvement in subjective lameness assessment to a score of 0 was noted at 5 weeks in 74.4% of elbows (veterinary) and 45.6% (owner) and at 12 weeks in 71.5% (veterinary), and 91.2% (owner). Subjective assessments of outcomes in the medium-term revealed 81.9% dogs remained sound, with significantly (P<.05) improved daily function scores compared with preoperative values, 83.5% of dogs received no NSAID. Clinical examination revealed good limb function and subjective assessment showed 51% of limbs were free from lameness. Radiographic progression of osteophytosis occurred on average by one grade. CONCLUSION: Management of MCD using the described management regime, including SCO via mini-arthrotomy, deserves consideration and comparison with existing treatment methods. CLINICAL SIGNIFICANCE: Management of MCD by SCO can be considered when gross fissuring or fragmentation of the MCP is not evident. This technique does not require specialized instrumentation.