Recurrence of disk herniation following percutaneous laser disk ablation in dogs with a history of thoracolumbar intervertebral disk herniation: 303 cases (1994-2011).

OBJECTIVE To determine rate of recurrence of disk herniation in dogs that underwent percutaneous laser disk ablation (PLDA) because of a previous episode of suspected or confirmed thoracolumbar intervertebral disk herniation (IVDH). DESIGN Retrospective case series. ANIMALS 303 dogs that underwent PLDA and for which a minimum of 3 years of follow-up information was available (n = 294) or for which recurrence was documented within 3 years after the procedure (9). PROCEDURES Information on signalment, previous episodes of IVDH, specifics of the PLDA procedure, and recurrence was obtained from the medical records. Owners were contacted to complete a questionnaire regarding outcome and recurrence. RESULTS 60 of the 303 (19.8%) dogs had an episode of suspected or confirmed IVDH after undergoing PLDA, but only 11 of the 303 (3.6%) dogs had a recurrence of IVDH confirmed by means of CT or MRI and hemilaminectomy. Recurrence rate following PLDA was not significantly different between dogs that had been treated medically for previous episodes of IVDH and dogs that had been treated surgically. Overall, 270 of 286 (94.4%) owners reported that their dog was the same (109 [38.1%]) or improved (161 [56.3%]) immediately after PLDA, and 265 (92.7%) owners rated their satisfaction with the procedure as ≥ 9 on a scale from 1 (completely dissatisfied) to 10 (completely satisfied). CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that PLDA was a relatively safe, minimally invasive procedure associated with a low rate of recurrence of disk herniation when performed in dogs with a history of previous episodes of suspected or confirmed IVDH.

Endoscope-assisted thoracolumbar lateral corpectomy.

OBJECTIVE: To report an endoscope-assisted lateral approach to expose the intervertebral foramen and disk and perform lateral corpectomy of thoracolumbar disks in dogs. STUDY DESIGN: Cadaver study. ANIMALS: Fresh canine cadavers (n=6). METHODS: A thoracic (T10-T11) and a lumbar (L3-L4) lateral approach were made on 6 fresh canine mixed breed cadavers. Through a limited skin incision, musculature was dissected and retracted using a neurosurgical self-retaining retractor and lateral corpectomy performed. The approach and bone removal, both performed under endoscopic control, were assessed. RESULTS: The foramen and intervertebral disk were clearly observed in all specimens without any iatrogenic injury of the ventral and dorsal nerve branches. Access to the foramen was possible in all specimens; in the thoracic area the head of the rib was always partially excised to observe the intervertebral disk medially. Lateral corpectomy was easily performed in all cadavers and spinal cord observation was good. Extension to foraminotomy or mini hemilaminectomy could easily be performed through the same limited approach. CONCLUSION: Endoscopic exploration provided a good viewing of the intervertebral disk and/or foramen. An endoscope-assisted thoracolumbar lateral corpectomy could effectively be performed through a limited approach to the thoracolumbar disks and allowed good ventral spinal cord assessment.

Transiliac approach for exposure of lumbosacral intervertebral disk and foramen: technique description.

OBJECTIVE: To describe and evaluate a transiliac approach to the L7-S1 disk and intervertebral foramen in dogs. STUDY DESIGN: Cadaver study. ANIMALS: Fresh canine cadavers (n=10). METHODS: A craniolateral approach was made to each iliac wing of 10 fresh canine mixed breed cadavers. An 18 mm hole was drilled in a standardized position through the iliac wing. The musculature connected to the cranial aspects of the sacral wing was dissected and retracted cranially through this iliac window. Endoscopic exploration of the area was performed. RESULTS: The foramen and intervertebral disk were clearly observed in all specimens without iatrogenic injury of the L7 nerve branch. Access to the foramen was possible in 16 of 20 specimens without excision of the sacral wing; however, it was always partially excised to observe the intervertebral disk which lies more caudally and ventrally. CONCLUSION: Transiliac approach to the lumbosacral joint allows direct exposure of the intervertebral disk and foramen through an iliac window. Endoscopic exploration provided good observation of the intervertebral disk and/or foramen. CLINICAL RELEVANCE: Transiliac approach could be used for lateral corpectomy and foraminotomy in dogs with degenerative lumbosacral stenosis caused by ventral or ventrolateral disk protrusion, foramen stenosis, or OCD of the L7-S1 joint. Clinical study will be necessary to evaluate the efficacy of this approach.

Partial percutaneous discectomy for treatment of thoracolumbar disc protrusion: retrospective study of 331 dogs.

OBJECTIVES: To determine retrospectively the prognosis and outcome for dogs diagnosed with thoracolumbar intervertebral disc disease treated with partial percutaneous discectomy (PPD). METHODS: Three hundred and thirty-one dogs presenting with symptoms of thoracolumbar intervertebral disc disease from 1998 to 2003 were treated with PPD. Diagnosis and location of intervertebral disc disease was confirmed by clinical examination, radiography, myelography and magnetic resonance imaging. PPD was performed via fluoroscopy-guided removal of a 5 mm bore cylinder out of the central intervertebral space. RESULTS: Clinical success after surgery was achieved in 159 (88.8 per cent) grade II to IV patients and 58 (38.2 per cent) grade V patients. The mean (sd) time from percutaneous discectomy to first improvement was 8.3 (13.2) days. CLINICAL SIGNIFICANCE: The PPD approach to the thoracolumbar spine involves minor trauma (yielding rapid recovery) and less pain, and produces results comparable with open fenestration. Consequently, this simple minimal invasive technique can be recommended as an alternative to the technique of fenestration and can be easily performed in addition to open surgical decompression techniques or prophylactically. However, it is not a replacement for surgical treatment in dogs with thoracolumbar disc disease that require removal of disc fragments causing spinal cord or nerve root compression.

Treatment of 10 dogs with discospondylitis by fluoroscopy-guided percutaneous discectomy.

Ten dogs suffering from discospondylitis were treated by percutaneous discectomy and local and systemic antibiotic therapy. With fluoroscopic guidance, a cylinder 5 mm in diameter was removed from the centre of the intervertebral space, yielding a fenestration and decompressing the disc without producing any spinal instability. The causative bacteria were identified in nine of the 10 biopsy specimens, but in only three urine cultures and four blood cultures. In two cases, the antibiotics used initially had to be changed owing to the organisms' antibiotic resistance. The clinical signs of the dogs improved markedly after two to nine days (mean 4.2 days) and had resolved completely after five to 14 days (mean 9.1 days). In all the cases the disease could be classified histologically as either acute or chronic, and the disease was classified as chronic in one dog. No side effects were observed.

Thoracolumbar lateral corpectomy for treatment of chronic disk herniation: technique description and use in 15 dogs.

OBJECTIVE: To describe a technique for thoracolumbar lateral corpectomy and to evaluate its use for treatment of chronic thoracolumbar disk disease in dogs. STUDY DESIGN: Retrospective study. ANIMALS: Fifteen dogs with signs of chronic thoracolumbar disk herniation. METHODS: After a dorsal or lateral approach to the spine, a lateral slot was created in 2 adjacent vertebral bodies on either side of the herniated disk and extruded/protruded material was removed. Data collected included history, duration of clinical signs, presurgical assessment of neurologic status, postsurgical neurologic status, complications, and outcome. RESULTS: Ambulatory capacity was maintained or regained, and neurologic status improved by 1 grade (3 dogs), 2 grades (8), 3 grades (2), or 4 grades (2). Eleven dogs were considered free of disease. A seroma in 1 dog was the sole complication observed. CONCLUSIONS: Lateral corpectomy permits relatively easy removal of protruded-extruded disk material from within the vertebral canal in chronic disk disease without further iatrogenic injury to the spinal cord. CLINICAL RELEVANCE: Lateral corpectomy is an alternative to dorsal decompression for treatment of ventral and lateroventral thoracolumbar chronic disk disease in dogs.

Outcome of and complications associated with prophylactic percutaneous laser disk ablation in dogs with thoracolumbar disk disease: 277 cases (1992-2001).

OBJECTIVE: To determine outcome of and complications associated with prophylactic percutaneous laser disk ablation in dogs with thoracolumbar disk disease. DESIGN: Retrospective study. ANIMALS: 277 dogs. PROCEDURE: Medical records of dogs with a history of thoracolumbar disk disease in which the 7 intervertebral disks from T10-11 through L3-4 were ablated with a holmium-yttrium-aluminum-garnet laser inserted through percutaneously placed needles were reviewed. Complications and episodes of a recurrence of neurologic signs (eg, paresis or paralysis) were recorded. Owners were contacted by telephone for follow-up information. RESULTS: Nine of 262 (3.4%) dogs for which follow-up information was available had a recurrence of paresis or paralysis. Follow-up time ranged from 1 to 85 months (mean, 15 months); signs recurred between 3 and 52 months (mean, 15.1 months) after laser disk ablation. Acute complications occurred in 5 dogs and included mild pneumothorax in 1 dog, an abscess at a needle insertion site in 1 dog, and proprioceptive deficits in 3 dogs, 1 of which required hemilaminectomy within 1 week because of progression and severity of neurologic signs. One dog developed diskospondylitis. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that prophylactic percutaneous laser disk ablation is associated with few complications and may reduce the risk of recurrence of signs of intervertebral disk disease in dogs.

Fluoroscopically guided percutaneous disk aspiration in 10 dogs with diskospondylitis.

Fluoroscopically guided percutaneous fine-needle aspiration of the intervertebral disk space was performed in 10 dogs with diskospondylitis. Positive bacterial cultures were obtained from 9 of 12 aspirated disk spaces, 1 of 6 blood cultures, and 6 of 10 urine cultures. Positive disk cultures were obtained from 2 dogs with negative blood and urine cultures and from 2 additional dogs with low numbers of Staphylococcus in urine cultures. Adverse clinical sequelae of the procedure were not noted. Percutaneous fine-needle aspiration of the intervertebral disk space is an alternative technique to surgical biopsy to obtain positive bacterial cultures from dogs with diskospondylitis.

Use of the holmium yttrium aluminum garnet laser for percutaneous thoracolumbar intervertebral disk ablation in dogs.

OBJECTIVE-To evaluate a laser ablation-technique for treatment of thoracolumbar intervertebral disk disease in dogs. DESIGN-Prospective case series. ANIMALS-33 dogs with signs of recurrent back pain associated with intervertebral disk disease after the initial episode had been managed conservatively for a minimum of 2 weeks. PROCEDURE-Spinal needles were placed percutaneously through the annulus fibroses to permit delivery of an optical fiber into the nucleus pulposes of thoracolumbar intervertebral disks T10-11 through L3-4. Fluoroscopy was used to guide needle placement. Holmium yttrium aluminum garnet laser energy then was used to ablate the contents of each selected intervertebral disk. Intervals from time of treatment to time of assessment ranged from 3 to 114 weeks. RESULTS-All dogs recovered without complication. Results of follow-up radiography and histologic evaluation indicated that percutaneous holmium yttrium aluminum garnet laser ablation reduces the volume of nucleus pulposus in treated disks. CLINICAL IMPLICATIONS-Used as a clinical treatment and prophylactically, this minimally invasive procedure should prevent further extrusion of partially herniated disks and should reduce the chances of subsequent herniation of disks at other treatment sites.