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.

Neointimal hyperplasia in low-profile Nitinol stents, Palmaz stents, and Wallstents: a comparative experimental study.

PURPOSE: To compare neointima formation following insertion of low-profile Nitinol stents, Palmaz stents, and Wallstents. METHODS: Nitinol stents, Palmaz stents, and Wallstents similar in size were transfemorally inserted into the iliac arteries of 12 sheep. Four stents per sheep were deployed; the position of the stents was varied so that each type of stent was placed in each position (right or left, proximal or distal) with equal frequency. Stent patency was followed by angiography. Six sheep were euthanized after 1 month, and the remaining six after 6 months. Iliac arteries were removed en bloc and prepared for histological examination. Neointimal and medial thickness were measured by light microscopy, and measurements were analyzed statistically. RESULTS: Mean neointimal thickness both over (NO) and between (NB) the stent struts was greater in Wallstents (NO = 0.341 mm, NB = 0.368 mm) than in the Nitinol (NO = 0.260 mm, NB = 0.220 mm) and Palmaz stents (NO = 0.199 mm, NB = 0. 204 mm), but differences were not significant (p > 0.05). Medial atrophy in the area between the stent struts was greater in Wallstents compared with Nitinol and Palmaz stents (p < 0.007 and p < 0.02, respectively); in the area under the stent struts there was a significant difference only between Palmaz stents and Wallstents (p < 0.02). CONCLUSION: Under defined experimental conditions, none of the three types of stent appears to be preferable to the others regarding neointima formation in the short- to mid-term follow-up period.

Suitability of incorporated vascular stents for surgical patch-plasty: an experimental study.

PURPOSE: Evaluate the feasibility of expanding arterial and venous stents incorporated into the vessel wall by surgical patch-plasty in an experimental study. METHODS: An 8-mm Wallstent was percutaneously implanted into the carotid artery of 11 sheep and into the ipsilateral jugular vein in three of them. Three months after implantation, a patch-plasty was performed on the incorporated stents using a 0.4-mm-thick synthetic patch made of polytetrafluoroethylene (PTFE). Stent patency was monitored by color-coded duplex ultrasound and angiography for 6 months after operation. RESULTS: No suture dehiscence or aneurysm formation were observed. Nine of 11 arterial and 2 of 3 venous stents remained fully patent during follow-up. In arteries, complications encountered were a complete stent thrombosis early after surgery, as well as a floating thrombus in the stent, found at final angiography after 6 months. In veins, one partial stent thrombosis was observed. Microradiographic and histological examinations revealed marked intimal hyperplasia in both arterial and venous stents. Intimal hyperplasia was significantly more pronounced in patched than in stented arterial segments (p < 0.005). CONCLUSION: Patch-plasty surgery of previously incorporated vascular stents is technically feasible. Mid-term patency rates were acceptable.

Experimental arterial stent placement. Comparison of a new Nitinol stent and Wallstent.

RATIONALE AND OBJECTIVES: To compare technical aspects and neointima formation of a new Nitinol stent and a Wallstent. METHODS: A Nitinol sten and a Wallstent were placed into the iliac arteries of 14 sheep (total of 28 stents) and followed angiographically. Seven sheep were killed after 1 month and 7 after 4.5 months. Examination of histologic specimen by light microscopy was performed to determine neointimal and medial thickness inside the stents. Measurements were analyzed statistically. RESULTS: Neointima was thicker in Nitinol stents (N) than in Wallstents (W) (P < 0.004), both adjacent to (W = 0.265 mm, N = 0.596 mm) and between the stent wires (W = 0.177 mm, N = 0.361 mm). Because of poor radiopacity and the Crochê releasing technique, delivery was more difficult with Nitinol stents. High-grade stenosis was found in two Nitinol stents at 1 and 4.5 months of follow-up, respectively. One Wallstent was insufficiently incorporated into the vessel wall. CONCLUSIONS: The observed difference in neointima formation that may be caused by differences in design, mechanical properties or the metal alloy of the stents probably is too insignificant to be relevant to patency of large arteries. However, it may be relevant in small vessels such as coronary arteries.