Randomized Controlled Trial of Durotomy as an Adjunct to Routine Decompressive Surgery for Dogs With Severe Acute Spinal Cord Injury.

Although many interventions for acute spinal cord injury (SCI) appear promising in experimental models, translation directly from experimental animals to human patients is a large step that can be problematic. Acute SCI occurs frequently in companion dogs and may provide a model to ease translation. Recently, incision of the dura has been highlighted in both research animals and human patients as a means of reducing intraspinal pressure, with a view to improving perfusion of the injured tissue and enhancing functional recovery. Observational clinical data in humans and dogs support the notion that it may also improve functional outcome. Here, we report the results of a multi-center randomized controlled trial of durotomy as an adjunct to traditional decompressive surgery for treatment of severe thoracolumbar SCI caused by acute intervertebral disc herniation in dogs. Sample-size calculation was based on the proportion of dogs recovering ambulation improving from an expected 55% in the traditional surgery group to 70% in the durotomy group. Over a 3.5-year period, we enrolled 140 dogs, of which 128 had appropriate duration of follow-up. Overall, 65 (51%) dogs recovered ambulation. Recovery in the traditional decompression group was 35 of 62 (56%) dogs, and in the durotomy group 30 of 66 (45%) dogs, associated with an odds ratio of 0.643 (95% confidence interval: 0.320-1.292) and z-score of -1.24. This z-score indicates trial futility to reach the target 15% improvement over traditional surgery, and the trial was terminated at this stage. We conclude that durotomy is ineffective in improving functional outcome for severe acute thoracolumbar SCI in dogs. In the future, these data can be compared with similar data from clinical trials on duraplasty in human patients and will aid in determining the predictive validity of the "companion dog model" of acute SCI.

Short- and long-term outcome after transcondylar screw placement to treat humeral intracondylar fissure in dogs.

OBJECTIVE: To describe the postoperative complications and long-term functional outcome after surgical management of humeral intracondylar fissure (HIF) by transcondylar screw (TCS) placement. STUDY DESIGN: Retrospective study. SAMPLE POPULATION: Nineteen dogs (26 elbows) METHODS: Medical records (2000-2009) were reviewed for dogs with a diagnosis of HIF according to results of computed tomography and treated by TCS placement at a single referral institution. Collected data included signalment, surgical technique, surgical duration, surgeon experience, use of antibiotics, and the presence and nature of any complications. Owner questionnaire, orthopedic examination, and pressure platform analysis were used to assess long-term outcome. The relationship between these variables was statistically analyzed. RESULTS: In total, 18 of 26 surgically managed elbows were diagnosed with a postoperative complication; 11 of these consisted of a surgical site infection (SSI). No risk factors for short-term complications or long-term outcome were identified. Dogs with an SSI (n = 11) were 28 times more likely to have an unsatisfactory long-term outcome than dogs without an SSI (n = 8). Symmetry indices (SI) between thoracic and pelvic limbs did not return to published normal values. There was no difference in the SI of dogs with HIF and a surgically repaired contralateral humeral condylar fracture. CONCLUSION: Placement of a TCS was commonly associated with short-term complications, affecting long-term outcome. CLINICAL SIGNIFICANCE: The high complication rate after placement of lateromedial TCS provides evidence to justify the development of alternative strategies to manage HIF.

Maxillomandibular circular external skeletal fixation for repair of bilateral fractures of the caudal aspect of the mandible in a dog.

OBJECTIVE: To describe the novel use of circular external skeletal fixation (CESF) for repair of bilateral fractures of the caudal aspect of the mandibles. STUDY DESIGN: Clinical report. ANIMALS: A 5-month-old female Newfoundland. METHODS: A 2-ring CESF was used to immobilize the mandible relative to the maxillae. RESULTS: Anatomic dental occlusion and reduction of the right hemimandible were achieved with mild malalignment of the left hemimandible. Fracture healing occurred within 20 days. Transient epistaxis and reduced temporomandibular joint range of motion occurred at the time of fixator removal but normal use of the mandible was reported 6 months postoperatively. CONCLUSIONS: CESF effectively immobilized the mandible permitting rapid fracture healing with minimal morbidity. CLINICAL RELEVANCE: Maxillomandibular CESF may represent a simple, effective option for the management of challenging fractures involving the caudal aspect of the mandible.