Minimally invasive video-assisted cervical ventral slot in dogs. A cadaveric study and report of 10 clinical cases.

OBJECTIVES: To investigate the feasibility of a minimally invasive video-assisted (MIVA) cervical ventral slot (VS) in dogs without the use of fluoroscopy, and to report our initial clinical experiences in dogs. METHODS: Two surgical approaches to an intervertebral disk space (IVDS) were performed in eight intact canine cadavers to determine the feasibility of MIVA-VS using the Destandau Endospine™ Devicea (DED) without fluoroscopic guidance. In a subsequent clinical study, 10 client-owned dogs admitted for a Hansen type 1 disk extrusion underwent a MIVA-VS. Recorded data in both studies included: incision lengths, correct targeting of the IVDS, technical problems encountered during the procedure, and potential damage to major anatomical structures. In the 10 clinical cases, duration of the procedure and clinical outcome at five and 12 days, and after a minimum of three months were also recorded. RESULTS: Correct exposure of the targeted IVDS was achieved in all cases. There was no major iatrogenic damage. Mean skin incision length was 39 mm and mean surgery time was 52 minutes. The technique provided increased illumination and magnification of the surgical field. Recovery was uneventful in all cases. CLINICAL RELEVANCE: The present study provided evidence that MIVA-VS using the DED was feasible and a relatively fast and safe procedure for the treatment of cervical disk herniation. Advantages of the technique seemed to include shorter incisions, less dissection and improved visibility.

Leprotic cervical spondylodiscitis.

Leprosy is a chronic infectious disease caused by the Mycobacterium leprae that leads to leprotic neuropathy involving the peripheral nerve and several characteristic skin lesions. Skeletal involvement can occur in peripheral joints, such as the wrist and the ankle. However, there is no report of an axial leprotic lesion involving the spine or paraspinal soft tissue. The authors report the first case of a leprotic cervical lesion involving the axial skeletal system. A 48-year-old male presented with neck pain and severe pain in the right suprascapular area and left arm. Preoperative MRI of the cervical spine revealed signal changes in the prevertebral soft tissue at the level of the C3, 4, 5 vertebral bodies. There were a lower signal intensity on T1-weighted image and high signal intensity on T2WI of the bone marrow at the level of the C5 and C6 vertebral bodies, and a C5/6 segmental ossification of the posterior longitudinal ligament. There were herniated cervical disc on the left C5/6 with C6 root and the right side of C6/7 with a C7 root compression. He was previously diagnosed with leprosy when he was 14 years old and received treatment intermittently over the course of 7 years. But patient did not disclose his past history. Surgical intervention was conducted using an anterior cervical approach. An incision was made in the anterior longitudinal ligament at C5/6, and a pinkish gray friable gelatinous material was observed on the C5/6 disc and on the anterior lower one-third surface of the C5 vertebral body. Specimens were obtained and subjected to pathological evaluation and microbiological culture. After C5/6 and C6/7 discectomies, nerve root decompression and autologous iliac bone grafting were performed at the C5/6 and C6/7 levels. The C5-6-7 vertebrae were fixed with an Atlantis cervical locking plate and a screw system. The pathological report indicated chronic inflammation with heavy plasma cell infiltration on the specimen. We sent the specimens to the Institute of Hansen's Disease, and polymerase chain reaction for leprosy tested positive. After surgery, his pain disappeared and he was given a prescription for antileprotic drugs. The authors describe the first case of leprotic cervical spondylodiscitis that was operatively treated in a 48-year-old patient with known leprosy history since his 14 years old.

Detection of spinal cord compression in dogs with cervical intervertebral disc disease by magnetic resonance imaging.

The medical records and magnetic resonance images of 33 dogs with surgically confirmed Hansen type I cervical intervertebral disc disease were reviewed. Fourteen of the dogs were chondrodystrophic and 19 were not chondrodystrophic. The most common clinical sign was neck pain, which affected 28 of the dogs, and 23 of the dogs were able to walk. Fifteen of the dogs had developed clinical signs acutely, within the previous 24 hours. On cross-sectional images the median area of spinal cord compression was 26 per cent (range 11 to 71 per cent) of the normal spinal cord area. The degree of spinal cord compression was significantly associated with the dogs' presurgical neurological status but not with their postsurgical neurological status. The dogs with an acute onset of clinical signs had more severe neurological dysfunction before surgery, but their condition improved more as a result of surgery.

Assessment of the usefulness of the fenestration method in cases of disc extrusion in the cervical and thoraco-lumbar spine in chondrodystrophic dogs.

The aim of this paper was to assess the effectiveness of treatment of Type I (according to Hansen) intervertebral disc extrusion using the fenestration method. The evaluated clinical material included 37 chondrodystrophic dogs in which multiple fenestration (from 2 to 6 intervertebral spaces) was performed. Dachshunds comprised 86.5% of patients. All dogs were administered corticosteroids during the operation. A mass similar to a slightly jelly-like yogurt, cottage cheese or plaster-like consistency was extracted. In one case a post-surgical pyogenic infection of the wound occured. In two cases, a deterioration in the neurological state followed the fenestration procedure of the cervical spine. In one case of thoraco-lumbar spine fenestration, a deterioration of clinical state was found. Recovery was observed after disc extrusion from the cervical spine in 8 out of 11 dogs, from the thoraco-lumbar spine in 12 out of 14 dogs with the 2nd grade clinical signs and in 11 out of 12 dogs with the 3rd grade clinical sings. In 6 dogs, recurrence of first or second grade clinical signs occurred, but only half of them had to undergo treatment. The probability of dog recovery did not depend on the degree of symptom intensity in a statistically significant way (p=0.11) or on the duration of the disease before the surgical treatment (p=0.87).