Charalambous M, Jeffery N D, Smith P M, Goncalves R, Barker A, Hayes G, Ives E, Vanhaesebrouck A E
Queen's Veterinary School Hospital, Faculty of Veterinary Medicine, University of Cambridge, Madingley Rd, Cambridge, Cambridgeshire CB 30ES, UK.
Hixson-Lied Small Animal Hospital, College of Veterinary Medicine, Iowa State University, 1600 S 16th St., Ames, IA 50011, USA.
Vet J. 2014 Nov;202(2):267-73. doi: 10.1016/j.tvjl.2014.08.011. Epub 2014 Aug 15.
This retrospective case series examined the effectiveness of spinal segmental stabilisation, with or without decompression, in nine dogs with neurological deficits associated with dorsal hemivertebrae. Data on signalment, preoperative neurological status, imaging findings, surgical techniques and outcome were evaluated. All cases occurred in young or adult, small-breed dogs with neurological signs ranging from progressive moderate pelvic limb ataxia to non-ambulatory paraparesis. Six dogs also showed urinary and faecal incontinence. In each dog, one or more dorsal thoracic hemivertebra(e) were detected by radiography and MRI. In all dogs, hemivertebra(e) were associated with kyphosis and reduced vertebral canal diameter. All dogs were surgically managed with spinal segmental stabilisation, using Steinmann pins and orthopaedic wires and/or sutures attached to the spinous processes. Three dogs also underwent additional decompressive surgery. Post-operative follow-up ranged from 1.5 to 5.5 years. Immediate or delayed post-operative complications occurred in three dogs, including implant migration or loosening. Eight dogs showed long-term gait improvement, with resolution of incontinence if previously present. At 2-6 years post-surgery, four dogs were neurologically normal, three had mild residual ataxia, one had moderate ambulatory paraparesis, and one dog relapsed 3.5 years after surgery, resulting in severe paraparesis. Spinal segmental stabilisation techniques, with or without decompression, can result in satisfactory outcomes in small dogs with hemivertebrae and mild to moderate neurological signs. Further adaptations might be required to avoid implant loosening and allow continued growth in immature dogs.
本回顾性病例系列研究了在9只患有与背侧半椎体相关神经功能缺损的犬中,进行或不进行减压的脊柱节段稳定术的有效性。评估了有关信号、术前神经状态、影像学检查结果、手术技术和预后的数据。所有病例均发生在年轻或成年的小型犬,神经症状从进行性中度盆腔肢共济失调到非行走性轻瘫不等。6只犬还表现出大小便失禁。通过X线摄影和MRI在每只犬中检测到一个或多个胸背侧半椎体。在所有犬中,半椎体与脊柱后凸和椎管直径减小有关。所有犬均接受了使用斯氏针和骨科钢丝及/或附着于棘突的缝线进行的脊柱节段稳定术。3只犬还接受了额外的减压手术。术后随访时间为1.5至5.5年。3只犬发生了即刻或延迟的术后并发症,包括植入物移位或松动。8只犬显示长期步态改善,若术前存在失禁则失禁症状消失。在术后2至6年,4只犬神经功能正常,3只犬有轻度残余共济失调,1只犬有中度行走性轻瘫,1只犬在术后3.5年复发,导致严重轻瘫。对于患有半椎体且有轻至中度神经症状的小型犬,脊柱节段稳定术技术,无论是否进行减压,均可产生满意的结果。可能需要进一步调整以避免植入物松动,并允许未成熟犬继续生长。