Flegel Thomas, Münch Maria, Held Karina, Salger Florian, Ziegler Luisa, Böttcher Peter
PD Dr. Thomas Flegel, Klinik für Kleintiere der Universität Leipzig, An den Tierkliniken 23, 04103 Leipzig, E-Mail:
Tierarztl Prax Ausg K Kleintiere Heimtiere. 2016 Dec 5;44(6):397-403. doi: 10.15654/TPK-160433. Epub 2016 Oct 25.
To report feasibility and outcome of multiple thoracolumbar partial lateral corpectomies (TLPLCs) in dogs with predominantly ventral spinal cord compression caused by intervertebral disc disease (IVDD) in the light of reported decreased spinal stability following single TLPLC. Material und methods: In a retrospective study the records of dogs treated by multiple TLPLCs for ventral spinal cord compression caused by Hansen type I or type II IVDD were reviewed. Presurgical spinal cord compression and postsurgical decompression, as well as slot dimensions were determined based on computed tomography (CT)-myelography images. Neurological outcome was assessed based on repetitive examinations applying a modified Frankel Score as well as on an owner questionnaire.
Seventeen dogs with a mean body weight of 20.3 kg (range 4.0-49.0 kg) were included. Fourteen dogs had two TLPLCs, two dogs had three TLPLCs and one dog had four TLPLCs performed. The mean slot depth was 63% of entire vertebral body width, the mean slot height was 29% of the entire vertebral body height, the mean slot length was 25% of the entire vertebral body length and the mean residual vertebral interslot length between two adjacent TLPLCs was 55% of the vertebral body length. At reevaluation 4 weeks after surgery, 6/17 dogs (35.3%) had the same modified Frankel Score as before surgery, whereas 11/17 dogs (64.7%) showed a neurological improvement. According to the owners 78.5% of dogs were walking normally within 6 months after surgery. The mean survival time of 16 dogs, where follow-up was available, was 951 days.
Multiple spinal cord compressions caused by IVDD can be eliminated by multiple, even consecutive, TLPLCs without the risk of a clinically significant risk of spinal instability.
鉴于已有报道称单次胸腰椎部分侧方椎体切除术(TLPLC)后脊柱稳定性下降,报告对因椎间盘疾病(IVDD)导致主要为腹侧脊髓受压的犬进行多次胸腰椎部分侧方椎体切除术的可行性及结果。材料与方法:在一项回顾性研究中,对因I型或II型汉森氏IVDD导致腹侧脊髓受压而接受多次TLPLC治疗的犬的记录进行了回顾。根据计算机断层扫描(CT)脊髓造影图像确定术前脊髓受压情况、术后减压情况以及骨槽尺寸。基于重复检查应用改良的弗兰克尔评分以及主人问卷来评估神经学结果。
纳入了17只平均体重为20.3千克(范围4.0 - 49.0千克)的犬。14只犬接受了两次TLPLC,2只犬接受了三次TLPLC,1只犬接受了四次TLPLC。平均骨槽深度为整个椎体宽度的63%,平均骨槽高度为整个椎体高度的29%,平均骨槽长度为整个椎体长度的25%,相邻两次TLPLC之间的平均残余椎体骨槽间长度为椎体长度的55%。术后4周复查时,6/17只犬(35.3%)的改良弗兰克尔评分与术前相同,而11/17只犬(64.7%)显示神经功能改善。根据主人的反馈,78.5%的犬在术后6个月内行走正常。16只可进行随访的犬的平均生存时间为951天。
IVDD导致的多次脊髓受压可通过多次甚至连续的TLPLC消除,而无临床上显著的脊柱不稳定风险。