Driver Colin J, Lopez Victor, Walton Ben, Jones Dan, Fentem Rory, Tomlinson Andrew, Rose Jeremy
Lumbry Park Veterinary Specialists, CVS Referrals, Alton, United Kingdom.
School of Engineering, University of Liverpool, Liverpool, United Kingdom.
Front Vet Sci. 2023 Jun 26;10:1208593. doi: 10.3389/fvets.2023.1208593. eCollection 2023.
To report the medium and long-term outcome of nine dogs with disk-associated cervical spondylomyelopathy (DA-CSM), treated by instrumented interbody fusion using patient specific end-plate conforming device that features a micro-porous structure to facilitate bone in-growth.
A retrospective clinical study.
Nine medium and large breed dogs.
Medical records at two institutions were reviewed between January 2020 and 2023. Following magnetic resonance imaging (MRI) diagnosis of DA-CSM, pre-operative computed tomography (CT) scans were exported to computer software for surgical planning. Interbody devices were 3D-manufactured by selecting laser melting in titanium alloy. These were surgically implanted at 13 segments alongside mono-or bi-cortical vertebral stabilization systems. Follow-up included neurologic scoring and CT scans post-operative, at medium-term follow up and at long-term follow-up where possible. Interbody fusion and implant subsidence were evaluated from follow-up CT scans.
Nine dogs were diagnosed with DA-CSM between C5-C7 at a total of 13 operated segments. Medium-term follow up was obtained between 2 and 8 months post-operative (3.00 ± 1.82 months). Neurologic scoring improved ( = 0.009) in eight of nine dogs. Distraction was significant ( < 0.001) at all segments. Fusion was evident at 12/13 segments. Subsidence was evident at 3/13 operated segments but was only considered clinically relevant in one dog that did not improve; as clinical signs were mild, revision surgery was not recommended. Long-term follow up was obtained between 9 and 33 months (14.23 ± 8.24 months); improvement was sustained in 8 dogs. The dog that suffered worsened thoracic limb paresis at medium-term follow up was also diagnosed with immune-mediated polyarthropathy (IMPA) and was euthanased 9 months post-operative due to unacceptable side-effects of corticosteroid therapy.
End-plate conforming interbody devices with a micro-porous structure were designed, manufactured, and successfully implanted in dog with DA-CSM. This resulted in CT-determined fusion with minimal subsidence in the majority of operated segments.
The technique described can be used to distract and fuse cervical vertebrae in dogs with DA-CSM, with favorable medium-and long-term outcomes.
报告9只患有椎间盘相关型颈椎病（DA-CSM）的犬，采用定制的终板贴合装置进行器械辅助椎间融合术的中长期结果，该装置具有微孔结构以促进骨长入。
一项回顾性临床研究。
9只中大型犬。
回顾了2020年1月至2023年期间两家机构的病历。在通过磁共振成像（MRI）诊断为DA-CSM后，将术前计算机断层扫描（CT）图像导出至计算机软件进行手术规划。椎间融合器采用激光熔融钛合金3D制造。这些融合器与单皮质或双皮质椎体稳定系统一起在13个节段进行手术植入。随访包括术后、中期随访和尽可能进行的长期随访时的神经功能评分及CT扫描。通过随访CT扫描评估椎间融合和植入物下沉情况。
9只犬在C5-C7节段被诊断为DA-CSM，共13个手术节段。术后2至8个月（3.00±1.82个月）进行了中期随访。9只犬中有8只神经功能评分有所改善（P=0.009）。所有节段均有明显的撑开（P<0.001）。13个节段中有12个节段融合明显。13个手术节段中有3个节段出现下沉，但仅1只犬的下沉被认为具有临床相关性且该犬病情未改善；由于临床症状较轻，不建议进行翻修手术。术后9至33个月（14.23±8.24个月）进行了长期随访；8只犬病情持续改善。在中期随访时出现胸肢麻痹加重的犬还被诊断为免疫介导性多关节炎（IMPA），并因皮质类固醇治疗出现不可接受的副作用，于术后9个月实施安乐死。
设计、制造了具有微孔结构的终板贴合椎间融合器，并成功植入患有DA-CSM的犬体内。这导致大多数手术节段在CT检查下实现融合且下沉最小。
所描述的技术可用于撑开和融合患有DA-CSM的犬的颈椎，中长期效果良好。
