Spinal Surgery in the Dog

Review localization of compressive

lesions of the spinal cord.
Upper motor neuron lesions:
Paresis or paralysis
Intact = hyperreflexia
Preserved = increased muscle tone
Atrophy = from disuse
Lower motor neuron lesions:
Paresis or paralysis
Decreased = hyporeflexia
Hypotonia = decreased muscle tone
Neurogenic atrophy
 Spinal cord lesions:
 If lesion is between C1-C5=UMN lesion
 If lesion is between C6-T2=(area of innervation of
forelimbs)= LMN lesion
 If lesion is between T3-L3=UMN lesion
 If lesion is between L4-S1=(area of innervation of pelvic
limbs)=LMN lesion
 If lesion is between S2-S3=LMN to bladder and rectal
sphinters disrupted
 If lesion is between Cd1-Cd5=LMN to tail muscle are
disrupted
 What are the important components of
conservative treatment for spinal cord disease?

• Used for management of mild cases and for

postoperative management
• Conservative treatment includes:
• Absolute cage rest
• Anti-inflammatory drugs +/- muscle
relaxants
• Serial neurological examinations
 What is the most common cause of
failure?
• b/c owner does not provide accurate cage
rest
 Why is fenestration alone seldom used in
management of spinal cord disease?
• Because it does not remove the nuclear
material from the spinal canal and foramina,
only from intervertebral spaces, therefore
need another procedure for the other areas
 Why is it used in conjunction with
decompressive surgery?
• reduces risk of recurrence of disk disease
 What are the 2 decompressive approaches for
the cervical spinal cord?
• Ventral slot decompression
• Cervical dorsal laminectomy and
hemilaminectomy
 What approaches are used for the
thoracolumbar spinal cord?
• Fenestration
• Dorsal laminectomy
• hemilaminectomy
 When is a durotomy indicated?
• Used for decompression of spinal cord and
for direct examination of traumitized cord
to assess damage
Describe postoperative management of the
spinal surgery patient.
• Cage rest – water bed, air mattress
• Hydrotherapy, tail walking, passive range
of motion exercise
• Care of urinary tract:
• Empty bladder at least 3 times/day
• Culture urine, treat as needed
 In general, which neurological
functions return first?
• Normal urination = 10-21 days
• Normal pain sensation = 10-21 days
• Voluntary paddling motions= 14-35 days
• Voluntary support of weight=14-42 days
• Ambulation= 14-90 days
• Proprioception= 21-180 days
 What is the average time interval for
recovery of urinary tract function?
• 10-21 days
 of complete function?
• I am assuming this means complete fxn of
everything….
• 21-180 days = proprioception last to return
 Compare Hansen’s Type I and Hansen’s Type II Disk
Disease in terms of: etiopathogenesis, signalment,
history, neurological signs and presenting complaint,

• Hansen’s type I:
prognosis.
• Etiology:
• chondroid degeneration of disk
• Nucleus pulposis becomes granular or calcified and thus less compressible
• Annulus ruptures and nucleus is extruded into spinal canal or foramen
• Signalment:
• Chondrodystrophoid breeds = dachshund and beagle are most commonly affected
• Adult, usually middle aged
• No sex predillection
• Disk rupture may occur with normal activity
• HX:????
• Hansen’s Type II:
• Etiololgy:
• Fibrinoid metaplasia of disk – common aging change in disk
• Annulus fibrosis hypertrophies and protrudes into ventral spinal canal but does not rupture
• No extrusion of nuclear material
• Signalment:
• Non-chondrodystrophoid breeds,often large breeds
• Middle age to old dogs
• No sex predilection
 Why is the Hansen’s Type I patient with
thoracolumbar disk extrusion more likely to show
severe signs of cord compression than the patient
with cervical disk protrusion?
• because cervical herniation has the dorsal
longitudinal ligament which decreases the
cord compression
 What are the indications for
decompression in Hansen’s Type I
patients with cervical disk
extrusion?
• Neurological abnormalities, severe pain,
frequent repeated episodes of mild pain
• Rad evidence of disk material compressing the
spinal cord or nerve root
• Deterioration while undergoing conservative
treatment
What are the indications for these
patients when the disk extrusion is
in the thoracolumbar region?
• Recurrent pain +/- mild paresis
• Severe paraparesis
• Paraplegia +/- deep pain sensation
• Patient that becomes worse during conservative
tx
List 3 factors associated with poor
prognosis for these patients.
• Acute onset
• Severe neuro signs
• Duration of paraplegia >48 hours
What are the types of lesions
seen in wobbler’s syndrome?
• Type 2 disk
• Vertebral tipping
• Congenital osseous malformation
• Hourglass compression
• Ligamentum flavum/ vertebral arch
malformation
 Which 2 are most common?
• Type 2
• Vertebral tipping
 Which may be dynamic?
• Chronic degenerative disk disease
• Vertebral tipping
• Malformation of the vertebral arch w
hypertrophy of the ligamentum flavum
 In what position of the neck
are these animals worse?
• If they hold their head up (dorsal extension)
Describe medical management for
the patient with wobbler’s
syndrome. When is it indicated?
• Indicated for dogs with pain only or with mild
weakness and motor deficits
• Strict confinement for 3-4 weeks followed by
gradual return to normal activity over next 3-4
weeks
• Neck brace
• Use of harness instead of collar
• Anti-inflammatory drugs
 What are the 3 objectives of
surgical treatment?
• Relief of SC compression
• Cervical spinal stabilization
• Reversal of neuro deficits
If you were to do surgery on a dog
with a Type II disk lesion and
ventral vertebral tipping, what
approach would you choose?
• Ventral
 If this dog had a dynamic
compressive lesion, what additional
procedure (in addition to
decompression) would be required?
• Ventral stabilization-traction
 Define cauda equina
syndrome.
• Complex of neuro signs caused by compression
of the terminal nerve roots in the lumbosacral
spinal canal
What are the common history
and clinical signs?
– Chronic lameness, back pain and hind limb
weakness
– Urinary or fecal incontinence
– Abnormal tail carriage or movement
– Muscle atrophy
– Self mutilation of the tail or hind feet
What is the surgical approach
and treatment?
• Dorsal laminectomy +/- facetectomy and
removal of interarcuate ligaments
• Retract nerve roots to remove disk
• Remove fibrous tissue surrounding nerve roots
• Stabilize, if instability is diagnosed
What 1 neurological abnormality is
most often associated with a poor
prognosis?
• Chronic cases with incontinence
Define atlanto-axial instability
• An alteration of the dens or the ligaments of the
atlantoaxial articulation that causes instability,
vertebral subluxation and spinal cord or nerve
root compression
What is one very important problem
to avoid during physical
examination and radiography of
these patents’?
• Avoid flexion of the neck and avoid open mouth
views when doing rads
 Describe, in general terms, 2
surgical methods of treating this
condition.
• Ventral approach: removal of dens and
reduction of subluxation; Cross pin stabilization
• Dorsal approach: hemilaminectomy place suture
through dorsal process of axis and arch of axis
 Where are spinal fractures
most likely to occur?
• C2
• L1
• L7
 When will you treat these
fractures conservatively?
• If patient has good motor and sensory function
treat conservatively
 When is surgical treatment
required?
• If motor or sensory function is impaired
decompression and stabilization are
indicated
 Review the types of stabilization
that can be used on these fractures.
• Cervical fx
– Dorsal stabilization: wire or screw fixation of laminae or
articular facets
– Ventral stabilization: cross pins +/- bone cement, ventral
plate or interbody screw fixation
• Thoracolumbar fx
– Hemilaminectomy
– Dorsal spinous process stabilization plus body cast
– Vertebral body plates
– Dorsal cross pins and bone cement
– Combination techniques (pins and bone cement + Lubra
plate)