Objective The aim of this study was to describe a novel technique using a gentamicin-impregnated polymethylmethacrylate (PMMA) plug for the surgical treatment of lumbosacral discospondylitis with concomitant instability.
Clinical Report A 7-year-old male German Shepherd dog with lumbosacral (LS) discospondylitis and previously diagnosed with degenerative lumbosacral disease underwent ventral slot and distraction of the L7 to S1 intervertebral space with a gentamicin-impregnated PMMA plug. The lumbosacral joint was accessed via the abdomen. Samples were collected for bacterial culture and sensitivity, fungal culture and histopathological examination. The surgical site was omentalized. Long-term oral antimicrobials were administered.
Results Clinical improvement was seen immediately after surgery. Complete return to previous activity level was observed 12 months after surgery. Follow-up radiographs 18 months after the procedure revealed no implant migration.
Clinical Significance The gentamicin-impregnated PMMA plug in addition to the surgical debridement seemed to be an effective way for short-term distraction, potentially contributing, along with the appropriate antimicrobial therapy and analgesia, to alleviation of pain immediately after surgery and providing for a good short-term outcome, in this clinical case. The use of cement plugs as sole devices in the LS joint warrants further study.
This study defines anatomical landmarks for transoral bulla osteotomy, without a high risk of damage to neurovascular and anatomical structures within and/or surrounding the tympanic cavity. This minimally invasive approach to the tympanic bulla is performed via a natural opening, and does not require simultaneous access through the ear canal. In vivo evaluation of this technique is required to verify its safety in clinical cases prior to large scale application.
OBJECTIVE
To analyze the results of transoral ventral bulla osteotomy (TOVBO) in cats.
ANIMALS
13 client-owned cats treated by TOVBO between February 2016 and February 2019.
PROCEDURES
Medical records of cats with a diagnosis of middle ear disease (MED) that underwent TOVBO were reviewed. The procedure was similar to the one described for dogs. Short-term follow-up was obtained via clinical examination before discharge and at day 15 postoperatively. Long-term follow-up was performed via telephone interview.
RESULTS
13 cats (age range, 8 months to 12 years) underwent unilateral (n = 10) or bilateral (3) TOVBO (16) for the treatment of tympanic bulla (TB) infection (10), nasopharyngeal inflammatory polyps (5), or bullet retrieval from the TB (1). There were no intraoperative complications. One cat with a poor preoperative status died at postoperative day 3 from pneumonia. Eight cats experienced postoperative complications including head tilt (n = 2), Horner syndrome (3), loss of appetite (2), and temporary blindness (1). Collected samples confirmed the presence of nasopharyngeal inflammatory polyps (5), or otitis media (8). Six months after surgical intervention, 9 cats were free of MED signs.
CLINICAL RELEVANCE
This oral approach provided a good access to the TB in all cases. The complications observed after TOVBO were similar to those for VBO. In cats, TOVBO seems to be an acceptable and safe minimally invasive alternative to the other approaches of the TB to address MED.
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