Effect of durotomy in dogs with thoracolumbar disc herniation and without deep pain perception in the hind limbs

Abstract

ObjectiveTo determine the effectiveness of durotomy as an adjunct to surgical decompression in dogs with thoracolumbar intervertebral disc herniation (TL‐IVDH) and loss of deep pain perception (DPP) in the hind limbs.Study designRetrospective study.AnimalsDogs (n = 116) with TL‐IVDH and loss of DPP treated with hemilaminectomy.MethodsSignalment, surgical site, recovery rate, incidence of progressive myelomalacia (PMM), time elapsed from onset of paraplegia of the hind limbs to surgery (TPS), and the length of area of hyperintensity of the spinal cord on magnetic resonance T2‐weighted images compared with L2 vertebral body length (LHT2) were compared between dogs treated with hemilaminectomy alone and those treated with adjunct durotomy. Multivariate logistic regression analyses were used to test the association between outcomes and the external view of the spinal cord parenchyma after durotomy.ResultsThe percentage of dogs regaining ambulation was greater when durotomy was performed (56.9%) than when dogs were treated with hemilaminectomy alone (38.5%; P = .04). In the hemilaminectomy group, 14 dogs died of suspected PMM, while no PMM was detected in the durotomy group. Durotomy, breed, surgical site, and LHT2 influenced recovery. No association was detected between age, sex, body weight, and TPS and recovery.ConclusionPerforming a durotomy in combination with decompression improved the return to function and prevented PMM in our clinical setting.Clinical significanceSurgeons should consider durotomy in dogs with TL‐IVDH and loss of DPP in hind limbs to improve surgical outcome.

Outcomes of extensive hemilaminectomy with durotomy on dogs with presumptive progressive myelomalacia: a retrospective study on 34 cases

“…Therefore, we hypothesized that extensive incision of the dura mater and hemilaminectomy in dogs with PMM could reduce intramedullary pressure. It was already observed that decompression with durotomy is possibly an effective treatment for recovering ambulation in severe acute IVDH [18,19]. These studies showed that durotomy in combination with decompression could potentially prevent the development of PMM in dogs with IVHD with NDPP of the pelvic limbs [18,19].…”

“…The improved outcome after durotomy or extensive durotomy seemed to result from physical decompression of the spinal cord [18,19]. Additionally, performing durotomy seemed to prevent the development of PMM in dogs with IVDH and NDPP in the pelvic limbs [19]. Another retrospective study also reported that prompt surgical decompression and treatment with corticosteroids were associated with lower odds of developing PMM in dogs with IVDH and NDPP [20].…”

“…Both durotomy and extended thoracolumbar durotomy were previously shown to improve the rate of regaining ambulation in dogs with IVDH and NDPP in the pelvic limbs [18,19]. The improved outcome after durotomy or extensive durotomy seemed to result from physical decompression of the spinal cord [18,19]. Additionally, performing durotomy seemed to prevent the development of PMM in dogs with IVDH and NDPP in the pelvic limbs [19].…”

Clinical Trial Design—A Review—With Emphasis on Acute Intervertebral Disc Herniation

“…In terms of surgical interventions, there is accumulating evidence that durotomy/duroplasty may be of value in reducing the intraparenchymal spinal cord pressure (thereby improving blood flow) in humans ( 23 ), experimental animals ( 24 ) and, recently, clinical canine patients ( 25 , 26 ). This intervention has the benefit of being applicable for many hours, or even days, following an acute spinal cord injury and so could readily be translated into clinical veterinary practice.…”

“…Although there has been debate over the value of durotomy as an additional decompressive technique that might aid in restoring blood supply (and therefore retaining tissue integrity) after spinal cord injury, there are now data supporting its efficacy in clinically paralyzed dogs ( 25 , 26 ).…”