Triple Pelvic Osteotomy Fixed with Lag Screw for the Treatment of Pelvic Canal Stenosis in Five Cats

Abstract

Objective The aim of this study was to describe the technique and the clinical outcome of cats with obstipation as a result of pelvic canal narrowing, treated using an alternative triple pelvic osteotomy technique. Methods Five cats with obstipation as a result of pelvic canal narrowing due to pelvic fracture malunion or secondary hyperparathyroidism were treated by triple pelvic osteotomy. After performing the iliac osteotomy and medial partial cortical debridement (4/5 cases), the pelvic canal was widened by moving the caudal fragment of the ilium to the lateral aspect of the cranial fragment. The iliac fragments were fixed by a 2.7-mm lag screw (5/5 cases) and an additional 2 Kirschner wires 0.8 mm (1/5 cases). Results The radiographic examination immediately postoperatively and 8 weeks postoperatively showed a mean pelvic canal enlargement of 20% (range 7–38%). Minor complication occurred in one case; this resolved 15 days postoperatively without any treatment. Complications and recurrence of obstipation did not occur during the final follow-up, ranging between 5 months and 1 year in any of these cases. Clinical Significance The use of lag screw fixed triple pelvic osteotomy resulted in widening of the pelvic canal and led to a satisfactory outcome with no major complications. This technique is fast, requires no expensive implants and it is relatively straightforward. Further cases are required to determine the success and complication risk of the procedure.

Ischiocavernosus Muscle Release for Urethral Obstruction Treatment after Pelvic Symphyseal Distraction Osteotomy in a Cat with Pelvic Stenosis

“…The ratio of the maximal diameter of the colon was 1.6 times the length of the L5 [12]. These findings were suggestive of pelvic narrowing, as the pelvic canal diameter ratio was 0.45 [8,13]. Preanesthetic laboratory investigations comprising a complete blood cell count, serum biochemistry profile, and electrolytes were unremarkable, except for increased albumin (4.5 g/dL) (reverence interval (RI): 1.9-3.9) and amylase (1906 U/L) (RI: 550-1800) levels.…”

“…The confirmation of urine flow on a retrograde urethrogram under the guidance of fluoroscopy after immediate muscle release could be supportive of the abovementioned clinical suspicion. However, there have been no reports of similar complication signs, although previous reports have described the use of pelvic symphyseal distraction for pelvic stenosis [1,3,5,8,19]. Therefore, it could be hypothesized that the distracted distance of the pelvic bone is important to determine whether compression of the urethra occurs postoperatively.…”

“…Surgical treatment of the pelvis in cats is challenging, although satisfactory outcomes have been reported with no major complications in pelvic canal stenosis [3,4]. The indications for surgery for pelvic canal stenosis have been previously described, but there is a lack of standards regarding clinical signs and the extent of distraction in patients with pelvic canal stenosis [3,8]. In general, the distraction distance can be determined preoperatively on CT and X-ray images [9].…”

“…Various types of spacers, including metal spacers, bone spacers, and polymethyl methacrylate (PMMA), can be used for the stable configuration of the hemipelvis after symphyseal osteotomy [4]. However, this technique could lead to several postoperative complications, such as worsening constipation due to unfavorable distraction, dislodgement of the spacer, and additional pelvic bone fractures due to postoperative increased tension and inflammation following implantation [2][3][4]8,10]. Although a few postoperative complications after SDO with spacers in cats with pelvic stenosis have been reported, there are no reports regarding secondary urethral obstruction due to IM tension after SDO with a PMMA spacer [3,4,11].…”

“…There are several reports of surgical treatment involving pelvic widening techniques, including triple pelvic osteotomy, partial pelvectomy, redirecting the ilium, and symphyseal distraction osteotomy (SDO) with or without subtotal colectomy to reduce clinical signs [2,4,[7][8][9]. All treatments resulted in favorable outcomes [2,10].…”