Ventral distraction‐stabilization in 5 continuous sites for the treatment of cervical spondylomyelopathy in a Great Dane

Abstract

Objective: To report the combined use of novel and commercially available implants for ventral distraction-stabilization of 5 continuous compressive sites in a Great Dane with cervical spondylomyelopathy (CSM). Study design: Case report. Animals: One 4-year-old male Great Dane weighing 78 kg. Methods: A tetraparetic 4-year-old Great Dane with osseous-associated CSM (OA-CSM) with 5 sites of dorsolateral compression was presented for surgical intervention. Custom designed Fitz intervertebral traction screws (FITS) and a commercially available polyaxial spinal system were used for ventral distraction-stabilization of all lesions. Multiple neurological reevaluations were performed, with the final evaluation at 27 months postoperatively. Preoperative, immediate-postoperative, and 27 month-postoperative computed tomography (CT) images were retrospectively reviewed to compare the vertebral canal dimensions at the affected sites. Results: Multilevel distraction-stabilization technique resulted in improvement of the dog's neurological function by 10 days postoperatively. The vertebral canal measurements were revealed to have improved in over half of the measured variables when the 27-month-postoperative images were compared with the preoperative CT images. Increased vertebral canal dimensions were observed immediately after surgery, and some of these measurements continued to improve by 27 months postoperatively. Conclusion: Ventral distraction-stabilization technique with custom-designed FITS and a polyaxial spinal system resulted in both clinical improvement and objective improvement in spinal canal measurements in an OA-CSM-affected Great Dane. Clinical significance: An indirect decompression technique can eliminate dynamic movements and result in regression of vertebral canal bony proliferation in dogs with OA-CSM.

Surgical management and long‐term outcome of dogs with cervical spondylomyelopathy with an anchored intervertebral titanium device

“…This is the first report of the C‐LOX implant used to indirectly decompress and stabilise a patient with dorsolateral spinal cord compression. Direct decompressive procedures such as a dorsal laminectomy are associated with a high morbidity . There have been recent investigations into treating OACSM with indirect decompressive techniques.…”

“…There have been recent investigations into treating OACSM with indirect decompressive techniques. This is aimed at reducing ongoing concussive injury and potentially allowing regression of the soft tissue proliferation once the vertebral segment is stabilised . The patient diagnosed with OACSM was minimally responsive to medical management prior to surgery.…”

“…Osseous vertebral malformations and osteoarthritis of the articular facets result in vertebral canal stenosis and dorsal, dorsolateral and lateral spinal cord compression . Concurrent intervertebral disc protrusion and cervical spine motion can lead to repeated concussive injury to the spinal cord, continued proliferation of soft tissues and progressive clinical signs …”

“…Vertebral distraction and stabilisation techniques have reported successful outcomes in 70%–90% of cases with DACSM . Successful outcomes have also been reported in a small number of cases with OACSM . Surgical complication rates remain high.…”

Biomechanical effects of a titanium intervertebral cage as a stand‐alone device, and in combination with locking plates in the canine caudal cervical spine

“…In comparison, numerous surgical techniques addressing CCSM result in 70%–90% improvement 12,14 . Surgery comprises a direct decompressive technique, for example, dorsal laminectomy or ventral slot, 14‐16 or distraction‐stabilization techniques, addressing the dynamic component of CCSM 2,4,17‐33 …”