Dorsal Cervical Decompression (Laminectomy/Hemilaminectomy and Laminotomy)

Fingeroth, James M.

doi:10.1002/9781118711545.ch16

Cited by 5 publications

(20 citation statements)

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“…The patient underwent surgical treatment through C4-C5 dorsal laminectomy [6]. During surgery, extradural compression could be seen on the right side from a synovial cyst (Figure 1D), which was emptied and subsequently removed.…”

Section: Casementioning

confidence: 99%

Extradural Synovial Cyst of the Cervical Spine in a Saint Bernard

Ferrarin

Neto

Schwab

et al. 2021

Acta Scientiae. Vet.

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Background: Extradural synovial cysts (ESC) originate from an extrusion of the synovium in unstable or degenerated joints. In the spine, this condition can cause neurological signs such as hyperesthesia, proprioceptive ataxia and paresis. Since extradural presentations of synovial cysts are unusual in dogs, the aim of this manuscript is to report a case of extradural synovial cyst of the cervical spine, as well as the clinical findings, diagnosis, surgical treatment and clinical evolution after therapy.Case: A 3-year-old spayed Saint Bernard weighing 60 kg was presented to a Veterinary Medical Teaching Hospital with a history of acute paraparesis that evolved to non-ambulatory tetraparesis five days after the appearance of the first clinical signs. Neurological examination revealed non-ambulatory tetraparesis, normal muscle tone and segmental spinal reflexes in the thoracic and pelvic limbs, as well as cervical pain associated with limited neck movement. According to the neurological examination, the likely lesion location was the C1-C5 spinal cord segment. The differential diagnosis list included intervertebral disc disease, caudal cervical spondylomyelopathy, neoplasm, infectious or noninfectious inflammatory disease, and cystic diseases. Complete blood (cell) count and serum biochemistry tests were within reference limits. The cerebrospinal fluid analysis revealed 35 mg/dL of protein (< 30 mg/dL) and 27 cells (up to 5 cells/mm3) with a predominance of lymphocytes. In plain radiography, bone proliferations of the C4 (caudal) C5 (cranial) articular processes were observed and, in myelography, extradural spinal cord compression was evident between C4-C5 on the right side. The animal underwent dorsal laminectomy for spinal cord decompression. An extradural synovial cyst and proliferated articular processes were removed. At 1,281 days after surgery, the dog was clinically normal and presented no neurological deficits.Discussion: The etiology of synovial cysts has not been well established. However, it is believed that osteoarthritic degeneration associated with joint mobility could cause a rupture in the articular capsule, leading to a synovial membrane protrusion, which would fill with synovial fluid and compress spinal structures. ESC in the cervical region have been reported, often associated with cervical neoplasm. The case we report had no evidence of bone or intervertebral disc compression in myelographic and radiographic exams, abnormalities that would appear in cervical neoplasm. The patient underwent dorsal laminectomy to confirm the presumptive diagnosis and decompress the spine. In the histopathological exam, the cystic material consisted of connective fibrous tissue with a synovial cell lining layer, compatible with synovial cysts. The fluid drained during surgery was also analyzed, showing similarities to synovial fluid drained from other conventional joints. Cerebrospinal fluid analysis revealed mononuclear pleocytosis, a common finding in ESC. The ESC should be included in the differential diagnosis of dogs with cervical myelopathy, especially in young animals and large breeds. A myelographic exam is an important but not definitive auxiliary tool for diagnosis and the therapeutic plan. Dorsal laminectomy is an effective technique for treating ESC.

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Section: Casementioning

confidence: 99%

Extradural Synovial Cyst of the Cervical Spine in a Saint Bernard

Ferrarin

Neto

Schwab

et al. 2021

Acta Scientiae. Vet.

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“…Após a tranquilização do paciente com midazolam [(Dormonid ® ) 4 0,3 mg/kg] e fentanil [(Fentanest ® ) 5 2 µg/kg] pela via intravenosa, a anestesia foi induzida com bôlus de propofol [(Propovan ® ) 5 4 mg/kg ] intravenoso e mantida com isoflurano [(Isoflurano ® ) 6 em oxigênio] e infusão contínua de fentanil 5 [dose de 0,4 µg/kg por h]. Cefazolina [(Kefazol ® ) 7 na dose de 30 mg/kg] foi administrada pela via intravenosa profilaticamente 30 min e reaplicada a cada 1 hora e meia durante o período transoperatório e mantida durante as primeiras 24 h do período pós-operatório, sendo administrada a cada 8 h. Foi então realizada tricotomia e antissepsia prévia com clorexidine degermante (Riohex 2%) 8 de toda a região cervical e occipital dorsal.…”

Section: Casounclassified

“…Se a massa estiver localizada no canal vertebral entre as vértebras C3-C7, a excisão cirúrgica pode ser realizada pelas técnicas de hemilaminectomia e laminectomia dorsal, entretanto, se o local da lesão for entre o atlas e áxis, o acesso cirúrgico à região dorsal da medula espinhal apresenta limitações devido à diferenças na conformação anatômica, com presença de estruturas ósseas e ligamentosas singulares à estas vértebras [6]. A hemilaminectomia permite acesso cirúrgico limitado, principalmente em animais de pequeno porte, havendo risco de hemorragia devido à localização da artéria vertebral no forame transverso.…”

Section: Introductionunclassified

“…A hemilaminectomia permite acesso cirúrgico limitado, principalmente em animais de pequeno porte, havendo risco de hemorragia devido à localização da artéria vertebral no forame transverso. Já a técnica de "slot" ou fenda ventral provê acesso limitado à face ventral da medula espinhal, impossibilitando a excisão de massas mais laterais [6]. A técnica de laminotomia do áxis permite acesso dorsal e preserva os ligamentos atlantoaxial e nucal, entretanto há poucas descrições em literatura [3,5,6].…”

Section: Introductionunclassified

“…Já a técnica de "slot" ou fenda ventral provê acesso limitado à face ventral da medula espinhal, impossibilitando a excisão de massas mais laterais [6]. A técnica de laminotomia do áxis permite acesso dorsal e preserva os ligamentos atlantoaxial e nucal, entretanto há poucas descrições em literatura [3,5,6]. Assim, o objetivo do presente relato é descrever a realização desta abordagem em um cão com meningioma em C2 e os cuidados realizados no período pós-operatório.…”

Section: Introductionunclassified

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Axis Dorsal Laminotomy for Excision of a Meningioma in a Dog

Pereira

Conceição

Arias

2020

Acta Scientiae. Vet.

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Background: Surgical access to the spinal cord at the level of C2 vertebra presents technical limitations, due to anatomical particularities in this region. The ventral slot technique does not allow space for the removal of dorsolateral masses. The axis hemilaminectomy technique provides limited access to the dorsal aspect of spinal cord and there is a risk of damaging the vertebral arteries. The axis dorsal laminotomy technique allows good access to spinal cord and preserves the atlantoaxial and nuchal ligaments, however few papers describe this technique. The objective of this paper is to report the axis dorsal laminotomy performed in a dog with a meningioma at this level.Case: An 11-year-old male, Maltese dog, was presented with a 15-day history of progressive weakness, intense cervical pain and difficulty in locomotion of the four limbs. He was being treated with painkillers without improvement. On clinical examination, the physiological parameters were normal. Neurological examination showed tetraparesis with the syndrome localized in the cranial cervical region. The main differential diagnoses were intervertebral disc disease, neoplasia, inflammatory or infectious disease. Computed tomography was performed and the evaluation of images allowed the visualization of an intradural-extramedullary neoplastic process, promoting important spinal compression, with approximate dimensions of the lesion 0.70 cm high x 0.67 cm wide x 0.78 cm long, with apparent involvement of the meninges, with a more lateralized location on the left, with meningioma being the main differential diagnosis. Thus, exploratory surgery, through the technique of dorsal laminotomy of the axis was performed. After the removal of the mass, the spinous process was repositioned in its anatomical location and fixed with 0.6 mm steel cerclage wire that was passed through the holes made in the dorsal lamina of the axis. After the surgery a neck brace was kept for 45 days. According to the histological changes observed, the neoplasm was classified as grade one meningothelial meningioma. The patient showed gradual improvement and started walking again 4 days after the surgery, staying well and without pain for 5 months, when there was a recurrence of the neoplasia.Discussion: Surgical access to the cervical region in question is limited due to the presence of complex ligamentous structures, vascular network and the anatomical features of the first and second cervical vertebrae. Thus, the dorsal axis laminotomy technique was used. The approach allowed good visualization of the spinal canal as well as the preservation of the atlantoaxial ligament, maintaining atlantoaxial stability. Through histopathological analysis, the neoplasm was classified as grade I meningothelial, which is considered a benign meningioma, but its behavior is considered malignant due to the compression of the spinal cord and the impossibility of removal with surgical margins, as recommended for oncological surgeries. The patient's survival after surgical treatment is in accordance with that described by other authors which varies from 2.2 to 47 months. Radiotherapy seems to improve the prognosis, but this therapeutic modality is not easily available in the country. There is also insufficient information on the use of chemotherapy for this type of neoplasia, or on the relationship between tumor graduation and survival. The surgery was proposed in order to confirm the suspicion, decompress the spinal cord and collect material for biopsy; the technique performed is feasible and no intraoperative complications have occurred.

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Ventral slot in the clinical recovery of dogs with lateralized compression as a result of cervical intervertebral disc disease - 20 cases (2008-2018)

et al. 2020

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The objective of this study was to verify the clinical recovery of dogs that underwent ventral slot surgical decompression with lateralized compressions of the cervical spinal cord caused by intervertebral disc disease (IVDD). Twenty patients were selected in different degrees of neurological dysfunction with definitive diagnosis of lateralized compression by cervical IVDD. Postoperative clinical recovery was assessed in patients who had undergone at least two months of the surgical procedure. There was a satisfactory recovery in 19 dogs (95%) and unsatisfactory recovery in another (5%), showing a significant clinical improvement (p<0.05) in the use of this technique in lateralized compression cases. The ventral slot promotes satisfactory clinical recovery of dogs with lateralized compression of the spinal cord caused by cervical IVDD and may be indicated as a surgical alternative.

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Dorsal Cervical Decompression (Laminectomy/Hemilaminectomy and Laminotomy)

Cited by 5 publications

References 10 publications

Extradural Synovial Cyst of the Cervical Spine in a Saint Bernard

Extradural Synovial Cyst of the Cervical Spine in a Saint Bernard

Axis Dorsal Laminotomy for Excision of a Meningioma in a Dog

Ventral slot in the clinical recovery of dogs with lateralized compression as a result of cervical intervertebral disc disease - 20 cases (2008-2018)

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