Intervertebral disc disease in the dog 2. Management options

Abstract

THE first part of this two-part article on degenerative disc disease in the dog covered intervertebral disc and spinal cord pathophysiology, historical and clinical features, differential diagnosis and diagnostic aids (In Practice, July/August 2000, pp 355-369). This article discusses the management options, both non-surgical and surgical, for cervical, thoracolumbar and lumbosacral disc disease.

Thoracolumbar disc disease

“…An alternative is for some form of stabilization to be applied following a standard hemilaminectomy. In addition, fenestration should probably not be performed at the affected site as it can compromise stability (Shires et al, 1991;McKee, 2000).…”

“…These various factors may be even more important in large-breed dogs, and may help to explain their apparent lower recovery rates, more frequent residual deficits and longer recovery times following grade 5 lesions compared to smaller dogs (Cudia and Duval, 1997;Olby et al, 2003 (Eule et al, 1999;Papagelopoulos et al, 1997); therefore surgeries that preserve the facet joints are a logical development for dogs and are in keeping with the trend towards microdiscectomy in humans (Hermantin et al, 1999) • Fenestration can decrease stability, which may be of clinical relevance in large-breed dogs or at sites of chronic compression (Shires et al, 1991). It could also cause collapse of an interspace thereby increasing compression (McKee, 2000).…”

Vertebral stabilisation and selective decompression for the management of triple thoracolumbar disc protrusions

“…The internal vertebral venous plexus was identified and a #11 scalpel blade carefully positioned between this and the dura mater to excise the protruded annulus fibrosus. Cuts were made in cranioventral and caudoventral directions to free segments of disc material that were retrieved with a dental tartar scraper or small rongeurs (McKee 2000b).…”

“…Decompression of the spinal cord is technically difficult with thoracolumbar annular protrusions because, in contrast to nuclear extrusions, the compressive disc material in the vertebral canal remains an integral part of the disc. Annulectomy involves risk of iatrogenic spinal cord injury and haemorrhage from the internal vertebral venous plexus (McKee 2000b, Moissonnier and others 2004). Vertebral stabilisation in conjunction with spinal cord decompression has been described (McKee 2000b, Macias and others 2002).…”

“…Annulectomy involves risk of iatrogenic spinal cord injury and haemorrhage from the internal vertebral venous plexus (McKee 2000b, Moissonnier and others 2004). Vertebral stabilisation in conjunction with spinal cord decompression has been described (McKee 2000b, Macias and others 2002). Because of the natural kyphosis of the thoracolumbar region of the canine spine, stabilising greater than three vertebrae with conventional bone plates is not possible because these plates can only be contoured with four degrees of freedom.…”