Minimally invasive approach to lumbosacral decompression in a cadaveric canine model

Abstract

AIMS: To determine efficacy of a minimally invasive (MI) surgical approach using a human MI lumbar retractor for canine lumbosacral dorsal laminectomy and partial discectomy and to compare this technique to the standard open surgical (OS) approach.METHODS: Lumbosacral dorsal laminectomy and partial discectomy was performed on 16 largebreed canine cadavers using either a standard OS (n=8) or MI (n=8) approach. Skin and fascial incision length, procedure time, and intraoperative complications were recorded. Postoperatively specimens were evaluated for laminectomy and discectomy dimensions, and visible damage to the cauda equina and exiting nerve roots.RESULTS: Median length of skin and fascial incisions in the OS group were longer than in the MI group (p<0.001). Median laminectomy length was similar between both approaches (p=0.234) but width was greater for the MI than OS approach (p=0.002). Both approaches achieved similar partial discectomy width (p=0.279). Overall surgical time was longer for MI approaches compared to OS, with a median of 18.5 (min 15.5, max 21.8) minutes for MI compared to 14.6 (min 13.1, max 16.9) minutes for OS (p=0.001).CONCLUSIONS: The MI approach reduced incision lengths while retaining comparable laminectomy and discectomy dimensions. For this in vitro model the MI approach required more time to complete, but this difference may not be relevant in clinical cases.

Determination of surgical exposure obtained with integrated endoscopic thoracolumbar hemilaminectomy in large‐breed cadaveric dogs

“…A minimally invasive approach to the spinal canal has been reported in canine cadavers . In one study, a minimally invasive approach for a foraminotomy was evaluated, and in another study a minimally invasive approach for a corpectomy in the thoracolumbar spine was evaluated; both were endoscopically assisted .…”

“…Leperlier et al reported the use of a minimally invasive device with video assistance to perform ventral slot decompression in canine cadavers and in 10 clinical cases. A dorsal approach to access the lumbosacral space by using a minimally invasive retractor was described by Dent et al, showing equal access and decreased soft tissue disruption compared with a standard approach. Dent et al did not use an endoscope to improve visualization.…”

“…A dorsal approach to access the lumbosacral space by using a minimally invasive retractor was described by Dent et al, showing equal access and decreased soft tissue disruption compared with a standard approach. Dent et al did not use an endoscope to improve visualization. None of the minimally invasive approach studies performed in the thoracolumbar spine of dogs reported information on the size and location of a hemilaminectomy.…”

Minimally invasive spine surgery in dogs: Evaluation of the safety and feasibility of a thoracolumbar approach to the spinal cord

“…Standard approaches to the spine, so called open techniques , involve muscle dissection from the bony elements with removal of ligaments, tendons, and bony structures, which are all important parts of the dorsal stabilizing element of the spine . Because of the frequency of spinal surgery in dogs, interest in MISS has been growing . However, most studies are limited to dog cadavers; only two reports have described MISS thoracolumbar technique in live dogs .…”

Minimally invasive microsurgical decompression of an intervertebral disc protrusion in a dog

“…Benefits associated with MISS strategy include smaller incision, less soft‐tissue damage, less blood loss, lower complication rate, less scarring, less postoperative pain, quicker recovery, shorter hospital stay, and a quicker return to daily life activity . Although MISS is common practice in human neurosurgery, limited reports have been published on its use for the thoracolumbar spine in dogs . All these reports except one (percutaneous endoscopic pediculectomy) refer to canine cadavers.…”