Operative techniques of percutaneous endoscopic mini-hemilaminectomy using a uniportal approach in dogs

Abstract

The present study aimed to investigate the technical feasibility of percutaneous endoscopic mini-hemilaminectomy via a uniportal approach, and to evaluate the possibility of decompression and endoscopic examination of the thoracic and lumbar spinal canals in small dogs during such procedures. Fresh canine cadavers of mixed-breed dogs (n=7) were used in this study. Following injection of a barium and agarose mixture (BA-gel) to stimulate intervertebral disc herniation, percutaneous endoscopic mini-hemilaminectomy was performed using a lateral approach to the thoracic and lumbar vertebrae. BA-gel was removed to decompress the spinal cord using an elevator and rongeurs after mini-hemilaminectomy. Pre and post-operative computed tomography (CT) scans were obtained to evaluate surgical outcomes. Intra-operative complications, incision length, and procedure time were recorded. All procedures were completed with clear visualization of the spinal cord and floor of the spinal canal. The mean total operating time was 58.00 ± 18.06 min. Lengths of incision were under 1 cm in all dogs. Intra-operative complications included iatrogenic nerve root injuries caused by the micro-rongeur in two dogs. CT imaging revealed that removal of BA-gel resulted in sufficient spinal cord decompression. Our findings indicated that percutaneous endoscopic thoracolumbar mini-hemilaminectomy is feasible for spinal cord decompression and allows for adequate observation of the spinal canal. Thus, this technique may be an alternative surgical option for treatment of thoracolumbar disk disease in dogs.

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

“…We concluded that the minimally invasive intramuscular approach through a 2‐cm channel offered adequate access to the target area, with the tendinous attachment onto the articular process as the sole structure being cut. These findings support the reports of MISS cadaveric study on the feasibility of the techniques.…”

“…Surgical loupes are popular among neurosurgeons but offer only limited magnification. The use of exoscopes and endoscopes has been reported in a few veterinary reports . Video‐assisted ventral slots have been used in cadavers and in clinically affected dogs, whereas mostly cadaveric studies have been reported for the thoracolumbar and lumbosacral region, with only one report of using an endoscope in a study in live dogs .…”

“…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.…”

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 .…”

Ultrasonography is more accurate than percutaneous palpation for identifying targeted thoracolumbar intervertebral disc spaces in dogs

“…In fact, today's surgical trends point toward reducing the invasiveness of all surgeries. Minimally invasive surgery of the spine is now performed routinely in humans and has also been reported clinically and experimentally for the cervical and thoracolumbar regions in dogs . These studies rely either on percutaneous palpation or fluoroscopy to target the correct intervertebral disc space.…”