Association between anesthesia duration and outcome in dogs with surgically treated acute severe spinal cord injury caused by thoracolumbar intervertebral disk herniation.

Joe Fenn,Adriano Wang‐Leandro,Sarah Moore,Franz J Soebbeler,Karen R Muñana,Andrea Tipold,Nick D Jeffery,Christopher L Mariani,Peter J Early,Natasha J Olby,Hongyu Ru

doi:10.1111/jvim.15796

Abstract

BackgroundRetrospective research recently identified a possible relationship between duration of surgery and outcome in severely affected dogs treated surgically for acute thoracolumbar intervertebral disk herniation (TL‐IVDH).HypothesisThat increased duration of surgery is associated with poorer outcome in dogs with absent pain perception treated surgically for TL‐IVDH.AnimalsTwo hundred ninety‐seven paraplegic dogs with absent pain perception surgically treated for acute TL‐IVDH.MethodsRetrospective cohort study. Medical records of 5 institutions were reviewed. Inclusion criteria were paraplegia with absence of pain perception, surgical treatment of TL‐IVDH, and 1‐year postoperative outcome (ambulatory: yes or no). Canine data, outcome, and surgery and total anesthesia duration were retrieved.ResultsIn this study, 183/297 (61.6%) dogs were ambulatory within 1 year, 114 (38.4%) dogs failed to recover, including 74 dogs (24.9%) euthanized because of progressive myelomalacia. Median anesthesia duration in dogs that regained ambulation within 1 year of surgery (4.0 hours, interquartile range [IQR] 3.2‐5.1) was significantly shorter than those that did not (4.5 hours, IQR 3.7‐5.6, P = .01). Multivariable logistic regression demonstrated a significant negative association between both duration of surgery and total anesthesia time and ambulation at 1 year when controlling for body weight and number of disk spaces operated on.Conclusions and Clinical ImportanceFindings support a negative association between increased duration of anesthesia and outcome in this group of dogs. However, the retrospective nature of the data does not imply a causal relationship.

Highlights

Acute thoracolumbar intervertebral disk herniation (IVDH) is the leading cause of acute spinal cord injury (SCI) in dogs.[1]
Whereas the variability of recovery within the group of dogs with absent pain perception can be ascribed in part to differences in initial injury severity captured by measurement of serum concentrations of glial fibrillary acidic protein and phosphorylated neurofilament heavy chain at time of injury,[10,11,12] as well as extent of injury seen on magnetic resonance imaging (MRI),[7] it is important to examine factors associated with management of these cases that could influence their ultimate outcome
The findings of this study provide further evidence of a negative association between increased duration of anesthesia and recovery of ambulation in severely affected dogs surgically treated for thoracolumbar IVDH

Summary

Introduction

Acute thoracolumbar intervertebral disk herniation (IVDH) is the leading cause of acute spinal cord injury (SCI) in dogs.[1] Spinal cord injury after acute IVDH occurs through a combination of contusive and compressive insults, leading to a cascade of progressive secondary cellular and biochemical injury pathways.[1,2,3] Treatment can be either medical or surgical, with the decision typically based on the severity of presenting clinical signs.[4,5] The most severely affected dogs are those with paraplegia and absent pain perception. Multivariable logistic regression demonstrated a significant negative association between both

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