Thoracolumbar Disc Herniation Research Articles

Outcomes of surgically and conservatively managed thoracolumbar and lumbosacral intervertebral disc herniations in cats.

Limited information is available regarding intervertebral disc herniation (IVDH) and its treatment in cats. Describe outcomes after surgical or conservative treatment of cats with thoracolumbar and lumbosacral IVDH. Ninety-two cats from 2 referral populations (2012-2022) with compressive IVDH between the T3 and S1 vertebrae. Retrospective cohort study evaluating outcomes of surgical (49 cats) and conservative (36 cats) management of IVDH; 7 cats were euthanized at diagnosis. Outcome was assessed using hospital and referring veterinarian records and client questionnaires. Successful outcome was defined as regained or improved ambulation, urinary and fecal continence, and no requirement for analgesic medication. Incidence of IVDH during the study period was 0.44% (92/20849). Surgical treatment resulted in 62% (6 weeks) and 74% success (6 months). Conservative treatment resulted in 54% (6 weeks) and 65% success (6 months). Neurological grade at presentation was higher in cats treated surgically (median, 2; range, 1-5) than in those treated conservatively (median, 2; range, 0-4; P = .001). Regardless of treatment type, cats suffering trauma were more likely to have a successful outcome 6 weeks after treatment compared with those without history of trauma (odds ratio, 5.3; 95% confidence interval, 1.05-26.78; P = .04). Neurological deficits remained in the majority of cats for both treatment types (92%, conservative; 86%, surgical at 6 weeks). Acute-on-chronic IVDH with characteristics of both extrusion and protrusion were identified in 10% of cats. Conservative treatment could be as effective as surgical decompression in cats with thoracolumbar or lumbosacral IVDH.

Accuracy of low-field magnetic resonance imaging for differentiating intervertebral disc extrusions and protrusions at the lumbosacral disc space in dogs.

MRI features differentiating extrusion from protrusion in thoracolumbar discs have been published, however little specifically evaluates the lumbosacral disc. The high prevalence of degenerative changes in apparently normal animals complicates assessment of this region and features relevant elsewhere in the spine may not apply. The aims of this study were to determine the accuracy of MRI in differentiating IVDE and IVDP at the lumbosacral disc space in dogs and determine which MRI characteristics discriminate between IVDE and IVDP. MRI examinations from dogs with surgically confirmed IVDE or IVDP at the lumbosacral disc space were collected retrospectively (2011-2019). Two radiologists independently recorded a diagnosis of IVDE or IVDP, gave a confidence rating, and evaluated specific MRI features. Univariable statistical analysis was performed to identify which MRI characteristics might help distinguish IVDE from IVDP. 117 dogs with lumbosacral IVDE (n = 16) or IVDP (n = 101) were included. Features associated with IVDE were in concordance with previous studies and included interruption of the dorsal annulus, suspected epidural hemorrhage, dispersed (rather than confined) intervertebral disc herniation on T2W sagittal images, lateralized intervertebral disc herniation and displacement of the cauda equina. Overall diagnostic accuracy was 68.8% and interobserver agreement was fair (κ = 0.37), which is lower than has been reported in thoracolumbar disc herniation, but accuracy increased to 85.3% with substantially improved agreement (κ = 0.87) in "confident" diagnoses. MRI characteristics used in differentiating thoracolumbar IVDE and IVDP can be extrapolated to the lumbosacral intervertebral disc space, but diagnostic accuracy in low-field MRI is lower than previously reported in herniations involving the thoracolumbar spine.

Transforaminal Endoscopic Discectomy for Thoracolumbar Disc Herniation: A Retrospective Study and Technical Note

Thoracolumbar disc herniation (TLDH) is a rare disorder with unique characteristics that can result in undesirable surgical outcomes after traditional discectomy. In view of the widespread use of transforaminal endoscopic discectomy for lower lumbar disc herniation, we investigated treatment of TLDH by this procedure. The purpose of this study was to evaluate the clinical efficacy of transforaminal endoscopic discectomy for treating TLDH and share our technical experience. We retrospectively evaluated the clinical data of 19 patients who had undergone transforaminal endoscopic discectomy for TLDH in our institution between April 2018 and July 2021. Operation time, follow-up time, blood loss, postoperative hospital stay, visual analog scale scores for low-back and leg pain, and Japanese Orthopedic Association (JOA) scores were evaluated. The differences between preoperative and postoperative JOA and visual analog scale scores were significant (P < 0.05). According to the JOA scores, 14 of the 19 patients had excellent improvement, 3 had good improvement, and 2 had fair improvement; thus, the rate of satisfactory improvement was 89.5%. Operation time, blood loss, postoperative hospital stay, and surgical outcomes were favorable. Transforaminal endoscopic discectomy is an ideal surgical procedure for treating TLDH.

Fully endoscopic transforaminal discectomy for thoracolumbar junction disc herniation with or without calcification under general anesthesia: Technical notes and preliminary outcomes.

To evaluate the feasibility, safety, and outcomes of percutaneous endoscopic transforaminal discectomy (PETD) for thoracolumbar junction disc herniation (TLDH) with or without calcification. This study included 12 patients diagnosed with TLDH with or without calcification who met the inclusion criteria and underwent surgery for PETD from January 2019 to December 2021. The mean patient age, operation time, hospitalization time, time in bed, and complications were recorded. Patients were followed up for at least 9 months. Visual analog scale (VAS) scores for low-back and leg or thoracic radicular pain and modified Japanese Orthopedic Association score (m-JOA) scores were preoperatively evaluated, at 1 day and 3, 6, and 12 months postoperatively or at last follow-up. The modified MacNab criteria were used to evaluate clinical efficacy at 12 months postoperatively or at last follow-up. The mean patient age, operation time, hospitalization time, and time in bed were 53 ± 13.9 years, 101.3 ± 9.2 min, 4.5 ± 1.3 days, and 18.0 ± 7.0 h, respectively. The mean VAS scores of low-back and leg or thoracic radicular pain improved from 5.8 ± 1.5 and 6.5 ± 1.4 to 2.0 ± 0.9 and 1.3 ± 0.5, respectively (P < 0.05). The m-JOA score improved from 7.5 ± 1.2 to 10.0 ± 0.7 (P < 0.05). The overall excellent-good rate of the modified MacNab criteria was 83.3%. No severe complications occurred. Fully endoscopic transforaminal discectomy and ventral decompression under general anesthesia is a safe, feasible, effective, and minimally invasive method for treating herniated discs with or without calcification at thoracolumbar junction zone.

Surgical strategy and outcomes for thoracolumbar disc herniation with Autologous Bone-Fusion or Cage-Fusion surgery: case series and literature review

ABSTRACT To analyze the clinical characteristics and surgical outcomes of TLDH with Autologous Bone-Fusion for T10-L1 TLDH or Cage-Fusion for T12-L3 TLDH. This is a retrospective multi-center clinical study, involving a total of 43 patients with TLDH who underwent surgery in our institutions from December 2013 to January 2021. In all, 15 of 43 patients (34.9%) with T10-11(2)/T11-12(5)/T12-L1 (8) TLDH underwent Autologous Bone-Fusion surgery and 28 of 43 patients (65.1%) with T12-L1(3)/L1-L2(12)/L2-L3(13) TLDH underwent Cage-Fusion surgery. Demographic data, clinical characteristics and perioperative outcomes were recorded. During the follow-up, pre- to post-operative ODI, VAS back and leg pain scores significantly decreased (P1.2 = 0.001) and the score changes had no significant difference between two groups (P3 = 0.81, 0.59, 0.68). The intraoperative blood loss and operation time showed no significant difference between two groups (P = 0.056, 0.072). The patients showed prominent improvement of hypokinesia and satisfactory rate in two groups (5/7, 71.4% VS 9/12, 75.0%, P = 0.633; 11, 73.3% VS 25, 89.3%, P = 0.281). Notably, no recurrence and severe complications were reported. The choice of surgery approach should be individualized by clinical characteristics and radiology. Selectively Autologous Bone-Fusion for T10-L1 TLDH or Cage-Fusion for T12-L3 TLDH provided adequate nerve decompression and immediate stability. The overall fusion surgical outcomes were satisfactory without major complications during follow-up.

No adverse consequences associated with targeting clinical signs to initiate antimicrobial treatment of postoperative subclinical bacteriuria in dogs following surgical decompression of Hansen type I thoracolumbar disk herniation.

To describe the prevalence of postoperative bacteriuria, clinical course of subclinical bacteriuria in the absence of antimicrobial intervention, clinical signs of bacteriuria that trigger antimicrobial treatment, and outcomes for dogs with subclinical bacteriuria following surgical decompression of acute intervertebral disc herniation (IVDH) Hansen type I. Twenty client-owned dogs undergoing hemilaminectomy for acute (≤ 6 days) IVDH Hansen type I affecting the thoracolumbar spinal cord segments between August 2018 and January 2019. In this prospective study, dogs were serially evaluated at presentation, hospital discharge, 2 weeks postoperatively, and between 4 and 6 weeks postoperatively. Dogs were monitored for clinical signs of bacteriuria, underwent laboratory monitoring (CBC, biochemical analyses, urinalysis, urine bacterial culture), and were scored for neurologic and urinary status. In the absence of clinical signs, bacteriuria was not treated with antimicrobials. Four of the 18 dogs developed bacteriuria without clinical signs 4 days to 4 to 6 weeks after surgery. In all 4 dogs, bacteriuria resulted in lower urinary tract signs 13 to 26 weeks postoperatively. No dogs had evidence of systemic illness despite delaying antimicrobial treatment until clinical signs developed. New-onset incontinence was the only clinical sign in 3 dogs. All bacterial isolates had wide antimicrobial susceptibility. Bacteriuria and clinical signs resolved with beta-lactam antimicrobial treatment. Postoperative bacteriuria occurs in some dogs with IVDH Hansen type I and, when present, may lead to clinical signs over time. Clinical signs of bacteriuria may be limited to new-onset urinary incontinence, inappropriate urination, or both. Delaying antimicrobial treatment until clinical signs of bacteriuria developed did not result in adverse consequences or systemic illness.

A 50-step walking test for analysis of recovery after decompressive surgery for thoracolumbar disc herniation in dogs.

BackgroundDespite its importance, there is no agreed definition of recovery of ambulation in dogs with spinal cord injury.ObjectivesTo validate a new walking test in dogs recovering from thoracolumbar spinal cord injury.AnimalsTwo hundred twenty‐four dogs weighing <20 kg: 120 normally ambulatory dogs, plus 104 dogs undergoing decompressive surgery for acute thoracolumbar intervertebral disc herniation.MethodsProspective cohort studies. The distance each freely‐ambulatory dog walked during 50 step cycles was regressed on ulna length. For each postsurgical dog, we recorded when the calculated 50‐step distance was completed without falling, or their inability to complete this distance by 4 months or more after surgery. Bayesian analysis compared outcomes for presurgical neurologic categories; association of recovery with several preoperative variables was explored using logistic and time‐to‐event regression.ResultsFor control dogs, 50‐step distance (m) = 1.384 × ulnar length (cm) + 2.773. In postsurgical dogs, the 50‐step test provided decisive evidence that deep pain‐negative dogs were less likely to recover ambulation than dogs with intact pain perception (12/29 recovered vs 71/75; Bayes factor [BF] = 5.9 × 106) and, if they did recover, it took much longer (median 91 days vs median 14 days; BF = 1.5 × 103). Exploratory analysis suggested that presurgical neurologic status (subhazard ratio [SHR] = 0.022; P < .001) and duration of presurgical anesthesia (SHR = 0.740; P = .04) were associated with rapidity of recovery.Conclusions and Clinical ImportanceThis straightforward 50‐step walking test provides robust data on ambulatory recovery well‐suited to large scale pragmatic trials on treatment of thoracolumbar spinal cord injury in dogs.

Clinical signs, MRI findings and long-term outcomes of foraminal and far lateral thoracolumbar intervertebral disc herniations in dogs.

As they have been seldomly described in the veterinary literature, the aims of this retrospective study were to describe the clinical presentation, MRI findings and long-term outcome after medical or surgical treatment of dogs presenting with foraminal and far lateral thoracolumbar intervertebral disc herniations. Retrospective multicentre study of dogs diagnosed with foraminal and far lateral thoracolumbar intervertebral disc herniations between 2009 and 2020 in seven referral hospitals. Thirty-seven dogs were included. Dachshunds and mixed breeds were most affected. Median age at presentation and duration of clinical signs were 6 years and 14 days, respectively. Pain was the most frequent clinical finding (92%), particularly on spinal palpation and/or hip manipulation, followed by pelvic limb lameness (71%). Eighty-seven percent of herniations occurred at L5-L6 or L6-L7. A good to excellent outcome was seen in 95% of surgically and 90% of medically treated dogs. Although much less frequently recognised than herniation affecting the vertebral canal, foraminal and far lateral thoracolumbar intervertebral disc herniations should be considered in the differential diagnosis list of chondrodystrophic dogs presenting with pain and pelvic limb lameness. Most dogs had a good to excellent outcome following medical or surgical treatment.

Wedging of vertebral bodies at the thoracolumbar spine in healthy individuals on whole body MRI screening: correlation with disc degeneration and disc herniation.

There have been no reports on the relationship between wedging of vertebral bodies at the thoracolumbar spine and disc herniation in healthy individuals on magnetic resonance imaging (MRI). To investigate the degree of wedging of vertebral bodies at the thoracolumbar spine in healthy individuals who underwent whole-body (WB) MRI. We also assessed the correlation between wedging and adjacent disc pathology. This retrospective study comprised 200 healthy patients who underwent WB MRI as part of a regular health check from January 2019 to February 2019. We measured anterior and posterior vertical heights of each vertebral body between T10 and L2. The ratio of anterior height to posterior height (APR) was calculated, and we evaluated disc degeneration or disc herniation using WB MRI. The APR of T10 was significantly higher than at the other levels (P < 0.05), and the APR of L1 was significantly lower (P < 0.05). Men had a significantly smaller APR than women at T12 to L2 (P < 0.05). Regarding the relationship between APR and disc degeneration, the group without disc degeneration had a higher APR, with statistical significance at T12, L1, and L2. Regarding the relationship between APR and disc herniation, the group without disc herniation had a higher APR, with statistical significance at T11, T12, L1, and L2. Wedging of vertebral bodies is most prominent at L1. Although the values were statistically significant only at some levels, the patients with disc degeneration or herniation had more prominent wedge deformity of thoracolumbar spine.

Analysis of sagittal profile and radiographic parameters in symptomatic thoracolumbar disc herniation patients

BackgroundFew studies describe thoracolumbar disc herniation (TLDH) as an isolated category, it is frequently classified as the lower thoracic spine or upper lumbar spine. Thus, less is known about the morphology and aetiology of TLDH compared to lumbar disc herniation (LDH). The aim of study is to investigate sagittal alignment in TLDH and analyze sagittal profile with radiographic parameters.MethodsData from 70 patients diagnosed with TLDH were retrospectively reviewed. The thoracic-lumbar alignment was depicted by description of curvatures (the apex of lumbar curvature, the apex of thoracic curvature, and inflexion point of the two curvatures) and radiographic parameters from complete standing long-cassette spine radiographs. The rank sum test was utilised to compare radiographic parameter values in each subtype.ResultsWe found two subtypes differentiated by the apex of thoracic kyphotic curves. The sagittal profile was similar to that of the normal population in type I, presenting the apex of the thoracic kyphotic curve located in the middle thoracic spine. The well aligned thoracic-lumbar curve was disrupted in type II, presenting the apex of the thoracic kyphotic curve located in the thoracolumbar region in type II patients. Thirty-six patients were classified as type I, and 34 patients were classified as type II. The mean sagittal vertical axis, T1 pelvic angle and L1 pelvic angle were 27.9 ± 24.8°, 8.2 ± 7.3° and 6.2 ± 4.9°, respectively. There was significant difference (p < 0.001) of thoracolumbar angle between type I (14.9 ± 7.9°) and type II patients (29.1 ± 13.7°).ConclusionsWe presented two distinctive sagittal profiles in TLDH patients, and a regional kyphotic deformity with a balanced spine was validated in both subtypes. In type I patients, disc degeneration was accelerated by regional kyphosis in the thoracolumbar junction and eventually caused disc herniation. In type II patients, excessive mechanical stress was directly loaded at the top of the curve (thoracolumbar apex region) rather than being diverted by an arc as in a normal population or type I patients. Mismatch between shape and sacral slope value was observed, and better agreement was found in Type II patients.

The Importance of Personally Reviewing Imaging for Clinical Correlation

Abstract A 64-yr-old man with a history of previous motor vehicle collision with chronic back pain presented as a referral to an outpatient spine clinic with a 3-yr history of bilateral lower limb weakness and numbness that progressed to severe bilateral foot drop. He had been seen by another practitioner from a different hospital 2 yrs prior who performed an electromyography that was interpreted as possible primary lateral sclerosis. His clinical picture was difficult to interpret as it did not fit any of the disease patterns, such as a motor neuron disease, suggested by previous electromyography. Repeated magnetic resonance imaging revealed multifactorial canal stenosis at L3-L4 and L4-L5 with foraminal stenosis. The ordering physician reviewed the magnetic resonance imaging of lumbar spine and noticed possible spinal canal stenosis in the lower thoracic region, not noted by the radiologist, and ordered a magnetic resonance imaging of thoracic spine for further evaluation. Overall, this is an interesting case of a patient who had prolonged weakness and numbness in his lower limbs that, although he underwent extensive workup, was misdiagnosed. It is important to realize that thoracolumbar disc herniations can cause mixed upper motor neuron and lower motor neuron signs. This case emphasizes the importance of reviewing the patient’s imaging personally and correlating the imaging to the clinic presentation.

TORAKOLOMBER BİLEŞKE DİSK HERNİASYONLARININ CERRAHİ TEDAVİSİNDE POSTEROLATERAL TRANSKAMBİN YAKLAŞIM

Objective: The optimal surgical approach for treatment of thoracolumbar junction disc herniations (TLJDH) remains controversial. Anterolateral retroperitoneal, anterior transthoracic, posterolateral, lateral and transforaminal endoscopic approaches are used in current surgical treatment of TLJDH. In a posterolateral transcambin approach, a small piece of bone is removed from the pars interarticularis and facet joints, and decompression is achieved by discectomy without causing instability. The transcambin approach has advantages such as discectomy without advanced neural tissue retraction, short recovery time and less postoperative complications. Methods: The eight patients with 3 T12-L1 and 5 L1-2 TLJDH who were operated on using the posterolateral transcambin approach between 2016-2018 in our clinic were presented retrospectively. The study included patients with extruded or sequestrated disc herniation that had far lateral, foraminal, and paramedian extension, and caused cauda equina syndrome, conus medullaris syndrome, and radiculopathy. A skin incision and fascia opening were done from midline. The exiting root was revealed at laterally of pars interarticularis by subperiosteally stripping of paravertebral muscles and the removal of disc fragments were targeted. Results: Three male and five female patients with a mean age of 45.1 (32-66). Mean operation time was 57.8 minutes. Preoperative VAS values were 8.75±0.51 and postoperative VAS values were 1.25±0.65. According to the MacNab classification, 62.5% excellent, 25% good and 12.5% were fair. There was no neurological injury, cerebrospinal fluid (CSF) fistula, pneumothorax, or operation field hematoma.Conclusion: The transcambin approach was found to be useful in terms of a relatively short operation time, low morbidity probability, and less postoperative pain in patients with TLJDH.&nbsp;

Extended durotomy to treat severe spinal cord injury after acute thoracolumbar disc herniation in dogs.

To report recovery of ambulation of dogs treated with extended thoracolumbar durotomy for severe spinal cord injury caused by intervertebral disc herniation. Descriptive cohort. Twenty-six consecutive paraplegic dogs presented with loss of deep pain sensation after acute thoracolumbar intervertebral disc herniation. Each dog underwent routine diagnostic assessment and surgery for removal of extradural herniated intervertebral disc, followed by a four-vertebral body length durotomy centered on the herniated disc. Each dog was followed up until it was able to walk 10 steps without assistance or until 6 months after surgery. Sixteen of 26 dogs recovered to walk unaided (all but one also recovered fecal and urinary continence), and six dogs did not; four dogs were lost to follow-up. One dog was euthanized because of signs consistent with progressive myelomalacia. There was no evidence of detrimental effects of durotomy within the period of study. Using Bayesian analysis, we found a point estimate of successful outcome of 71% with 95% credible interval from 52% to 87%. Extended durotomy seemed to improve the outcome of dogs in our case series without increase in morbidity. Extended durotomy appears safe and may improve the outcome of dogs with severe thoracolumbar mixed contusion and compressive injuries associated with acute intervertebral disc extrusion.

Effect of durotomy in dogs with thoracolumbar disc herniation and without deep pain perception in the hind limbs.

To determine the effectiveness of durotomy as an adjunct to surgical decompression in dogs with thoracolumbar intervertebral disc herniation (TL-IVDH) and loss of deep pain perception (DPP) in the hind limbs. Retrospective study. Dogs (n = 116) with TL-IVDH and loss of DPP treated with hemilaminectomy. Signalment, surgical site, recovery rate, incidence of progressive myelomalacia (PMM), time elapsed from onset of paraplegia of the hind limbs to surgery (TPS), and the length of area of hyperintensity of the spinal cord on magnetic resonance T2-weighted images compared with L2 vertebral body length (LHT2) were compared between dogs treated with hemilaminectomy alone and those treated with adjunct durotomy. Multivariate logistic regression analyses were used to test the association between outcomes and the external view of the spinal cord parenchyma after durotomy. The percentage of dogs regaining ambulation was greater when durotomy was performed (56.9%) than when dogs were treated with hemilaminectomy alone (38.5%; P = .04). In the hemilaminectomy group, 14 dogs died of suspected PMM, while no PMM was detected in the durotomy group. Durotomy, breed, surgical site, and LHT2 influenced recovery. No association was detected between age, sex, body weight, and TPS and recovery. Performing a durotomy in combination with decompression improved the return to function and prevented PMM in our clinical setting. Surgeons should consider durotomy in dogs with TL-IVDH and loss of DPP in hind limbs to improve surgical outcome.

Hip or spine surgery first?: a survey of treatment order for patients with concurrent degenerative hip and spinal disorders

Patients may present with concurrent symptomatic osteoarthritis (OA) of the hip and degenerative disorders of the lumbar spine, with surgical treatment being indicated for both. Whether arthroplasty of the hip or spinal surgery should be performed first remains uncertain. Clinical scenarios were devised for a survey asking the preferred order of surgery and the rationale for this decision for five fictional patients with both OA of the hip and degenerative lumbar disorders. These were symptomatic OA of the hip and: 1) lumbar spinal stenosis with neurological claudication; 2) lumbar degenerative spondylolisthesis with leg pain; 3) lumbar disc herniation with leg weakness; 4) lumbar scoliosis with back pain; and 5) thoracolumbar disc herniation with myelopathy. This survey was sent to 110 members of The Hip Society and 101 members of the Scoliosis Research Society. The choices of the surgeons were compared among scenarios and between surgical specialties using the chi-squared test. The free-text comments were analyzed using text-mining. Responses were received from 51 hip surgeons (46%) and 37 spine surgeons (37%). The percentages of hip surgeons recommending 'hip first' differed significantly among scenarios: 59% for scenario 1; 73% for scenario 2; 47% for scenario 3; 47% for scenario 4; and 10% for scenario 5 (p < 0.001). The percentages of spine surgeons recommending 'hip first' were 49% for scenario 1; 70% for scenario 2; 19% for scenario 3; 78% for scenario 4; and 0% for scenario 5. There were significant differences between the groups for scenarios 3 (more hip surgeons recommended 'hip first'; p = 0.012) and 4 (more hip surgeons recommended 'spine first'; p = 0.006). In patients with coexistent OA of the hip and degenerative disorders of the spine, the question of 'hip or spinal surgery first' elicits relatively consistent answers in some clinical scenarios, but remains controversial in others, even for experienced surgeons. The nature of neurological symptoms can influence surgeons' decision-making. Cite this article: Bone Joint J 2019;101-B(6 Supple B):37-44.

Relationship of preoperative neurologic score with intervals to regaining micturition and ambulation following surgical treatment of thoracolumbar disk herniation in dogs.

OBJECTIVE To estimate the times required for dogs to regain micturition and ambulation following surgical treatment for thoracolumbar Hansen type I intervertebral disk extrusion (IVDE) and determine whether these variables were associated with preoperative modified Frankel score (MFS). DESIGN Retrospective case series with nested cohort study. ANIMALS 54 dogs weighing < 20 kg (44 lb) that were surgically treated for Hansen type I IVDE at a referral hospital between January and December 2015. PROCEDURES Medical records and CT and MRI data were reviewed. Information was collected regarding dog signalment, type and duration of clinical signs, preoperative MFS, degree of spinal cord compression, type of medical and surgical treatment provided, and intervals from surgery to regaining micturition and ambulation (outcomes). Collected data were evaluated for correlations with outcomes. RESULTS Mean ± SD interval from surgery to regaining micturition was 4.1 ± 4.4 days, and mean interval from surgery to regaining ambulation was 13.8 ± 25.1 days. These intervals differed significantly. Significant negative correlations with MFS were identified for interval to regaining micturition (r = -0.63) and interval to regaining ambulation (r = -0.64). No other correlations with outcome were identified. CONCLUSIONS AND CLINICAL RELEVANCE The amount of time required for dogs to regain micturition and ambulation following surgery for thoracolumbar IVDE was correlated with preoperative severity of clinical signs, as reflected by preoperative MFSs. This information should be useful for pre- and postoperative decision-making and setting of expectations for owners of and clinicians treating affected dogs.

Surgical Site Infection Rate after Hemilaminectomy and Laminectomy in Dogs without Perioperative Antibiotic Therapy.

The aim of this study was to retrospectively review the surgical site infection (SSI) rate in dogs undergoing laminectomies without perioperative antibiotics, and compare those data with the expected infection rate for clean surgical wounds in dogs undergoing similar procedures. This was a retrospective single-centre study composed of dogs that underwent hemilaminectomies or laminectomies for thoracolumbar disc herniation or lumbosacral disease during a 2-year period (during 2015 and 2016). All incisional complications within 30 days were recorded and divided into superficial, deep or organ/space infections. Those dogs that received perioperative or postoperative antibiotics due to non-related comorbidities and those with incomplete medical records during the study period were excluded. Of 221 consecutive hemilaminectomy and laminectomy procedures, 154 were included in this research study. One superficial wound infection was recorded and treated with antimicrobials. Overall, the SSI rate was 0.6%, while the expected SSI rate in clean operative wounds in dogs and cats is 2.0 to 4.8%. The SSI rate in human spinal surgery is 0.7 to 4.3%. Considering the low incidence of SSI in our study group, the routine use of perioperative antibiotic prophylaxis in dogs undergoing laminectomy procedures should be reconsidered to help address the global problem of bacterial resistance.

A randomized, blinded, prospective clinical trial of postoperative rehabilitation in dogs after surgical decompression of acute thoracolumbar intervertebral disc herniation.

BackgroundExperimental evidence shows benefit of rehabilitation after spinal cord injury (SCI) but there are limited objective data on the effect of rehabilitation on recovery of dogs after surgery for acute thoracolumbar intervertebral disc herniations (TL‐IVDH).ObjectiveCompare the effect of basic and intensive post‐operative rehabilitation programs on recovery of locomotion in dogs with acute TL‐IVDH in a randomized, blinded, prospective clinical trial.AnimalsThirty non‐ambulatory paraparetic or paraplegic (with pain perception) dogs after decompressive surgery for TL‐IVDH.MethodsBlinded, prospective clinical trial. Dogs were randomized (1:1) to a basic or intensive 14‐day in‐house rehabilitation protocol. Fourteen‐day open field gait score (OFS) and coordination (regulatory index, RI) were primary outcomes. Secondary measures of gait, post‐operative pain, and weight were compared at 14 and 42 days.ResultsOf 50 dogs assessed, 32 met inclusion criteria and 30 completed the protocol. There were no adverse events associated with rehabilitation. Median time to walking was 7.5 (2 – 37) days. Mean change in OFS by day 14 was 6.13 (confidence intervals: 4.88, 7.39, basic) versus 5.73 (4.94, 6.53, intensive) representing a treatment effect of −0.4 (−1.82, 1.02) which was not significant, P=.57. RI on day 14 was 55.13 (36.88, 73.38, basic) versus 51.65 (30.98, 72.33, intensive), a non‐significant treatment effect of −3.47 (−29.81, 22.87), P = .79. There were no differences in secondary outcomes between groups.ConclusionsEarly postoperative rehabilitation after surgery for TL‐IVDH is safe but doesn't improve rate or level of recovery in dogs with incomplete SCI.

The posterior approach operation to treat thoracolumbar disc herniation: A minimal 2-year follow-up study.

Thoracolumbar disc herniation (TLDH) is a rare and progressively disabling disorder; surgical procedures predispose the subjects to high incidence of complications including recurrence, neurological aggravation, and adjacent segment degeneration.Ten patients with TLDH underwent posterior approach operation in our institution from January, 2006 to December, 2015. The mean preoperative duration of clinical symptoms was 16.5 months. The clinical data including operative time, blood loss, and hospitalization duration were investigated. Furthermore, pre and postoperative neurological status was evaluated by the modified Japanese Orthopedic Association (JOA) scoring system and pain by visual analog scale (VAS) scoring system.The mean operative time was 176.50 ± 20.55 minutes, the mean blood loss was 435.00 ± 89.58 mL, and the mean hospitalization length was 13.30 ± 2.97 days. All patients were followed with a mean period of 35.1 months. The mean JOA score of all patients before operation, at discharge, 3 months after operation, and at last follow-up was 6.50 ± 1.28, 7.60 ± 1.22, 8.90 ± 0.99, and 9.00 ± 0.92, respectively. The differences between the pre and postoperative JOA and VAS scores were significant (P < .05). However, the differences of JOA and VAS scores at postoperative 3 months and final follow-up were not statistically significant.Posterior approach operation is an ideal surgical technique for treatment of TLDH; the operative time, blood loss, hospitalization duration, and symptomatic improvement are favorable.

Radiological analysis for thoracolumbar disc herniation in spinopelvic sagittal alignment: A retrospective study.

A retrospective study aims to explore differences in spinopelvic sagittal alignment between thoracolumbar disc herniation (TLD) and lower lumbar disc herniation (LLD).A total of 185 patients included 26 with TLD and 129 with LLD and 30 asymptomatic volunteers in normal group (NG). Each individual took full spine X-ray to evaluate pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis (TK), TK+LL+PI, TK/LL, and sacrum-femoral-pubic symphysis (SFP). The Roussouly classification was used to categorize all subjects according to their sagittal alignment. Spinopelvic parameters and Roussouly classification results were compared between groups.PI (51.0°), SS (30.5°), and LL (42.0°) in the TLD were significantly higher than those in the LLD (47°, 27°, 33°, respectively). However, TK (30.0°), TK/LL (0.75), and TK+LL+PI (40.0°) in the TLD were significantly lower than these in the LLD (33.0°, 1.07, 47.2°, respectively) and the similar trend between TLD and NG (34.3°, 0.93, 48.5°, respectively). But LL (42.0°) in the TLD was significantly higher than in the NG (35°). Roussouly types among 3 groups were marked differences. The LLD had a higher rate (59.7%) of type II lordosis (flat back), and the TLD had a higher rate (61.5%) of type III lordosis than other groups.This study implied that patients with TLD have higher LL, lower TK, TK/LL, and TK+LL+PI than LLD patients. We inferred that high LL combined with low TK may be the prospective factors of TLD.