A blind, placebo–controlled clinical trial was performed to evaluate the postoperative analgesic effect of topically administered, intraoperative, epidural morphine (Duramorph™) and intramuscular infiltration of the incision site with bupivacaine prior to closure of the skin in dogs undergoing hemilaminectomy for Hansen type I Intervertebral Disk Disease (IVDD). Thirty-three dogs were randomly allocated into four treatment groups: epidural Duramorph™ with incisional bupivacaine (DUR/BUP), epidural saline with incisional bupivacaine (SAL/BUP), epidural Duramorph™ with incisional saline (DUR/SAL), and epidural saline with incisional saline (SAL/SAL). All dogs were premedicated with a standard protocol and were anesthetized with propofol and isoflurane. After surgery, scores were assigned using a visual analog scale (VAS) for both pain and sedation and a composite pain scale (CPS). In addition, a von Frey anesthesiometer was used to determine pain thresholds at 1 cm and 3 cm from the surgical incision line (primary hyperalgesia) as well as on the lateral aspect of the stifle (secondary hyperalgesia). Assessments were carried out at fixed intervals over the 48 hour postoperative period. Significant differences were found between those groups treated with the epidural Duramorph™ and those that received epidural saline. Those dogs in the DUR/BUP and DUR/SAL groups exhibited lower von Frey pain thresholds and higher VAS and CPS scores than the SAL/BUP and SAL/SAL groups. The administration of bupivacaine had no significant effect on any measured outcome. The authors conclude that topically administered epidural Duramorph™ and intramuscular incisional bupivacaine do not enhance analgesia following hemilaminectomy in the dog. / Master of Science

Trauma of diverse origins is a common reason for presentation of pets for treatment. It is often difficult clinically to objectively measure the severity of any trauma to an animal. One approach is to measure the changes in the various serum parameters which are known to alter in response to trauma or inflammation. If the changes over time of relevant and easily measurable parameters can be established under two controlled but different conditions of surgical trauma, it may provide the foundation for evaluating their future use in establishing the severity of trauma in a patient. A prospective study was performed on animals presented to the Onderstepoort Veterinary Academic Hospital for either thoracolumbar disc disease or for elective ovariohysterectomy. The two surgical procedures chosen for the study involved significant surgical trauma, particularly to muscle, in the case of thoracolumbar decompression and relatively minor surgical trauma in the case of ovariohysterectomy. Serial evaluation of creatine kinase (CK) and C-reactive protein (CRP) were performed both pre- and post-operatively on two sets of patients derived from the two surgical categories. CK is an enzyme found predominantly in skeletal muscle and significantly elevated serum activity is largely associated with muscle damage. CRP is an acute phase protein which shows elevated serum concentration in response to a broad range of inflammatory stimuli. Analysis of the data showed a very wide range of results at each time point for both CK and CRP. There were no significant differences between the two surgical groups for either analyte preoperatively. Thereafter CK results were markedly and significantly different between the two groups. CRP results were very similar in the two groups with no statistical difference at any time point. The results of this study suggest that the evaluation of CK and CRP at any one time point in a traumatized animal is of limited value. However the evaluation of the trend of these two analytes, even over a relatively short time period, may allow for useful prognostication in clinical cases. / Dissertation (MMedVet)--University of Pretoria, 2008. / Companion Animal Clinical Studies / unrestricted

This thesis is an investigation of the access provided to the vertebral canal in dogs by the hemilaminectomy and mini-hemilaminectomy surgical techniques using computed tomography (CT), and the completeness of evacuating extruded material in dogs with intervertebral disc (IVD) extrusion using magnetic resonance imaging (MRI). Hemilaminectomy and mini-hemilaminectomy were performed on opposite sides of the spine at T11-T12, T13-L1, and L2-L3 in 10 cadavers. Measurements of the vertebral canal height, defect height, and any dorsal and ventral remnants of the vertebral arch were obtained by CT. A covariate analysis was used to compare measurements with the surgical technique, surgical site, and side of the vertebral column. Defect height was greater with hemilaminectomy due to a smaller dorsal lamina remnant. There was no statistical difference in the height of the ventral remnant, or with surgical site. Nineteen prospectively recruited dogs with suspected IVD extrusion were randomly assigned to hemilaminectomy (10 dogs) or mini-hemilaminectomy (9 dogs) groups. Intervertebral disc extrusion was identified pre-operatively with MRI and later confirmed surgically, and immediate post-operative MRI was performed at the surgical site. The volume of extruded IVD material pre- and post-operative was calculated from transverse T2 images. Although residual IVD material was present in post-operative images from all dogs in the hemilaminectomy group and only 4 in the mini-hemilaminectomy group, there was no statistically significant difference between the proportionate volumes of material removed by either technique. The median residual volume with hemilaminectomy was 13.6% (confidence interval: 7.8 – 23.6%), and with mini-hemilaminectomy was 7.7% (4.3 – 13.8%). The results of this study confirm that the difference in the defect height between techniques is related to the removal of the articular processes creating a larger defect along the dorsal vertebral canal, while no difference in access to the ventral canal was observed. No effect of vertebral site was detected suggesting neither procedure provides an advantage over the other due to location of the lesion along the thoracolumbar spine. Residual extruded IVD material occurs with both techniques; while no statistical difference was noted, a larger population should be examined. / Ontario Veterinary College Pet Trust

Made available in DSpace on 2014-06-11T19:31:06Z (GMT). No. of bitstreams: 0 Previous issue date: 2008-12-18Bitstream added on 2014-06-13T20:27:19Z : No. of bitstreams: 1 joaquim_jgf_dr_botfmvz.pdf: 1751207 bytes, checksum: 18a2c91a32f8aa041a2876a9d9e2f6d6 (MD5) / Universidade Estadual Paulista (UNESP) / As enfermidades do disco intervertebral são doenças neurológicas freqüentemente encontradas na prática clínica. A compreensão das alterações patológicas associadas à discopatias, ainda não é completa. A opção pelo tratamento clínico ou cirúrgico varia com os achados clínicos e a experiência do médico veterinário. O objetivo deste estudo foi comparar a resposta a diferentes formas de tratamento da discopatia toracolombar e lombar, com base na avaliação do quadro clínico de animais antes e após tratamentos específicos: cirurgia descompressiva, tratamento clínico com eletroacupuntura ou associação de cirurgia e eletroacupuntura. Os 40 pacientes selecionados foram atendidos no período de janeiro de 2003 a julho de 2007, com quadro clínico de discopatia toracolombar. Estes foram então classificados conforme o grau de envolvimento medular (de I a V, com severidade clínica crescente) segundo a classificação de adaptada de Takahashi et al. (1997), Schulz et al. (1998) e Chierichetti e Alvarenga (1999) e divididos em três grupos: G1 (Cirurgia), G2 (Acupuntura) e G3 (Acupuntura e Cirurgia), de acordo com o tipo de tratamento a qual foram submetidos. Para análise estatística utilizou-se o Teste de Goodman para contrastes entre e dentro de populações multinomiais com o nível de significância de 5% (p<0,05). Todos pacientes dos três grupos tinham quadro clínico medular grave (IV ou V), a exceção de um animal grau II do G2. No G1, houve melhora de 40% dos animais tratados, no G2 de 79% e no G3 de 72,7%. Em nenhum animal houve piora clínica. Concluiu-se que o grupo do tratamento com eletroacupuntura foi mais eficiente que o grupo da cirurgia descompressiva tardia para recuperação do quadro neurológico em cães portadores de discopatia. / Intervertebral disc disease is the most commom cause of neurologic disease in small animals. Spinal cord alterations in disc herniation are not completly understood. Treatment options are depending on neurological examination. The aim of this study was to compare the effectiveness of surgery, acupuncture or surgery followed by eletroacupuncture in dogs with disc disease. Dogs with thoracolumbar and lumbar intervertebral disc disease were selected from january 2003 to july 2007. Patients were classified according to a score adapted from Takahashi et al. (1997), Schulz et al. (1998) and Chierichetti and Alvarenga (1999) scale of myelopathy, ranging from I to V with a crescent severerity. Forty animals were treated with surgery (G1), acupuncture (G2) and surgery followed by acupuncture (G3). All of them had a high degree of myelopathy (grade IV-V) except one dog (grade II) in G2 group. Statistical analysis was performed using the Goodman test for comparison of differences between the polinomial populations (p<0,05). We obtained that 40% of the animals improved in G1, 79% in G2 and 72,7% in G3. Electroacupuncture was more effective than late surgery for neurological improvement in dogs with disc disease.

Orientador: Stelio Pacca Loureiro Luna / Banca: Rogerio M. Amorim / Banca: Sheila C. Rahal / Banca: Sandra Torelli / Banca: Maria Doris Bedoya Henao / Resumo: As enfermidades do disco intervertebral são doenças neurológicas freqüentemente encontradas na prática clínica. A compreensão das alterações patológicas associadas à discopatias, ainda não é completa. A opção pelo tratamento clínico ou cirúrgico varia com os achados clínicos e a experiência do médico veterinário. O objetivo deste estudo foi comparar a resposta a diferentes formas de tratamento da discopatia toracolombar e lombar, com base na avaliação do quadro clínico de animais antes e após tratamentos específicos: cirurgia descompressiva, tratamento clínico com eletroacupuntura ou associação de cirurgia e eletroacupuntura. Os 40 pacientes selecionados foram atendidos no período de janeiro de 2003 a julho de 2007, com quadro clínico de discopatia toracolombar. Estes foram então classificados conforme o grau de envolvimento medular (de I a V, com severidade clínica crescente) segundo a classificação de adaptada de Takahashi et al. (1997), Schulz et al. (1998) e Chierichetti e Alvarenga (1999) e divididos em três grupos: G1 (Cirurgia), G2 (Acupuntura) e G3 (Acupuntura e Cirurgia), de acordo com o tipo de tratamento a qual foram submetidos. Para análise estatística utilizou-se o Teste de Goodman para contrastes entre e dentro de populações multinomiais com o nível de significância de 5% (p<0,05). Todos pacientes dos três grupos tinham quadro clínico medular grave (IV ou V), a exceção de um animal grau II do G2. No G1, houve melhora de 40% dos animais tratados, no G2 de 79% e no G3 de 72,7%. Em nenhum animal houve piora clínica. Concluiu-se que o grupo do tratamento com eletroacupuntura foi mais eficiente que o grupo da cirurgia descompressiva tardia para recuperação do quadro neurológico em cães portadores de discopatia. / Abstract: Intervertebral disc disease is the most commom cause of neurologic disease in small animals. Spinal cord alterations in disc herniation are not completly understood. Treatment options are depending on neurological examination. The aim of this study was to compare the effectiveness of surgery, acupuncture or surgery followed by eletroacupuncture in dogs with disc disease. Dogs with thoracolumbar and lumbar intervertebral disc disease were selected from january 2003 to july 2007. Patients were classified according to a score adapted from Takahashi et al. (1997), Schulz et al. (1998) and Chierichetti and Alvarenga (1999) scale of myelopathy, ranging from I to V with a crescent severerity. Forty animals were treated with surgery (G1), acupuncture (G2) and surgery followed by acupuncture (G3). All of them had a high degree of myelopathy (grade IV-V) except one dog (grade II) in G2 group. Statistical analysis was performed using the Goodman test for comparison of differences between the polinomial populations (p<0,05). We obtained that 40% of the animals improved in G1, 79% in G2 and 72,7% in G3. Electroacupuncture was more effective than late surgery for neurological improvement in dogs with disc disease. / Doutor

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The aim of this study was to investigate if surgical manipulation of the spinal cord in dogs submitted to thoracolumbar dorsolateral hemilaminectomy influences the development of neurological and myelographic signs at immediate postoperative time. For this reason, fourteen healthy mongrel dogs were used, weighing from 7 to 10 kilos and submitted to hemilaminectomy between T13 and L1 vertebrae and distributed randomly in three groups, denominated as GI or control (n=4), GII or 15 movements (n=5) and GIII or 30 movements (n=5). The dogs in GI were only submitted to thoracolumbar dorsolateral hemilaminectomy surgical technique, on the left side. The dogs in GII and GIII were submitted to the same procedure as GI, followed by 15 and 30 movements, respectively, over the dorsal, left lateral and ventral surfaces of the spinal cord. Neurological exams were carried out 24 and 72 hours after surgery and after these periods, the dogs were submitted to myelography to evaluate filling and irregular delineation of the contrast line in the subarachnoid space. The myelographic evaluation results in lateral and ventrodorsal positions did not show significant difference, even though there was variation between the groups. In the neurological exam, the animals did not demonstrate neurological deficiencies in any of the days of evaluation at PO. According to the proposed experimental model and the results obtained, it can be concluded that the surgical manipulation of the spinal cord in healthy dogs submitted to thoracolumbar hemilaminectomy does not influence the development of neurological deficiencies at immediate postoperative time and the proposed myelography technique, via cisterna magna, presents limitations in evaluating alterations of the spinal cord at the thoracolumbar region. / O objetivo deste trabalho foi investigar se a manipulação cirúrgica da medula espinhal em cães submetidos à hemilaminectomia toracolombar dorsolateral influencia no aparecimento de sinais neurológico e mielográfico no pós-operatório imediato. Para isto, foram utilizados quatorze cães hígidos, sem raça definida, pesando entre 7 e 10 quilos e submetidos à hemilaminectomia entre as vértebras T13 e L1 e distribuídos aleatoriamente em três grupos, denominados de GI ou controle (n= 4), GII ou 15 movimentos (n=5) e GIII ou 30 movimentos (n=5). Os cães do GI foram submetidos apenas à técnica cirúrgica de hemilaminectomia dorsolateral toracolombar, lado esquerdo. Os cães dos GII e GIII foram submetidos ao mesmo procedimento do GI seguido, respectivamente, de 15 e 30 movimentos sobre as superfícies dorsal, lateral esquerda e ventral da medula espinhal. Foram realizados exames neurológicos 24 e 72 horas após a cirurgia e decorridos estes períodos, os cães foram submetidos à mielografia para avaliar o preenchimento e desvio da linha de contraste no espaço subaracnóide. Os resultados das avaliações mielográficas nas posições lateral e ventro-dorsal não apresentaram diferença significativa, mesmo havendo variação entre os grupos. No exame neurológico, os animais não demonstraram deficiências neurológicas em nenhum dia de avaliação no PO. De acordo com o modelo experimental proposto e dos resultados obtidos, pode-se concluir que a manipulação cirúrgica da medula espinhal em cães hígidos submetidos à hemilaminectomia toracolombar não influencia no aparecimento de deficiências neurológicas no pós-operatório imediato e a técnica proposta de mielografia, via cisterna magna apresenta limitações em avaliar alterações da medula espinhal na região toracolombar.

The objective of this prospective pilot study is to assess the feasibility of a minimally invasive, integrated endoscopic hemilaminectomy in chondrodystrophic dogs with clinically relevant Hansen type 1 intervertebral disc extrusion (IVDE). Study subjects included five client-owned chondrodystrophic dogs under 15kg with an acute, single site IVDE between T10 and L5 of less than 90 days duration and no loss of deep pain perception. The extent of the extrusion could not exceed 2/3 the diameter of the cannula to be used as defined by magnetic resonance imaging (MRI). A postoperative MRI was performed to assess remaining spinal cord compression. If significant compression remained, patients returned to surgery for a standard, open hemilaminectomy. Only the first dog required conversion to an open approach which resulted in adequate decompression. The same dog had a significant surgical complication of iatrogenic damage to the spinal cord during the minimally invasive approach. The other 4 dogs had no complications and achieved adequate spinal cord decompression. Three dogs eventually returned to normal neurologic status and another was improved compared to presentation. One dog was euthanized for reasons unrelated to IVDE. The authors conclude that a minimally invasive, integrated endoscopic hemilaminectomy is a feasible approach and can allow for adequate decompression of the spinal cord secondary to acute, single-site extrusion. Endoscopic approaches have a steep learning curve and extra care is required in the learning phase to avoid complications. Further studies are warranted to compare the safety and efficacy of this technique to a standard approach. / Master of Science / Acute intervertebral disc extrusion, or "slipped disc", is a common spinal emergency in dogs, particularly in small, chondrodystrophic breeds like dachshunds. Surgery is aimed at removing the disc material causing spinal cord compression. The traditional approach, known as a hemilaminectomy, involves elevating the muscles along the spine over multiple vertebrae, followed by creating a window in the bone with a surgical burr. Minimally invasive spinal surgery that minimizes the elevation of muscles, has the potential to decrease postoperative pain, surgical time, hospital stay, intraoperative blood loss and recovery time. This study was designed to assess the use of a minimally invasive, integrated endoscopic approach to a hemilaminectomy in clinical patients. Five dogs were enrolled with an acute, single site intervertebral disc extrusion between T10 and L5 that was no more than 2/3 the diameter of the cannula to be used in surgery. Study subjects were chondrodystrophic breeds under 15kg. All dogs had intact deep pain perception. Spinal cord compression was assessed by magnetic resonance imaging (MRI) both before and after a minimally invasive approach. If significant acute compression remained, a standard, open approach was immediately performed. Spinal cord decompression was adequate in all but one dog which required a second procedure to remove the remaining material. This same dog had accidental damage to the spinal cord during the minimally invasive approach. Three dogs eventually returned to normal neurologic status and the dog that required a second, traditional approach surgery eventually improved compared to his preoperative status. One dog was improving but euthanized eight days later due to chronic disease unrelated to IVDE. This approach is feasible for decompressing the spinal cord after a single site, acute intervertebral disc extrusion in a chondrodystrophic dog. However, like any endoscopic surgery, previous experience is of great benefit and errors are more likely to happen during the learning phase.