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

Authors: 
Jeffery ND, Mankin JM, Ito D, Boudreau CE, Kerwin SC, Levine JM, Krasnow MS, Andruzzi MN, Alcott CJ, Granger N
Vet Surg. 2020 Apr 11. doi: 10.1111/vsu.13423.

OBJECTIVE: To report recovery of ambulation of dogs treated with extended thoracolumbar durotomy for severe spinal cord injury caused by intervertebral disc herniation.

STUDY DESIGN: Descriptive cohort.

ANIMALS: Twenty-six consecutive paraplegic dogs presented with loss of deep pain sensation after acute thoracolumbar intervertebral disc herniation.

METHODS: 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.

RESULTS: 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%.

CONCLUSION: Extended durotomy seemed to improve the outcome of dogs in our case series without increase in morbidity.

CLINICAL SIGNIFICANCE: 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.

Small animal: