RU2822325C2 - Method for partial lateral corpectomy in dogs with chronic discopathies - Google Patents

Abstract

FIELD: medicine; veterinary science.

SUBSTANCE: invention refers to veterinary medicine, particularly to veterinary vertebrology and veterinary surgery, and can be used for partial lateral corpectomy in dogs with chronic discopathies. Portion of the vertebral body is resected depending on the localization of the hernia in the spinal canal with the localization of chronic extrusion/protrusion cranial to the intervertebral disc; the cut is made in the body of the cranial vertebra only. When localized above the disc or caudal to it - only in the body of the caudal vertebra, wherein the dorsal edge of the kerf corresponds to the base of the spinal canal, the depth of the kerf corresponds to the sagittal plane of the vertebral body with ventrolateral protrusion of the intervertebral disc or half of the spinal canal with its ventromedial protrusion. Following proportions are used to form the saw cut: 1/4 of the length of the caudal vertebral body for the caudal edge, 1/4 of the length of the cranial vertebral body for the cranial edge, 1/2 of the width of the vertebral body for depth and 1/2 of the height of the vertebral body for the lower edge of the cut.

EFFECT: method provides reducing traumatism, time of surgical intervention, period of postoperative recovery and recovery of neurological deficits on pelvic extremities due to application of modified partial-lateral corpectomy.

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Description

The invention relates to veterinary medicine, in particular to veterinary vertebrology and veterinary surgery.

Intervertebral disc degeneration is a natural and inevitable part of aging and results in a series of progressive disorders of the intervertebral disc structure in humans and animals. However, this degenerative process has minimal clinical significance if extrusion/protrusion of the intervertebral disc does not lead to damage to the spinal cord or roots and the development of neurological pathologies. A number of studies have been devoted to the treatment of discopathy in dogs [2,5]. However, there is virtually no data on the treatment of chronic discopathy. In connection with the above, the development of a method for surgical correction of this pathology is relevant.

There are various methods of surgical correction of this pathology, such as dorsal laminectomy, hemilaminectomy, mini-hemilaminectomy, foraminotomy are the surgical treatment of choice for dogs with chronic extrusion/protrusion of the intervertebral disc causing mild to severe neurological deficits [6,7,8]. But the above-mentioned surgical procedures do not provide sufficient visualization of the extruded/protruded intervertebral disc causing compression of the spinal cord and located ventrally without manipulation of the spinal cord and can cause iatrogenic injury, the complete removal of which is almost impossible.

There are many patented methods of treatment and prevention for pathologies of the spinal column in animals, in particular dogs, but there is no modern data on methods of surgical treatment for chronic extrusion/protrusion of the intervertebral disc in dogs.

There is a known method for treating spinal column injuries in the thoracic and lumbar regions in dogs and cats (RF Patent No. 149172, published on December 20, 2014), but it is intended for the treatment of spinal column injuries only.

The closest analogue of the claimed invention is a method for the treatment of herniated intervertebral discs in dogs (RF Patent No. 2535005, published on December 10, 2014), including the treatment of hernia in dogs using a 3-5.5% aqueous solution of lithium chloride at a rate of 2.5-3. 5 mmol/kg body weight of the animal intravenously. However, this method is intended for drug treatment of this pathology.

Partial lateral corpectomy was first described in foreign literature [4, 9]; it is one of the methods of surgical intervention in dogs with chronic extrusion/protrusion, but does not allow to accurately determine the localization of surgical transosseous access in relation to chronic extrusion/protrusion of the intervertebral disc. Due to the lack of precise landmarks, when performing classical partial-lateral corpectomy, a greater volume of trauma is still observed with a greater degree of damage to soft tissue and bone structures during surgery, which also affects the instability of the spinal column and recovery in the postoperative period.

The technical result of the claimed invention is the reduction of injuries and the transition to minimally invasive interventions during surgical correction of chronic extrusion/protrusion in the thoracolumbar spine using a modified partial-lateral corpectomy.

Surgical correction for chronic extrusion/protrusion according to the claimed method is carried out under general anesthesia as follows:

1. Based on the results of MRI diagnostics, the segment of the spinal column and the exact localization of extrusion/protrusion of the intervertebral disc are determined for surgical intervention.

2. The animal is placed in a thoracic position with the body tilted 45 degrees towards the surgeon. An incision of the skin 5-9 cm long, subcutaneous tissue, thoracolumbar fascia, longissimus dorsi and multifidus muscles is made layer by layer, 2-3 cm away from the spinous processes, then without visualizing the articular processes and completely exposing the accessory process, by bluntly disconnecting the muscles from the bone basics.

3. After surgical access to the vertebrae and accessory process, a cut is made using a high-speed neurosurgical cutter.

4. The cut is made in the body of either the cranial or caudal vertebra, depending on the location of the intervertebral disc herniation. When the intervertebral disc herniation is localized cranial to the disc, cuts are made in the body of only the cranial vertebra, and when the intervertebral disc herniation is localized above the disc or caudal to the disc, only in the body of the caudal vertebra.

5. The dorsal edge of the cut corresponds to the base of the spinal canal. The depth of the cut corresponds to the sagittal plane of the vertebral body with ventrolateral protrusion of the intervertebral disc or half of the spinal canal with its ventromedial protrusion. To form the cut, the following proportions are followed: 1/4 the length of the caudal vertebral body for the caudal edge, 1/4 the length of the cranial vertebral body for the cranial edge, 1/2 the width of the vertebral body for depth and 1/2 the height of the vertebral body for the lower edge of the cut.

6. When the depth of the cut is reached below the spinal cord, it is expanded cranially and caudally, depending on the size of the hernia, the formed septum, and it is prolapsed using a raspator.

The use of the described method of surgical correction for chronic extrusion/protrusion in the area of the thoracolumbar spine in dogs allows to reduce trauma to soft tissues and bone structures, the time of surgical intervention, the period of postoperative recovery and restoration of neurological deficits in the pelvic limbs.

Conducted at the Department of Veterinary Surgery of the Federal State Budgetary Educational Institution of Higher Education MGAVMiB-MVA named after. K.I. Scriabin's studies of the effectiveness of this method on 62 clinically sick animals made it possible to determine the effectiveness of its use in chronic extrusion/protrusion in the area of the thoracolumbar spinal column in dogs. It has been established that the effectiveness of this technique is 85%.

Clinical examples of using the technique:

Clinical example No. 1

Dog, dachshund breed, 7 years old, weight 7 kg. Diagnosis: Chronic extrusion at the Th13-L1 level without pronounced lateralization. Griffiths grade 3 neurological deficit. The animal was placed in a thoracic position with the body tilted 45 degrees towards the surgeon. A 5 cm long incision was made in the skin, subcutaneous tissue, thoracolumbar fascia, longissimus dorsi and multifidus muscles layer by layer, departing 2-3 cm from the spinous processes, then without visualizing the articular processes and completely exposing the accessory process by bluntly disconnecting the muscles from the bone base.

After surgical access to the vertebrae and the accessory process, a cut was made using a high-speed neurosurgical cutter.

The cut was made in the arch and body of the caudal part of the cranial vertebral body (Th13), due to the localization of the extrusion cranial to the intervertebral disc Th13-L1. After reaching the required depth below the spinal cord in the Th13 vertebral body, the cut was expanded cranially to the required size to prolapse the resulting septum (extrusion) using a raspator.

On the 3rd day after surgery, a neurological deficit of the 2nd degree was observed, and on the 7th day there was no neurological deficit.

Clinical example No. 2

Dog, German Shepherd breed, 9 years old, weight 37 kg. Diagnosis: Chronic protrusion at the L2-L3 level without pronounced lateralization.

Neurological deficit grade 4 according to Griffiths. The animal was placed in a thoracic position with the body tilted 45 degrees towards the surgeon. A 9 cm long incision was made in the skin, subcutaneous tissue, thoracolumbar fascia, longissimus dorsi and multifidus muscles layer by layer, 2-3 cm away from the spinous processes, then without visualizing the articular processes and completely exposing the accessory process by bluntly disconnecting the muscles from the bone base.

After surgical access to the vertebrae and the accessory process, a cut was made using a high-speed neurosurgical cutter.

The cut was made in the arch and body of the caudal part of the cranial body of the L2 vertebra, due to the localization of the extrusion caudal to the L2-L3 intervertebral disc. After reaching the required depth below the spinal cord in the L3 vertebral body, the cut was expanded cranially to the required size to prolapse the resulting septum (protrusion) using a raspator.

On the 5th day after surgery, a neurological deficit of the 3rd degree was observed, and on the 7th day, a neurological deficit of the 2nd degree and on the 14th day, no neurological deficit was observed.

Bibliography

1. Pat. RU 2 535 005 U1, MPK A61K 31/25. Method for the treatment of herniated intervertebral discs in dogs / Kozlov N.A.; applicant and patent holder N.A. Kozlov; application 2013.06.11; publ. 2014.12.10; Effective date: 2014.12.10 – 1 s.

2. Kozlov, N. A. Development and substantiation of methods for diagnosis and treatment of dogs with intervertebral disc herniations: dissertation of the Doctor of Veterinary Sciences: 02/06/04 Moscow, 2013. - 351 pp.: ill.

3. Pat. RU 2 481 790 C1, IPC A61B 6/00. A method for predicting the likelihood of developing post-traumatic changes in the sacroiliac joint in dogs / Slesarenko N.A., Krasnov V.V.; applicant and patent holder N.A. Slesarenko, V.V. Krasnov; application 2011.12.27; publ. 2013.05.27; Effective date: 2013.05.27 – 1 s.

4. Pat. RU 149172 U1, IPC A61B 17/56. Method for the treatment of spinal column injuries in the thoracic and lumbar region in dogs and cats/ Kiselev I.G.; applicant and patent holder I.G. Kiselev; application 2014.07.21; publ. 2014.12.20; start of action: 2014.12.20 – 1 s.

5. Sotnikov V.V. Diagnosis and surgical treatment of discopathy of the thoracolumbar spine in dogs. Abstract of dissertation. candidate of veterinary sciences. M.: 2008. p. 30.

6. Forterre, F., Gorgas D., Dickomeit M. et al: Incidence of spinal compressive lesions in chondrodystrophic dogs with abnormal recovery after hemilaminectomy for treatment of thoracolumbar disc disease: a prospective magnetic resonance imaging study. Vet Surg 2010;39:165–172.

7. Kozlov N.A. Biomechanics of vertebral column after performing modified partial lateral corpectomy / N.A. Kozlov, A.A. Oleshkevich, B. Bhattarai, S.V. Pozyabin // RAD Conf. Proc, vol. 4, 2020, pp. 113–117.

8. Kozlov N. Surgical management of intervertebral disc extrusion in a rabbit / N. Kozlov, S. Pozyabin, B. Bhattarai, T. Lipták, J. Fuchs, S. Marešová, M. Kuricová // Journal of Small Animal Practice. -2022.- p. 24-28 DOI: 10.1111/jsap.13496.

9. Moissonnier, P, Meheust, P, Carozzo, C. Thoracolumbar lateral corpectomy for treatment of chronic disk herniation: technique description and use in 15 dogs. VetSurg.2004;33:620–628.

Claims (1)

A method of performing partial lateral corpectomy in dogs with chronic discopathy, which consists of performing a surgical operation to remove the hernial contents, characterized in that part of the vertebral body is resected depending on the location of the hernia in the spinal canal when the chronic extrusion/protrusion is localized cranial to the intervertebral disc, the cut is carried out in the body of only the cranial vertebra, when localized above the disc or caudal to it - only in the body of the caudal vertebra, while the dorsal edge of the cut corresponds to the base of the spinal canal, the depth of the cut corresponds to the sagittal plane of the vertebral body with ventrolateral protrusion of the intervertebral disc or half of the spinal canal with its ventromedial protrusion, to form the cut, the following proportions are followed: 1/4 the length of the caudal vertebral body for the caudal edge, 1/4 the length of the cranial vertebral body for the cranial edge, 1/2 the width of the vertebral body for depth and 1/2 the height of the vertebral body for the lower edge of the cut.