Cervical Laminectomy for the Treatment of Chronic Caudal Cervical Spondylomyelopathy in a Dog

 Background: Cervical spondylomyelopathy (CSM) is a common disease of the cervical spine, and causes neurogenic disorders commonly diagnosed in large and giant breeds dogs. There are many surgical procedures proposed for the treat­ment of CSM. Although many authors report a high success rate (between 70% and 90%) after surgical procedures, the high number of techniques described reflects the difficulty in treating this disorder. The objective of this paper is to report a case of CSM with chronic ventral compression (intervertebral disc extrusion) that was treated with dorsal decompres­sion, and to demonstrate the effectiveness of the decompressive technique through pre- and post-operative myelograms.Case: A 9-year-old Doberman Pinscher dog weighing 41.8 kg presented due to a history of tetraparesis. Neurological exami­nation did not reveal any alteration in mental status. There was absence of conscious proprioception on the four limbs; the pelvic limbs were more severely affected. Bilateral patellar hyperreflexia and normal flexor withdrawal reflex were observed on the hind limbs. There was decreased flexor withdrawal reflex and increased extensor tone on the forelimbs. The patient exhibited pain during caudal cervical palpation, and no alterations were seen on the cutaneous trunci reflex. Superficial pain was absent in the hind limbs; forelimbs exhibited presence of motor function with severe paresis. Survey radiographs revealed intervertebral disc space narrowing between C6-C7. A myelogram revealed ventral and dorsal compressions of the spinal cord in the C6-C7 area. Surgical treatment was elected, and laminectomy of the sixth and seventh cervical vertebrae was performed. Improvements were progressive on evaluations made on the seventh, eighteenth, forty-fifth, and sixtieth days after surgery. On the forty-fifth day after surgery, the patient was able to walk with the aid of a support sling, but was incapable of standing and walking without help. Muscle atrophy and paresis progressively improved up to the sixtieth day after surgery, but such improvement was not enough for the patient to get up and walk without the aid of the sling. In view of the evolution of the clinical signs during the post-operative period, another myelogram was performed to check if the extruded intervertebral disc, which was not removed during laminectomy, was still causing spinal cord compression. In comparison to the first myelogram, the compression was significantly attenuated by the surgical procedure. In this examination, the contrast medium columns were minimally compromised by the presence of herniated material; because of that, we opted not to perform a second surgical intervention for removal of herniated disc content.Discussion: Cervical laminectomy is indicated primarily for cases of dorsal compression associated with osteoarthritic changes of facet joints, malformation of the dorsal lamina, or ligamentum flavum hypertrophy however, this technique has also been used to treat ventral compressions, especially if they are multiple. There are no reports of direct comparison between laminectomy and other surgical techniques for the treatment of chronic ventral compressions; consequently, the choice of the technique depends on the surgeon’s experience and preference. Some authors argue that cervical laminec­tomy is not enough to attenuate the compression caused by the disc because this technique does not allow removal of the herniated disc material located ventrally. However, in the case reported here, a comparison between pre- and postopera­tive myelograms revealed that even though the herniated material was not removed, dorsal decompression allowed dorsal dislocation of the spinal cord and, consequently, promoted considerable attenuation of ventral compression.Keywords: Wobbler syndrome, nervous system, spinal cord, cervical vertebrae

Cervical Laminectomy for the Treatment of Chronic Caudal Cervical Spondylomyelopathy in a Dog

 Background: Cervical spondylomyelopathy (CSM) is a common disease of the cervical spine, and causes neurogenic disorders commonly diagnosed in large and giant breeds dogs. There are many surgical procedures proposed for the treat­ment of CSM. Although many authors report a high success rate (between 70% and 90%) after surgical procedures, the high number of techniques described reflects the difficulty in treating this disorder. The objective of this paper is to report a case of CSM with chronic ventral compression (intervertebral disc extrusion) that was treated with dorsal decompres­sion, and to demonstrate the effectiveness of the decompressive technique through pre- and post-operative myelograms.Case: A 9-year-old Doberman Pinscher dog weighing 41.8 kg presented due to a history of tetraparesis. Neurological exami­nation did not reveal any alteration in mental status. There was absence of conscious proprioception on the four limbs; the pelvic limbs were more severely affected. Bilateral patellar hyperreflexia and normal flexor withdrawal reflex were observed on the hind limbs. There was decreased flexor withdrawal reflex and increased extensor tone on the forelimbs. The patient exhibited pain during caudal cervical palpation, and no alterations were seen on the cutaneous trunci reflex. Superficial pain was absent in the hind limbs; forelimbs exhibited presence of motor function with severe paresis. Survey radiographs revealed intervertebral disc space narrowing between C6-C7. A myelogram revealed ventral and dorsal compressions of the spinal cord in the C6-C7 area. Surgical treatment was elected, and laminectomy of the sixth and seventh cervical vertebrae was performed. Improvements were progressive on evaluations made on the seventh, eighteenth, forty-fifth, and sixtieth days after surgery. On the forty-fifth day after surgery, the patient was able to walk with the aid of a support sling, but was incapable of standing and walking without help. Muscle atrophy and paresis progressively improved up to the sixtieth day after surgery, but such improvement was not enough for the patient to get up and walk without the aid of the sling. In view of the evolution of the clinical signs during the post-operative period, another myelogram was performed to check if the extruded intervertebral disc, which was not removed during laminectomy, was still causing spinal cord compression. In comparison to the first myelogram, the compression was significantly attenuated by the surgical procedure. In this examination, the contrast medium columns were minimally compromised by the presence of herniated material; because of that, we opted not to perform a second surgical intervention for removal of herniated disc content.Discussion: Cervical laminectomy is indicated primarily for cases of dorsal compression associated with osteoarthritic changes of facet joints, malformation of the dorsal lamina, or ligamentum flavum hypertrophy however, this technique has also been used to treat ventral compressions, especially if they are multiple. There are no reports of direct comparison between laminectomy and other surgical techniques for the treatment of chronic ventral compressions; consequently, the choice of the technique depends on the surgeon’s experience and preference. Some authors argue that cervical laminec­tomy is not enough to attenuate the compression caused by the disc because this technique does not allow removal of the herniated disc material located ventrally. However, in the case reported here, a comparison between pre- and postopera­tive myelograms revealed that even though the herniated material was not removed, dorsal decompression allowed dorsal dislocation of the spinal cord and, consequently, promoted considerable attenuation of ventral compression.Keywords: Wobbler syndrome, nervous system, spinal cord, cervical vertebrae

Bilateral Double-Pigtail Ureteral Stent Placement for Management of Ureteral Obstruction Secondary to Transitional Cell Carcinoma in a Dog

Background: Transitional cell carcinoma (TCC) usually affects the trigone region of the bladder and proximal portion of the urethra. TCC in dogs is often complicated by local tumor invasion and obstruction of the urethra, ureters, or both. Urinary obstruction is the cause of death in approximately 60% of dogs with TCC. Radical surgeries are associated with morbidity and mortality rates. Stents have recently been evaluated for use in dogs with ureteral obstruction resulting from a variety of urinary tract tumors. This report aims to describe bilateral ureteral stent placement for treatment of malignant ureteral obstruction and long-term follow-up in a dog.Case: An 11‐year‐old female spayed Maltese with ureteral obstruction secondary to transitional cell carcinoma (TCC) in the bladder trigone. After palliative debulking procedure and diagnostic of TCC in bladder and NSAIDs treatment, recurrence has occurred causing ureteral obstruction and TCC had invaded the abdominal wall. Abdominal wall local tumor resection, trigone mass debulking and bilateral ureteral stent placement was made. A double-pigtail ureteral stent of appropriate length was advanced to bypass the ureteral obstruction. Stent sizes were 3.5 Fr in diameter and from 8 to 32 cm in length. The patient underwent surgical resection of the transitional cell carcinoma in the abdominal wall. The correct location of the bilateral ureteral pigtail stent was certified by abdominal radiography. Recovery was uneventful and the dog was discharged 2 days after surgery. Eleven months after stent placement, the dog developed lumbar vertebrae metastasis, without evidence of recurrent ureteral obstruction. The owners elected euthanasia 517 days after original presentation and 337 days after ureteral stent placement. Euthanasia was unrelated to the local tumor obstruction but was related to the bone metastasis.Discussion: Ureteral stent placement is feasible techniques for treatment of bladder TCC in dogs, with the objective of delaying the evolution of the disease and preventing ureteral obstruction. According to previous studies, although distant metastatic disease is worrisome, in the majority of dogs with bladder TCC, the primary location of the tumor is the most common cause of death. In patients with ureteral obstruction, early intervention preserves functional renal tissue. Thus, relief of obstruction should be recommended as soon as possible before irreversible renal damage occurs. The authors encourage aggressive and timely intervention, particularly when ureteral obstruction is bilateral. In the present report, 90 days postoperatively local recurrence causing ureteral obstruction was not evidenced on bladder ultrasound images and laboratory test follow-up. After this period, until 180 days after debulking surgery, tumor recurrence occurred, causing clinical signs and compromising renal function. Complications associated with stent placement included stent migration, recurrent ureteral obstruction, stranguria/pollakiuria, presumably due to irritation of the trigonal region from the distal stent; imperfect stent location; ureteral trauma during stent placement; and urinary tract infection. In the present report, the ureteral stents were placed for palliative treatment for malignant ureteral obstructions. Although urinary tract infection was recurrent, other complications associated with bilateral ureteral stent did not occur, such as accidental dislocation or stent obstruction by the tumor. The results obtained were satisfactory for urinary tract obstruction, allowing survival of 517 days. These findings may support long-term ureteral stenting in veterinary patients

Ureteral Stent Placement Using a Double J-Catheter in the Treatment of Ectopic Ureter in a Dog

Background: Ectopic ureter is a congenital anomaly in which the final segment of one or both ureteral orifices is located distal to the bladder trigone. It may be classified as intra- or extramural. Surgical treatment of ectopic ureters in dogs is recommended and the approach varies with the classification. In the postoperative period, complications are common. When stenosis of the new ureteral ostium occurs, immediate repeated surgery is recommended. This study aimed at using the double J catheter placement following neoureterostomy to treat urethral obstruction secondary to the surgical treatment of an intramural ectopic ureter in a dog.Case: An 8-month-old female French bulldog with dysuria and urinary incontinence was seen at a private veterinary hospital in Jaboticabal, São Paulo. The patient had previously been diagnosed with an intramural ectopic ureter on the right side following imaging tests (ultrasound, computed tomography, and abdominal radiography, excretory urography) and had undergone neoureterostomy and closure of the intramural pathway approximately a year ago. Ultrasonographic examination showed dilation of the caudal portion of the ureter and hydroureter, which was suggestive of right ureteral stenosis. Computed tomography was also performed to evaluate the kidneys, ureters, and bladder; an increase in the diameter of the right ureter in its middle portion and close to the bladder triangle was observed. A new surgical intervention was indicated and performed. The ureteral route was identified in a region of the bladder trigone, incised, and probed with a urethral probe No. 04. The intramural course in the proximal urethra was identified and probed with a 16G epidural catheter. It was necessary to perform a neoureterostomy. A longitudinal incision (spatulation) of approximately 5 mm was made in the distal portion of the right ureter to increase the circumference of the anastomosis. The double J 4.7 French (Fr) catheter was inserted through the new ureter ostium into the bladder and advanced into the right kidney in a retrograde manner. Once the proximal end of the double J catheter reached the renal pelvis, the guidewire was withdrawn slowly to allow the catheter to bend in the areas of the renal pelvis and the trigone. The distal end of the double J catheter that extended beyond the bladder lumen was sectioned for better bladder closure. The patient underwent clinical evaluation and laboratory tests (complete blood count and serum creatinine concentration, urine test with bacteriological culture and susceptibility test) 2 weeks after the procedure and, subsequently, every 3 months. Ultrasonography of the urinary tract was performed every 2 months.Discussion: We used a double J catheter in the patient due to a previous obstruction of the ureter ostium after the first surgical procedure. In this way, complications such as postoperative obstructions due to ureteritis and ureteral constriction were avoided and ureteral anastomosis was facilitated. It has been reported that animals subjected to ureteral stent placement have high incidences of dysuria and urinary tract infection, and low incidences of stent migration and occlusion. In this case, no signs of occlusion or obstruction of the implant were identified, but there was a recurrence of urinary tract infections. These frequently cause urethral obstruction associated with the healing of the new ureteral ostium. Patient follow-up and findings associated with the long-term insertion of the double J catheter provide support for the clinical relevance of the present report

Comparative evaluation of three laparoscopic cholecystectomy techniques in rabbit’s model

ABSTRACT Purpose: The aim of this randomized study was to compare the complications and perioperative outcome of three different techniques of laparoscopic cholecystectomy (LC). Changes in the liver function test after LC techniques were investigated. Also, we compared the degree of postoperative adhesions and histopathological changes of the liver bed. Methods: Thirty rabbits were divided into three groups: group A) Fundus-first technique by Hook dissecting instrument and Roeder Slipknot applied for cystic duct (CD) ligation; group B) conventional technique by Maryland dissecting forceps and electrothermal bipolar vessel sealing (EBVS) for CD seal; group C) conventional technique by EBVS for gallbladder (GB) dissection and CD seal. Results: Group A presented a longer GB dissection time than groups B and C. GB perforation and bleeding from tissues adjacent to GB were similar among tested groups. Gamma-glutamyl transferase and alkaline phosphatase levels increased (p ≤ 0.05) on day 3 postoperatively in group A. By the 15th postoperative day, the enzymes returned to the preoperative values. Transient elevation of hepatic transaminases occurred after LC in all groups. Group A had a higher adherence score than groups B and C and was associated with the least predictable technique. Conclusions: LC can be performed using different techniques, although the use of EBVS is highly recommended