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Comparison of the effect of single-site and multiple-site disk fenestration on the rate of recurrence of thoracolumbar intervertebral disk herniation in dogs

Brigitte A. Brisson DMV, DVSC, DACVS1, David L. Holmberg DVM, MVetSc, DACVS2, Joane Parent DMV, MVetSc, DACVIM3, William C. Sears MS, MSc4, and Sara E. Wick MSc, DVM5
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  • 1 Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada.
  • | 2 Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada.
  • | 3 Département de Sciences Cliniques, Faculté de Médecine Vétérinaire, Université de Montréal, St-Hyacinthe, QCJ2S 2M2, Canada.
  • | 4 Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada.
  • | 5 C.A.R.E. Centre Animal Hospital, 7140 12th St SE, Calgary, AB T2H 2Y4, Canada.

Abstract

Objective—To prospectively assess whether multiple-site disk fenestration decreases the incidence of recurrent thoracolumbar intervertebral disk herniation (IVDH), compared with single-site disk fenestration, in small-breed dogs treated for IVDH.

Design—Randomized controlled clinical trial.

Animals—207 client-owned dogs.

Procedures—Dogs undergoing decompressive surgery of the spinal cord because of thoracolumbar IVDH between 2001 and 2004 were randomly assigned to receive single-site disk fenestration at the level of surgical decompression (n = 103) or multiple-site disk fenestration of all disks from T11 through L4 (104). Follow-up consisted of complete reevaluation of patients, telephone surveys, and further surgery if signs indicative of recurrence occurred.

Results—189 dogs were available for long-term follow-up: 95 dogs in the single-site disk fenestration group and 94 in the multiple-site disk fenestration group. Twenty-four dogs developed 28 confirmed episodes of recurrent thoracolumbar IVDH. The rate for first-time recurrence was 12.7% (24/189). First-time recurrence rates for single-and multiple-site disk fenestration groups were 17.89% (17/95) and 7.45% (7/94), respectively. Dogs undergoing single-site disk fenestration were significantly more likely to have recurrent thoracolumbar IVDH than were dogs undergoing multiple-site disk fenestration. Disk mineralization at the time of first surgery was associated with recurrence, and 87.5% (21/24) of recurrences occurred at a disk space adjacent to or 1 disk away from the initial lesion. Regardless of disk fenestration group, 22 of 24 (91.7%) recurrences occurred at a nonfenestrated disk space.

Conclusions and Clinical Relevance—Multiple-site disk fenestration decreased the rate of recurrent IVDH in small-breed dogs, compared with the use of single-site disk fenestration.

Contributor Notes

Deceased.

Supported by the Ontario Veterinary College Pet Trust.

Presented as an oral presentation at the 27th Annual Forum of the American College of Veterinary Internal Medicine, Montreal, June 2009; at the 2010 American College of Veterinary Surgeons Veterinary Symposium, Seattle, October 2010; and at the European College of Veterinary Surgeons 19th Annual Scientific Meeting, Helsinki, July 2010.

The authors thank Kathryn Gyselinck for technical assistance.

Address correspondence to Dr. Brisson (bbrisson@uoguelph.ca).