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Dorsal laminectomy for treatment of cervical vertebral stenotic myelopathy in an alpaca

W. H. J. BarkerDepartment of Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, Hertfordshire AL9 7TA, England.

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T. H. WitteDepartment of Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, Hertfordshire AL9 7TA, England.

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C. J. DriverDepartment of Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, Hertfordshire AL9 7TA, England.

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P. JullDepartment of Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, Hertfordshire AL9 7TA, England.

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C. E. WhiteheadCamelid Veterinary Services, The Old Barracks, Lady Grove Road, Goring Heath, Reading RG8 7RU, England.

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H. A. VolkDepartment of Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, Hertfordshire AL9 7TA, England.

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Abstract

Case Description—An 11-year-old male breeding alpaca was evaluated for a 2-day history of lowered head carriage and lethargy.

Clinical Findings—On initial examination, the alpaca had signs of lethargy and lowered carriage of the head and neck, but no specific neurologic deficits. Medical management improved the clinical signs, but 8 months later, the alpaca developed acute, progressive general proprioceptive ataxia affecting all 4 limbs and was referred for further evaluation and treatment. Magnetic resonance imaging and CT identified disruption of the normal osseous architecture of C7 and T1. Medical management was attempted, but because of a lack of improvement, the patient underwent surgery 14 months after initial examination.

Treatment and Outcome—A dorsal laminectomy of C7 and T1 via a dorsal midline approach was performed, and the spinous processes of both vertebrae were removed prior to removal of the overlying lamina. Free dorsal expansion of the spinal cord was ensured by resection of the ligamentum flavum. Six months after surgery, the alpaca had returned to successful breeding with 7 hembra bred in the first year after surgery, producing 6 crias, and 4 crias in the second year. The patient was eventually euthanized 28 months after surgery because of neurologic deterioration but was still ambulatory at that time.

Conclusions and Clinical Relevance—A good outcome with adequate alleviation of clinical signs and breeding soundness for > 2 years following dorsal laminectomy was achieved in this camelid patient. The surgical approach was similar to that in other species and was associated with mild postoperative morbidity. Veterinarians treating camelids should be aware of the initial clinical signs and treatment options for cervical vertebral stenotic myelopathy. In acute cases, the signs of reduced cervical mobility and pain on manipulation should prompt investigation including appropriate diagnostic imaging. Timely surgical intervention should be considered in patients that respond poorly to medical treatment to avoid irreversible spinal cord injury and optimize outcome.

Abstract

Case Description—An 11-year-old male breeding alpaca was evaluated for a 2-day history of lowered head carriage and lethargy.

Clinical Findings—On initial examination, the alpaca had signs of lethargy and lowered carriage of the head and neck, but no specific neurologic deficits. Medical management improved the clinical signs, but 8 months later, the alpaca developed acute, progressive general proprioceptive ataxia affecting all 4 limbs and was referred for further evaluation and treatment. Magnetic resonance imaging and CT identified disruption of the normal osseous architecture of C7 and T1. Medical management was attempted, but because of a lack of improvement, the patient underwent surgery 14 months after initial examination.

Treatment and Outcome—A dorsal laminectomy of C7 and T1 via a dorsal midline approach was performed, and the spinous processes of both vertebrae were removed prior to removal of the overlying lamina. Free dorsal expansion of the spinal cord was ensured by resection of the ligamentum flavum. Six months after surgery, the alpaca had returned to successful breeding with 7 hembra bred in the first year after surgery, producing 6 crias, and 4 crias in the second year. The patient was eventually euthanized 28 months after surgery because of neurologic deterioration but was still ambulatory at that time.

Conclusions and Clinical Relevance—A good outcome with adequate alleviation of clinical signs and breeding soundness for > 2 years following dorsal laminectomy was achieved in this camelid patient. The surgical approach was similar to that in other species and was associated with mild postoperative morbidity. Veterinarians treating camelids should be aware of the initial clinical signs and treatment options for cervical vertebral stenotic myelopathy. In acute cases, the signs of reduced cervical mobility and pain on manipulation should prompt investigation including appropriate diagnostic imaging. Timely surgical intervention should be considered in patients that respond poorly to medical treatment to avoid irreversible spinal cord injury and optimize outcome.

Contributor Notes

Address correspondence to Dr. Witte (twitte@rvc.ac.uk).