Every week, the BVNS neurologists, residents and interns convene to discuss a human or veterinary neurology/neurosurgery article.
NeuroBites is a digestible synopsis written by Dr. Bush of the article covered in journal club.
Welcome to NeuroBites.
Medl SC, Reese S, and Medl NS. Individualized mini-hemilaminectomy-corpectomy (iMHC) for treatment of thoracolumbar intervertebral disc herniation in large breed dogs. Veterinary Surgery. 2017;46:422-432. doi:10.1111/vsu.12616
Click HERE for the full article.
Dr. Barker reported on a procedure she is doing that is much better than what we used to do. I applaud her innovation and that of BVNS for adopting this better surgical method. We have practiced this procedure in one of our surgery labs.
The punchline is that for large breed dogs, a mini-hemilaminectomy with a partial lateral corpectomy yielded excellent results in a study of 57 days (I will explain this innovation below).
- 90.6% successful outcome typically with just 2 days of hospitalization
- Recurrence rates were 14%
- 95% of owners said they would opt for the same surgery or do another surgery if needed
Why is this so important?
The dogs in this study were all large breed dogs (greater than 18 kg) and this population typically does not do all that well with the typical hemilaminectomy surgery.
What did we used to do that was not so great?
If you imagine that the spinal cord is surrounded in all 4 sides by a boney box – we used to do a hemilaminectomy where we removed the side of the box. Although this procedure is a little destabilizing and can lead to scar formation, it worked well when all the disk was on the side of the spinal cord. HOWEVER, most disks are a little on the side and a lot under the spinal cord – so this surgery required spinal cord manipulation to remove the disk. Many dogs would get worse from this manipulation and some would not get better.
What does Dr. Barker (and BVNS) do now that is so innovative and similar to this paper?
We remove the lower corner of the box (mini-hemilaminectomy) and about half of the bottom of the box so we can remove the disk extrusion directly without manipulating the spinal cord. This does not destabilize or lead to scar formation and as this paper reports, leads to excellent results.