Ventral Slot Surgery Recovery

Posted on 7/29/2022 admin

Disc Disease

(n = 31), caudal (n = 125) or both (n = 5) types of myelography at the same time, and surgery - ventral slot decompression (SLOT) (n = 18) or hemilaminectomy (n = 143). During the post-surgical period we observed seizures, GIT complications, cystitis, and surgical wound healing problems or even death of the patients.

Disc disease is most prevalent among small and toy breed dogs such as Dachshunds, Lhasa Apsos, Poodles, Beagles and Pekingese dogs. However, there is also a significant occurrence of disc disease in large and giant breed dogs such as Dobermans, Dalmations, Labradors, Mastiffs, St. Bernards, German Shepherds, Rottweilers, and Great Danes as well as cats! In the more prevalent smaller breeds, primarily due to genetic factors, the disc is prone to premature aging thus making them more likely to rupture even with minimal movements. In these genetically predisposed breeds the highest incidence of disc rupture occurs between three and six years of age. Intervertebral discs can rupture either in the middle-back (thoraco-lumbar region) or the neck (cervical spine). Different clinical signs in the effected patient will depend on the site of rupture and the amount of trauma associated with the disc rupture.

Dog presented for neck pain. A massive C3-4 disc was discovered. A C3-4 ventral slot is being live streamed at 4:00 pm. To compare the recovery times and complication rates between the standard ventral slot and the modified slanted ventral slot for the treatment of cervical disc disease in dogs with the same. The ventral slot technique when properly performed offers adequate spinal decompression, and fusion is expected to occur between 8 and 12 weeks after surgery.1 However, ventral decompression can be technically challenging and can exacerbate vertebral instability. A triple ventral slot decompression surgery was performed. The dog regained ambulation after surgery with only mild deficits remaining. © 2017, Israel Veterinary Medical Association.

The Disc: Anatomy and Pathology

A normal disc resembles a jelly-filled doughnut. The outer layer (the dough) is called the annulus and consists of a tough fibrous tissue that connects each of the spinal vertebrae together into a column. (Fig. 1) Due to the flexibility of the annular fibers, the vertebral column is able to flex and bend. The center of the intervertebral disc (the jelly) is called the nucleus and contains a viscous liquid.

Within degenerating discs (discs susceptible to rupture), the nucleus changes in consistency, becoming denser and more like toothpaste rather than jelly. Simultaneously, cracks will develop in the annulus: when these cracks become sufficiently large or sufficiently weaken the structure, the central nuclear material can herniate (squirt out), resulting in compression and damage to the spinal cord.

Even a small amount of ruptured nuclear material may cause your pet to experience mild to moderate back or neck pain with or without limb weakness (paresis) and unsteadiness (ataxia). Larger quantities of disc material expelled (extruded) at once and with extreme velocity, however, can cause acute loss of control of the legs (paralysis), sudden loss of bowel and bladder function and, in severe cases, difficulty breathing, abnormal heart rhythms and death.

The chance of your pet recovering from a ruptured disc depends on overall medical health, the number of previous episodes of pain or paralysis, and the length of time between the onset of the current problem and the intervention of veterinary care. The best indicator of return to good function is your pet’s neurologic status at the time of surgery.

Myelography

If your pet fails to respond sufficiently to non-surgical, medical management, surgery may be indicated. If so, radiographs (x-rays) and a myelogram are important diagnostic tools to identify the exact location of disc rupture.

A myelogram must be performed with the patient under general anesthesia. A spinal tap is performed and radio-opaque dye is injected around the spinal cord to make its shape visible on radiographs. Following the injection a series of radiographs may indicate which disc has ruptured and delineate the amount of compression of the spinal cord. (Fig. 2) The surgeon can then determine which type of surgical technique to use and where the surgical approach should take place.

Rarely, following a myelogram, a patient may have transient seizures (usually resolving with overnight monitoring and treatment). A more common side-effect of myelography is an increase in limb weakness that may last for as long as one to two weeks. More severe side effects are rare but possible. The benefits of myelography far outweigh these risks and this diagnostic modality still remains one of the most routine tests available to identify a ruptured disc. In some situations, myelograms are slowly being replaced by CT’s and MRI’s. (Figs 3 & 4) However, these alternatives are more expensive, they are not always available on an emergency basis, nights or weekends, and even with these advanced imaging techniques, radio-opaque dye injection may still be indicated.

Disc Surgery: Back

Often, pets with back pain only or minor spinal cord injury can benefit from a fenestration surgery. (Fig. 5) In this procedure, the surgeon cuts a window in the annulus of several discs in the back and removes the inner, abnormal nuclear material that is applying pressure to the spinal cord. This technique removes the nucleus from the currently rupturing disc as well as that of other discs that appear likely to rupture in the future. Unfortunately, this technique is rarely effective in patients with demonstrable disc extrusion.

Instead, paralyzed patients, or patients with demonstrable disc extrusion, are candidates for laminectomy surgery. (Fig. 6) This technique involves removing part of the bony vertebrae surrounding the region of damaged spinal cord. The material extruded from a ruptured disc is removed from around the spinal cord, thus relieving pressure and preventing further trauma. As the swelling in the cord gradually subsides following surgery, some nerve function returns to the legs. It is important to realize that recovery does not happen overnight, and that not all nerve function may recover.

Some pets suffer temporary setbacks in their neurologic status following surgery. These delays relate to the effects of the myelogram, manipulation of the spinal cord during surgery and the progressive swelling and damage from the initial disc rupture. While these setbacks are not usually permanent, they do prolong the patient’s postoperative rehabilitation and require additional efforts by owner, pet and veterinarian alike.

Disc Surgery: Neck

Once a cervical (neck) disc has ruptured, your pet will rarely improve without treatment or surgery. Often, there may be a reduction in the pain by administering anti-inflammatory medications and muscle-relaxants, but steroids are not recommended because of harmful side effects when used long-term. Surgical repair of ruptured cervical discs is generally quite successful.

After the specific ruptured disc is located by myelography or MRI, a ventral cervical slot procedure allows access to the spinal cord and removal of the extruded material. The ventral slot technique relieves pressure from the spinal cord and also fenestrates additional cervical discs to remove abnormal nuclear material and prevent at-risk discs from rupturing in the future. (Fig. 7) The annulus is left intact to stabilize the neck and to allow the vertebrae of the neck to move normally after surgery.

Similar to disc surgery in the back, inflammation and neck pain start to subside once the pressure on the spinal cord is relieved. Some nerve function should start to return and gradual recovery begins.

Postoperative Recovery and Care

After back surgery one should expect approximately four weeks of intensive home nursing care before clinicians may fully determine the outcome of the procedure. During this recovery phase your pet may not have bladder or bowel control and may have no or only partial movement of the limbs. Because of these conditions, the patient will require a great deal of assistance and attention. Our staff will provide you with complete instructions to assist you during this recovery period.

Many paralyzed pets start to move their legs in approximately two to four weeks time. Within four to eight weeks many will regain continence and start to walk. Some pets return to very good hind limb function, while others may have permanent impairments and wobble or have difficulty jumping for the remainder of their lives.

The primary goal of neck surgery is to relieve the pain caused by the ruptured disc and most pets also regain very good motor function. It is important to keep the patient quiet and confined for four weeks following surgery to help with healing and recovery. Again, temporary neurologic deficits may persist and, although generally they are not permanent, they may prolong postoperative rehabilitation.

In most cases the swelling and pain associated with a ruptured neck disc subside in two to four weeks. If nerve damage also exists, improvement may take four to eight weeks or longer. Decreasing doses of steroids may be administered during this transition to decrease inflammation and associated pain. Even with the most ideal surgical technique and recovery management, it is possible that your pet may not recover full function of the limbs or return to pre-injury functional status.

Remember, regardless of the location along the spine of a disc rupture, the very best indicator of your pet’s chances of recovering full functional status (walking and continence) is the neurologic status at the time of surgery. Fortunately, even pets that remain permanently paralyzed and incontinent, while challenging to care for, can live happy and healthy lives.

Conclusion

An accurate diagnosis and prognosis for surgical success can be made only after a thorough medical, physical and neurologic examination of your pet. We will discuss our findings and expectations with you to help make the best decisions for your family and for your friend. Please call Veterinary Surgical Centers with any questions or concerns about intervertebral disc disease in your pet.

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What is Cervical Ventral Slot?

When a dog experiences a slipped, ruptured, or herniated disc, damage from the displaced disc can result in injury to the spinal cord. This causes the hind legs to be weakened, sometimes to the point of paralysis. The disc compresses the root of the nerve, which is excruciatingly painful for the animal. Instances of lameness may be ongoing or may occur seemingly out of nowhere.

The deterioration of a disc can be the result of genetic issues or can develop from the regular aging process. To treat this issue, often surgery is needed to remove all damaged materials causing the pain. This procedure is called a cervical ventral slot surgery. In this operation, the spinal cord is drilled open and the deteriorated disc is taken out. This surgery may be paired with other treatments or procedures. It should only be performed by an ACVS board-certified veterinary surgeon.

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Pathophysiology

IVD DEGENERATION

Biochemically, the IVD consists of proteoglycans, glycoproteins, and both collagenous and noncollagenous proteins. In the immature dog, the composition of the nucleus pulposus is higher in proteoglycans and glycoproteins while the anulus fibrosus has a higher collagen content ( 7,68 ) (Figs. 62-2 through 62-4 ).

FIG-62-2 Mesenchymal tissue taken from the lumbar area of a canine fetus 30 days postfertilization At this stage, the notochord chord is present and intact. The spinal cord is developing at the top The notochord, at the site of the nucleus pulposus, is looped over The notochord cells are no longer dividing at this stage but are capable of producing matrix. Segments of the vertebral bodies, the nuclei pulposi, and the anuli fibrosi are identified. (Courtesy of Dr. w. H. Riser)

FIG. 62-3 Lumbar spine of a 35-day fetus, 5 days after Figure 62-2. The cavity of the nucleus pulposus is formed. The notochord has disappeared, the anulus fibrosus is more prominent, and the mesenchymal cells of the vertebral bodies have hypertrophied. (Courtesy of Dr. W. H. Riser)

FIG. 62-4 Lumbar spine of a l-week-old Great Dane. The vertebral epiphyses are composed Of cartilage, but ossification is beginning. Primary bony trabeculae have been formed, and blood vessels are present where they entered from the periphery of the midvertebral area. The structural components of the IVD, the anulus fibrosus, the nucleus pulposus cartilage lining of the nucleus pulposus cavity, and the notochord remnant cells are all well defined. (Courtesy of Dr. W. H. Riser)

FIG. 62-5 Lumbar spine of an aged beagle in which the notochord cells have been replaced entirely by chondroid cells. This nuclear material has ruptured the anulus fibrosus fibers and migrated both dorsally into the spinal canal and ventrally, causing the formation of spondolysis and osteophyte bridging of the adjoining vertebral bodies. (Courtesy of Dr. W. H. Riser)

FIG. 62-6 IVD and lumbar spine of a 12-year-old German shepherd. The nuclear chondroid material has ruptured the anulus fibers and migrated dorsally into the spinal canal and ventrally, causing the formation of spondolysis and osteophyte budging of the adjoining vertebral bodies. (Courtesy of Dr. W. H. Riser)

IVD PROTRUSION

Degenerative changes in the IVD begin at the periphery of the nucleus, proceed centrally, and are usually accompanied by degeneration of the anulus. As the dorsal anulus degenerates, the nucleus pulposus follows a path of least resistance and begins to protrude dorsally ( 23,28 ) ( Fig. 62-7 ). Other pathways of IVD protrusion (lateral, ventral) occur but may be less significant. ( 68 )

FIG. 62-7 Lumbar spine of a 4-year-old dachshund with hindlimb paresis in which the IVD is chondrometaplastic. Chondroid material is present in the spinal canal, causing injury to the spinal cord. The material has also migrated ventrally, causing spondolysis and osteophyte formation. (Courtesy of Dr. W. H. Riser)

FIG. 62-8 Hansen type I and type 2 IVD protrusions. (Redrawn after Shores A: Intervertebral disk syndrome in the dog: Part 1. Pathophysiology and management. The Compendium on Continuing Education for the Practicing Veterinarian 3:639-647, 1981)

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History

Acute adverse events associated with ventral slot decompression in 546 dogs with cervical intervertebral disc disease.

Rossmeisl JH Jr 1, White C , Pancotto TE , Bays A , Henao-Guerrero PN .

Author information

1Department of Small Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia.

Abstract

OBJECTIVE:

To report the frequency, types, and risk factors for acute perioperative adverse events (AEs) in dogs that had ventral slot decompression (VSD) for cervical intervertebral disc disease (IVDD).

DESIGN:

Retrospective, case-control study.

ANIMALS:

Dogs (n = 546) with cervical IVDD treated by VSD; 54 cases experiencing AE and 492 controls.

METHODS:

Historical, clinical, diagnostic, operative, and outcome data were collected. AE were graded using a Spine Adverse Events Severity (SAVES) system. Associations between the development of AE and hypothesized risk factors were analyzed using bi- and multi-variable analyses.

RESULTS:

CONCLUSIONS:

AE occurred in 9.9% of dogs that had VSD, and were significantly associated with perioperative hypotension, C7-T1 disc extrusions, surgeon experience, and NSAID usage. Identification of a major postoperative AE is an indication for immediate diagnostic imaging studies, as 50% of dogs experiencing major AE required reoperation.

PMID: 23980621 DOI: 10.1111/j.1532-950X.2013.12039.x [Indexed for MEDLINE] Share

Publication type, MeSH terms

Publication type

Research Support, Non-U.S. Gov't

MeSH terms

Animals
Case-Control Studies
Cervical Vertebrae/surgery
Decompression, Surgical/adverse effects
Decompression, Surgical/veterinary*
Dog Diseases/surgery*
Dogs
Female
Intervertebral Disc Displacement/surgery
Intervertebral Disc Displacement/veterinary*
Male
Postoperative Complications/veterinary*
Retrospective Studies
Risk Factors
Treatment Outcome

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Miscellaneous Indian Casino Near Manteca Ca Ventral slot - Wikipedia

Cervical Ventral Slot Prevention in Dogs

Dog breeds that carry a genetic deformity of the legs that causes them to be angled and shorter in height (called chondrodystrophy) experience disc deterioration much earlier than other breeds. Obtain the dog's family health history when purchasing the animal. Watch its movement closely during the first year to spot the first signs of disc herniation. Do not breed dogs that present with early intervertebral disc disease.

For aged dogs, preventing certain movements can help a weakened disc to heal. Keep the dog from jumping up onto furniture or other objects. Do not allow the dog to go up or down stairs if possible. Regular exercise that is not excessive has also been proven to help keep a dog's spine healthy. Dogs who are of appropriate weight experience less disc problems than overweight ones. Provide a high-quality and healthy diet for your animal.

Thank you Dr McDonnell, Dr Harris and Dr Langford! Sam is pain free and doing sooooo well!Sam is my 5 year old Chinese Crested dog... I adopted Sam about 2 years ago. He has always been such an awesome, high energy, active guy.... super agile, a big runner, jumper, sort of a crazy wildman! Sam is sweet to his family, but he hates the neighbors... he bites the chain link fence thinking he can get at them....but that biting of the fence, wild jumping, etc probably caused his issue.Recently, Sam had neck issues... his back was hunched up, he was crying constantly in pain, he would not eat and would not rest because the pain was so bad. It was horrible to see this high energy, healthy dog in agonizing pain.We visited his doc a few times - Dr Langford at Three Notch Veterinary Hospital, and he knew what the problem was right away. He was sure it was a cervical disc issue. We tried controlling his pain with meds, but it did not go any good....Dr Langford referred us to Veterinary Neurology of the Chesapeake, where we met Dr Harris and Dr McDonnell.We tried a few other meds, but it was recommended that Sam have an MRI to see what is causing all this pain....so we scheduled the MRI, and sure enough, it was a disc rupture between C3 and C4. Dr Harris said that Sam's condition would improve with surgery....so he stayed the night at the hospital and Dr McDonnell performed surgery the following afternoon.Veterinary Neurology of the Chesapeake has an awesome staff working around the clock. I was updated constantly about Sam's condition as he started his recovery.... Ryan, Dr McDonnell's vet tech, was such a great communicator who really helped me stay positive through the whole ordeal.By Sunday, Sam was ready to come home. He is on confined rest for the next 6-8 weeks. Too much movement can cause scar tissue to form and that would be terrible...so, Sam is crated (this is new to him) and only taken out to go potty.You will see the drastic change in this video from day 2, post surgery, to day 5.... He can shake his whole body, stretch, walk straight with a little skip to his step, etc.... in 5 days, post surgery, Sam is doing awesome!Thank you Dr McDonnell, Dr Harris and Dr Langford!

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