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A dorsal laminectomy is a surgical procedure of the spine, which aims to provide access to a prolapsed disc and therefore relieve pressure on the spinal cord. Where the decompressive surgery is needed, the location must first be ascertained by imaging such as an MRI or CT scans.
Surgery can take place only once the location of the trouble spot is known. When the problem lies between the last thoracic vertebra and the first lumbar vertebra, then a thoracolumbar laminectomy is appropriate
Given the need for sophisticated pre-surgical imaging, only available at referral centers, laminectomy is usually performed by specialist surgeons. In some circumstances, such as the paralyzed dog where there is no option to refer, talented surgeons in first opinion practice may carry out this technique.
Spinal surgery is usually a procedure of last resort, used for dogs with severe neurological damage to the hind limbs, bladder, or bowel, as a result of spinal cord compression.
The clinician must first carefully select those patients to take forward to surgery. Since some cases respond to cage rest and pain relief, it is not appropriate to operate on every patient. However, those with severe numbness or loss of sensation to the back end are most likely to benefit from the rapid decompression afforded by surgery.
The dog has a CT or MRI scan, to identify which discs are causing the problem. Then, under anesthesia the hair is clipped from the appropriate region on the back and the skin aseptically prepared.
A skin incision is made and the surgeon dissects down to reveal the dorsal arch of the vertebra. Using a high speed burr or a surgical rongeur, the bone of the dorsal arch of the vertebra is nibbled away. This relieves pressure within the spinal column and allows the surgeon to see the prolapsed disc.
The damaged disc is carefully scooped out of the vertebral canal. A small plug of fat is used to fill the gap in the bone, and then the surgical incision closed, and the patient woken.
The efficacy of decompressive surgery depends on how severe the nerve damage was at the time of surgery. In cases where the spinal cord is bruised and swollen, rather than severely compressed, the outlook for a full recovery is better.
In studies, a similar technique called a hemi-laminectomy produced slightly better outcomes. The difference is that a dorsal laminectomy involves removal of bone from the top of the vertebra, whilst for a hemi laminectomy the bone is removed from the side.
For the majority of dogs with back pain, the initial treatment is rest and pain relief for four to six weeks. In many cases, this is effective and allows swellings to subside and the dog to return to normal. However, should nerve damage be worsening or already severe, surgical options should be considered.
Immediately after surgery it is important the dog has strict rest for a period of weeks, to allow swelling and inflammation to subside. The dog requires appropriate pain relief, and for those with impaired limb or bladder/bowel function, nursing care is essential to prevent bed sores or urine scald.
In the intermediate term, physiotherapy such as hydrotherapy, massage, and passive movement exercises can help to maintain muscle tone and aid recovery.
In the long, term many dogs do very well following surgery. Of those that initially make a good recovery, around 20% may have future episodes of back pain. There is always a risk of a new disc herniating, so even after successful surgery, it is sensible to avoid activities that place strain on the back.
The cost of diagnostic scans is significant, at around $800 to $2,000. The surgical expertise and equipment needed means this is an expensive procedure and you should expect to pay anywhere between $1,500 and $6,000. It should also be borne in mind the dog may need intensive care for a few days following surgery, which costs around $600 per night.
No surgeon undertakes a laminectomy lightly and those cases taken to surgery usually have a bleak prognosis without it. In this respect, laminectomy can be life-saving, when it offers a paralyzed pet their best chance of a return to mobility.
The success rate does vary depending on the severity of the pre-existing nerve damage. Also, unfortunately, there is also a long term risk of complications due to scar tissue formation which can potentially constrict the spinal cord.
Where there is a recognized predisposition to disc disease, such as in the dachshund, the owner should avoid activities which place strain on the back. In addition, at the first indication of back pain the dog should be strictly rested and given pain relief. Dogs that show signs of numbness on the back end, such as staggering, weakness, or poor coordination, should be rested and see a vet as soon as possible in order to receive appropriate therapy and limit damage.
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