Hemilaminectomy
The disease behind the procedure:
IVDD (intervertebral disc disease) is more common in chondrodystrophic dogs, but can occur in any breed. IVDD can be acute (Trauma) or gradual onset. The inter-vertebral disc material between the spinal vertebrae either bulges or ruptures causing compression or trauma to the spinal cord.
Clinical signs, treatment plans and prognosis depend on the severity of compression, and the amount of time that has lapsed. Symptoms can range from pain, hunched back, and ataxia, to full paralysis. Not all cases are surgical. Some may be managed with medications, rest, and rehabilitation.
The Procedure:
A portion of the vertebrae in front and behind the damaged disc is removed from the side. This allows visualization of the spinal column and removal of the disc material causing compression.
Postoperative care:
- Pets with hemilaminectomy must be confined for 4 weeks post operative aside from controlled rehabilitation. When changing bedding, moving, restraining, or positioning patient, ensure that their body is kept level and supported. Take care not to compress the vertebrae, or bend the patient sideways as there may be some instability to the surgical site.
- Patients post operatively will have varying degrees of neurological deficits. Most patients have reduced sensation in their hind end. Bladder care is extremely important. Patients will either have a urinary catheter in place and this will need to be maintained as per hospital policy, or the bladder will need to be closely monitored and expressed at minimum every 4 hours if patient is not completely urinating on their own. All bladder care should be vigilantly recorded in the patient’s medical record. These patients are prone to urinary tract infections.
- Hospital staff must be diligent in ensuring that bedding is kept clean and dry, and recumbency is rotated every 2 hours as needed to prevent pressure sores, skin infections, etc. Hygienic clipping of hair may also be indicated.
- These patients are unable to move like normal ambulating dogs post operative, their balance and proprioception are off, and the hind limbs will likely be stiff. It is important that when we offer food and water, we ensure that they are able to reach the bowls. We may need to hold the bowls up to them. If that is the case, hold a bowl up and offer water at minimum every 2 hours.
- Immediately after surgery, range of motion of the hip, stifle, and tarsus, and brushing of the limbs should begin 2-3 times daily.
- Rehabilitation is recommended to begin 36-48 hours post operative.
Outcome:
All dogs recover differently from this procedure. Some may regain normal function, some may regain some function, and some may not regain any function. This depends greatly on the amount of spinal cord compression and damage preoperatively. The time frame in which function returns varies greatly as well from several weeks to several months. Rehabilitation helps to speed recovery, and regain function.
Poor Surgical Outcome:
Some patients never regain function, and many patients never regain normal function. This possibility should be discussed preoperatively. Although these patients may not have normal function, at minimum surgical intervention will subside the pain from the protruding disc. Clients should be educated on postoperative care, and care if their pet does not regain function in the future. (use of carts, bladder care, etc)
Complications:
Swelling, incision discharge, seroma, dehiscence, surgical site infection
