Dr. Lucian Fodor
Dr. Lucian Fodor (Happy Pet Timisoara, Romania)
Introduction
Hemilaminectomy is a surgical tehnique of decompresion of the spinal cord wich is made by making a bone space in the lateral part of the vertebral arch.
Hemilaminectomia made a direct decompression of the spinal cord and extraction slight herniated disc. It is indicated after lateral medullary compression, lateral or ventral-dorsal side.
Case presentation
Amstaff female, 9 years old, spayed, at 2 years sufered a car crash who took to the amputation of the left anterior leg.24 hours ago she expresssed paraplegia on the posterior legs, no related to the trauma she had 7 years ago.(Fig 1,2)
Clinical exam
Normotermia, heart and respiratory rate are phyziological, biochemical parameter of blood also in normal rates.Neurological tests are showing a flasc paralysis of the posterior legs with keeping of the deep sensitivity and lack of the superficial one.
Complementary exam
RMN which shows a protusion of the L6-L7 intervertrebal disc.(Fig 3-8)
Diagnosis
Right ventro-lateral disc hernia
. Treatment
Right Hemilaminectomy
Surgical tehnique
Skin incision paramedian
Subconjunctival tissue incision until dorsal lombar fascia
Fascia incision and supraspinos ligament(fig.10) lombar mulfifizi muscle removed from the spinous processes(fig. 11).
Highlighting mamilonat process and the process of lumbar vertebra accessory(fig. 12).
Sectioning mamilonat process using a bone pinching (fig. 13).
Highlighting the nerve root L6-L7 (fig. 14).
Milling articular surfaces L6-L7 (fig. 15).
Highlighting the spinal cord and intervertebral disc herniation(fig. 16-17).
Curettage intervertebral disc and nerve root highlighting decompressed (fig. 18).
Collagen Dressing(fig. 19).
fig 2
fig 1
Postoperative treatment was followed five days containing corticosteroids, antibiotics five days and bladder catheterization in the first 24 hours after it is no longer necessary.
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Results and discution
Hemilaminectomy indication:
Hypotonic paraplegia more than 5 days
flaccid paraplegia with profund sensitivity and no more than 24 hours (1)
cauda equina sindrom (2)
Surgery is superior to conservative treatment (2).
In the case of a herniated disc which is manifested clinically by flaccid paraplegia but keeping deep painful sensitivity, the percentage of success and full recovery of patients is 80% (4).
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Conclusion
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fig 20
– Postoperative evolution of the case presented was very good at 24 hours postoperatively she maintained the tripodal position and the movement is made supported by the owner(Fig 20)
– Three months after surgery the animal is completely heald, exhibiting no neurological symptoms
Bibliography
- Robin (Y) – Les traitements de la maladie discale du chien P.M.C.A.C. 2008 (413-424)
- Shores (A) – Intervertebral disc discose. Textbook of small animal ortopedics, ed. Philadelphia, J.B. Lippincot Co 2006 (739-764).
