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182 Section III: Spinal Procedures

The durotomy does not provide significant additional decompres- of IVD material from the spinal canal without excessive spinal
sion in the majority of cases [11]. A durotomy is often necessary if cord manipulation and, when necessary, a durotomy can be per-
removing a suspected mass or marsupializing a subarachnoid formed with the exposure provided. This procedure is easily com-
diverticulum. If a durotomy is performed, a #12 scalpel blade is bined with prophylactic fenestration from a dorsolateral or lateral
used. The cutting edge of the scalpel blade is directed upward to approach [4,13].
protect the spinal cord [2,9]. The durotomy is extended by tenting
the dura with small tissue forceps (microsurgical, ophthalmic) or a
5‐0 silk suture and using small tenotomy scissors or Potts scissors. Video clips to accompany this book can be found on
the companion website at:
www.wiley.com/go/shores/neurosurgery
Closure
Several applications of irrigation solution are applied to the decom-
pression site to remove any remaining blood clots, tissue debris, or References
small bone fragments. Complete hemostasis is achieved before clo- 1 Gage ED. Modifications in dorsolateral hemilaminectomy and disc fenestration in
the dog. J Am Anim Hosp Assoc 1975;11:407–411.
sure and may require application of a gelatin sponge for a period of 2 Hoerlein BF. Intervertebral disks. In: Hoerlein BF (ed.) Canine Neurology, 3rd edn.
time to eliminate hemorrhage from the venous sinus. The exposed Philadelphia, PA: WB Saunders, 1978:470–560.
spinal cord is protected with a layer of sublumbar fat or absorbable 3 Toombs JP, Waters DJ. Intervertebral disc disease. In: Slatter D (ed.) Textbook of
gelatin sponge [2,12]. The stored fat is rinsed with warm saline Small Animal Surgery, 3rd edn. Philadelphia, PA: WB Saunders, 2003: 1193–1209.
before placing it over the decompression site. 4 Shores A. Intervertebral disk disease. In: Newton CD, Nunamaker DM (eds)
The incision is closed in three layers. The thoracolumbar fascia is Textbook of Small Animal Orthopaedics. Philadelphia, PA: JB Lippincott, 1985:
739–764.
closed with 2‐0 absorbable sutures in an interrupted cruciate mat- 5 Braund KG, Taylor TKF, Ghosh P, Sherwood AA. Lateral spinal decompression in
tress pattern. The thoracolumbar muscle should be completely cov- the dog. J Small Anim Pract 1976;17:583–592.
ered with the fascia. The subcutaneous layer is closed with 3‐0 6 Shores A. The intervertebral disk syndrome in the dog: Part III. Thoracolumbar
disk surgery. Compend Contin Educ Pract Vet 1982;4:24–31.
absorbable suture, and the skin is closed in a routine manner. 7 Huska JL, Gaitero L, Brisson BA, Nykamp S, Thomason J, Sears WC. Comparison
of the access window created by hemilaminectomy and mini‐hemilaminectomy in
the thoracolumbar vertebral canal using computed tomography. Can Vet J
2014;55:449–455.
Discussion 8 Swaim SF. Use of pneumatic surgical instruments in neurosurgery. I. Spinal surgery.
Prophylactic fenestrations of IVDs from T11–T12 through L3–L4 are Vet Med Small Anim Clin 1973;68:1275–1280.
often performed in association with the hemilaminectomy [2]. The ben- 9 Gage ED. Practical management of thoracolumbar disc disease. Proc Am Anim
efits of prophylactic fenestration have been debated over many years and Hosp Assoc 1980;47:283.
many investigations; however, recent evidence seems to indicate it is 10 Swaim SF. Bilateral hemilaminectomy: a technique for extensive spinal decompres-
sion. Auburn Vet 1976;32:62–65.
strongly warranted in the chondrodystrophic dog. When performing a 11 Parker AJ, Smith CW. Functional recovery from spinal cord trauma following
hemilaminectomy in a chondrodystrophic dog, because it is known that delayed incision of the spinal meninges in dogs. Res Vet Sci 1975;18:110–112.
the offending IVD already has a tear in the dorsal annulus, it would be 12 Prata RG. Neurosurgical treatment of thoracolumbar disks: the rationale and value
poor surgical judgment to not at least fenestrate the offending IVD. of laminectomy with concomitant disk removal. J Am Anim Hosp Assoc 1981;
17:17–26.
The hemilaminectomy provides good decompression and 13 Hoerlein BF. Various surgical methods for repair of intervertebral disc protrusions.
visualization of the spinal cord and nerve roots, it allows removal Anim Hosp 1968;4:12.