Page 65 - Zoo Animal Learning and Training

6 Minimum Database: Spinal Surgery

Luis Gaitero and Brigitte A. Brisson

Introduction minimum database (MDB) is always recommended, even if in some
Therapeutic options for spinal neurological diseases often include cases the results will only be available postoperatively.
both medical and surgical procedures. Neurosurgical treatment is Laboratory testing is not a substitute for complete physical
selected when the procedure has proven to be significantly more examination and the value of a detailed history should not be
effective than the conservative approach, the disease does not underestimated. Orthopedic conditions such as bilateral cruciate
respond to medical therapy, the clinical signs are severe or rapidly rupture can also easily be misinterpreted as neurological disorders.
progressive, or when there is spinal instability [1]. Some of the most Equally, accurate lesion localization based on a neurological exami-
common indications for spinal surgery are intervertebral disc nation is very important for identifying the significance of any
herniation, cervical spondylomyelopathy, degenerative lumbosacral identified spinal lesions, since asymptomatic lesions are commonly
stenosis, and vertebral fracture/luxation. The main complications detected on advanced diagnostic imaging.
include iatrogenic injury to neural structures, severe intraoperative The presurgical MDB for a neurosurgical patient includes com-
hemorrhage, spinal vascular compromise, vertebral column instabil- plete history, physical examination, neurological and orthopedic
ity, and excessive scar tissue formation [1]. examinations, complete blood count (CBC), comprehensive serum
The specific surgical risk for each patient varies depending on biochemistry profile, and urinalysis. In cats, assessment of feline
the primary condition and other preexisting abnormalities that leukemia virus (FeLV)/feline immunodeficiency virus (FIV) status
affect the general health of the patient [2]. Evaluation of the surgi- before spinal surgery is strongly advised, particularly when spinal
cal risk will allow the neurosurgeon to weigh the potential bene- lymphoma is suspected due to its association with FeLV‐positive
fits of a spinal neurosurgical procedure against the potential results in more than 50% of cases [3]. Thoracic radiographs and
complications and prognosis. A comprehensive presurgical evalu- abdominal ultrasound are recommended as part of the MDB in
ation allows the surgeon to detect risk factors that could affect dogs and cats with a spinal cord disorder. This is especially impor-
outcome and guides the surgeon to anticipate and, where possible, tant in patients aged 6 years and older, in those where cardiovascu-
limit complications. Furthermore, it provides valuable informa- lar or respiratory abnormalities are suspected, and in those with an
tion on the presurgical status to establish a patient’s baseline val- accompanying history, clinical signs or MDB abnormalities that
ues so that changes during and after surgery can be adequately increase suspicion for spinal neoplasia (primary, secondary or met-
interpreted. astatic), infectious disease, trauma, or other complicating medical
Diagnostic tests are performed to screen asymptomatic patients conditions such as cardiac, hepatic, or renal disease. Diagnostic
and identify risk factors for occult disease. These are extremely tests directed toward identification of extraneural neoplasia, infec-
valuable in evaluating anesthetic risk, particularly considering that tious conditions, or concomitant disease have diagnostic value for
neurosurgical patients almost invariably require initial general the final diagnosis, but can also provide prognostic value to the
anesthesia for extensive diagnostic imaging investigations or cere- owner. Further diagnostic tests can be selected for investigation of
brospinal fluid collection. The information obtained contributes to disorders suspected on the basis of the initial screening tests or
planning the most appropriate anesthetic strategy. Although eco- based on the planned surgical procedure.
nomic considerations should be taken into account, a thorough In people, spinal procedures have historically been associated
presurgical examination can avoid more expensive complications. with higher rates of infection in comparison to other orthopedic
The extent of the presurgical screening is typically adjusted procedures, with rates ranging between 0.3 and 9% compared with
according to the animal’s unique circumstances such as age and the 1–2% for primary total joint arthroplasty [4]. Although intraopera-
emergent nature of the procedure; however, obtaining a standard tive factors play a significant role in the risk of developing infection,

Current Techniques in Canine and Feline Neurosurgery, First Edition. Edited by Andy Shores and Brigitte A. Brisson.
© 2017 John Wiley & Sons, Inc. Published 2017 by John Wiley & Sons, Inc.
Companion website: www.wiley.com/go/shores/neurosurgery

59