ORTOPEDIE
The use of the string of pearls locking plate system in the stabilisation of a spinal thoracal fracture in a giant breed dog
multifidus muscle from the dorsal spinous procecces from every vertebra within the surgery field. The longissimus lumborum muscle was incised to enhance a better exposure. Gelpi retractors were used to retract the soft tissue (Tobias and Johnston, 2012). The fracture was identified and stabilised with 3.5 mm String of Pearls (SOP) locking plate. The SOP locking plate was attached with minimum 2 cortical screw cranially and caudally to the affected vertebrae on the right side of the spine (Figure 2.). The cortical screws were placed in the holes and inserted in 30Ëšat the level of the accessory process or the tubercule of the rib to traverse the pedicle in to the vertebral body. Polymethylmethacrylate (PMMa) Synthes was prepared as for any application and added to the screws and plate. Because of the exothermic reaction, cold saline was used for irrigation (Johnston and Tobias, 2018). Closure of the site was started with the closure of the fascia, then subcutaneous fat, subcuticular layer than locking nodes for the skin. Postoperative plain radiograph was done to check the accuracy of the vertebral alignment (Figure 3.). Postoperative treatment included Augmentin (Amoxicillin/Clavulanic Acid) 12.5 mg/kg p.o. q 12h for 5 days was administered, Tramadol 4 mg/kg p.o. q8h for 5 days was administered, Previcox 5 mg/kg p.o. q24h was administered for 3 days, Gabapentin 10 mg/kg p.o. q12h was administered for 10 day and Omeprazole was added in dose of 1 mg/kg p.o. q24h for 7 days. The second day after the surgery seroma was formed and it was drained. Deep pain perception was assesed the day after surgery and it was present. The dog was discharged from the hospital 7 days after the surgery. Recommendation to the owner included restriction of the range of motion in a cage 3 weeks more after the surgey (Tobias and Johnston, 2012). The dog was rechecked at 2 weeks after the surgery for suture removal. The owner clamed improvement in the dog such as turning from one side to the other in the cage also movement in the legs and attemt to bare weight. In the 4th week after the surgery, at the second recheck, the dog was walking without any support (Figure 4.).
Discussion
The thoracolumbar spine area is most commonly affected by fractures and luxations in dogs and cats (Bali et al., 2009; Bruce et al., 2008; Grasmueck et al., 2004). Because of the small ratio of the vertebral canal to the spinal cord diameter of this region, lesions may have a dra-
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matic impact on the spinal cord (Sharp, 2005). The most important and relevant prognostic factor is the presence of deep nociception. Some authors indicate that the absence of nociception in the limbs caudally to the lesion in the spine indicates a poor prognosis. The prognosis for paraplegic dogs without deep nociception because of severe spinal cord trauma is guarded (Olby, 2003). For this reason we also consider and support that complete neurological examination is critical for localization of the spinal cord lesion and for the prognosticating outcome. In our case, the dog had deep pain perception at the arrival at the clinic. Radiographs should be performed in lateral recumbency on a board after the neurological examination (Tobias and Johnston, 2012) even if it has limited sensitivity. In addition is not sensitive for the bone fragments inside the vertebral canal (Sharp, 2005). In Kinns et al., 2006 studies on radiographic sensitivity on acute canine spinal trauma, they found that radiography was found to have a moderate sensitivity for fractures (72%). So in their conclusion, radiography cannot be used to rule out potentially unstable acute vertebral lesions, and further imaging is indicated for canine patients with risk of such injuries. We also found that CT was more accurate in the visualisation of the spinal fracture. Treatment options in spinal fractures can be surgical or medical, some authors claim that it should be based primarily on the neurological status and the compressive characteristics of the fracture (Weh, 2012). Also in Jeffery, 2010; studies he sees an advantage on care for animals soon after surgical intervention than to provide optimal nursing care for animals that must be rested for prolonged periods because of vertebral fractures. The goal of surgical treatment is the realignment and the stabilization of the spine. Medical management usually minimizes secondary spinal cord injuries with neuroprotective treatment (Weh et al., 2012). Four main categories of injury on the vertebra are classified after the failed components according to Sharp (2005). Our dog was classified in the type 4, because of failure of more than one component of a vertebrae. Sharp (2005) indicated metal implants and bone cement or an external fixator. We chose the String of Pearls (Orthomed, UK) veterinary implant system which is a locking plate system that utilises standard cortical screws which provide a versatile method of fixation. They consist of individual spherical stainless steel nodes with threaded holes that accept standard cortical bone screws. The nodes are connected to each other by cylindrical internodal
Vol IV - Nr. 7(2/2017)