Instrumented cervical fusion using patient specific end-plate conforming interbody devices with a micro-porous structure in nine dogs with disk-associated cervical spondylomyelopathy.

Abstract

OBJECTIVE: To report the medium and long-term outcome of nine dogs with disk-associated cervical spondylomyelopathy (DA-CSM), treated by instrumented interbody fusion using patient specific end-plate conforming device that features a micro-porous structure to facilitate bone in-growth. STUDY DESIGN: A retrospective clinical study. ANIMALS: Nine medium and large breed dogs. METHODS: Medical records at two institutions were reviewed between January 2020 and 2023. Following magnetic resonance imaging (MRI) diagnosis of DA-CSM, pre-operative computed tomography (CT) scans were exported to computer software forsurgical planning. Interbody devices were 3D-manufactured by selecting laser melting in titanium alloy. These were surgically implanted at 13 segments alongside mono-or bi-cortical vertebral stabilization systems. Follow-up included neurologic scoring and CT scans post-operative, at medium-term follow up and at long-term follow-up where possible. Interbody fusion and implant subsidence were evaluated from follow-up CT scans. RESULTS: Nine dogs were diagnosed with DA-CSM between C5-C7 at a total of 13 operated segments. Medium-term follow up was obtained between 2 and 8&#x2009;months post-operative (3.00&#x2009;&#xb1;&#x2009;1.82&#x2009;months). Neurologic scoring improved (&#x2009;=&#x2009;0.009) in eight of nine dogs. Distraction was significant (&#x2009;<&#x2009;0.001) at all segments. Fusion was evident at 12/13 segments. Subsidence was evident at 3/13 operated segments but was only considered clinically relevant in one dog that did not improve; as clinical signs were mild, revision surgery was not recommended. Long-term follow up was obtained between 9 and 33&#x2009;months (14.23&#x2009;&#xb1;&#x2009;8.24&#x2009;months); improvement was sustained in 8 dogs. The dog that suffered worsened thoracic limb paresis at medium-term follow up was also diagnosed with immune-mediated polyarthropathy (IMPA) and was euthanased 9&#x2009;months post-operative due to unacceptable side-effects of corticosteroid therapy. CONCLUSION: End-plate conforming interbody devices with a micro-porous structure were designed, manufactured, and successfully implanted in dog with DA-CSM. This resulted in CT-determined fusion with minimal subsidence in the majority of operated segments. CLINICAL SIGNIFICANCE: The technique described can be used to distract and fuse cervical vertebrae in dogs with DA-CSM, with favorable medium-and long-term outcomes.