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A surgical treatment of disc associated wobbler syndome (DAWS) by a distractable, intervertebral titanium cage: a preliminary study of 5 cases

Steven De Decker (UGent) , Jacques Caemaert (UGent) , Mulenda Tshamala (UGent) , Iris Van Soens (UGent) , Tim Bosmans (UGent) , Ingrid Gielen (UGent) , Sofie Bhatti (UGent) and Luc Van Ham (UGent)
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Organization
Abstract
The most common problems in the surgical treatment of DAWS are the difficulty of treating multiple sites of compression, implant failure and adjacent segment disease. The goals of this study were to describe the technical considerations, complications and preliminary results of 5 dogs treated with a new surgical implant. Four dogs demonstrated neck pain and ambulatory ataxia/paresis. One dog demonstrated non ambulatory tetraplegia. Diagnosis was made by MRI in all dogs. The surgical procedure was performed by a standard ventral approach. The intervertebral discs of C5-C6 and C6-C7 were completely excised. The largest part of the vertebral body of C6 was removed. The lateral walls and dorsal cortex of the vertebral body were preserved. The removed bone was preserved to act as a bone graft. The implant was placed in the bony defect of C6. After placement, the titanium cage was distracted by a mechanism inherent to the implant. Subsequent, the implant was fixed by 2 screws in C5 and 2 screws in C7. In 2 dogs, self expandable monocortical screws were used. In 3 dogs, cancellous bone screws were placed monocortically. Finally, the implant was filled and covered with the bone graft to promote bony fusion. Wound closure was routinely. Postoperative radiographs were taken in all dogs. One dog demonstrated severe tilting of C7. This was already present (but less severe) preoperatively. This dog was immediately admitted for revisional surgery. Post surgically the dogs received cage rest and a splint during 6 weeks. One dog experienced a major implant failure, with loosening of the implant, and revisional surgery 4 days postoperatively. Six months after surgery, cervical radiographs and computed tomography were performed. Correct position of the implant was demonstrated in all dogs, but displacement of the screws was present in the dogs where the cancellous bone screws were used. Bony fusion and incorporation of the implant was demonstrated in all cases. Two dogs were free of clinical signs and 3 dogs demonstrated an improvement in clinical status at the moment of study enrolment. This surgical technique allows a combination of direct decompression and distraction-stabilization with bony fusion at two adjacent intervertebral disc spaces (IVDs). Although, early postsurgical implant failure is still possible, the possibility exists that the incorporation of the implant into the vertebral body decreases the incidence of implant failure after a longer period of time. Longer follow-up data and a larger patient population are necessary to determine if the standard fusion of two adjacent IVDs would decrease the incidence of adjacent segment disease.

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MLA
De Decker, Steven, Jacques Caemaert, Mulenda Tshamala, et al. “A Surgical Treatment of Disc Associated Wobbler Syndome (DAWS) by a Distractable, Intervertebral Titanium Cage: a Preliminary Study of 5 Cases.” Annual Symposium of the ESVN, 21st, Book of Abstracts. 2008. 64–65. Print.
APA
De Decker, Steven, Caemaert, J., Tshamala, M., Van Soens, I., Bosmans, T., Gielen, I., Bhatti, S., et al. (2008). A surgical treatment of disc associated wobbler syndome (DAWS) by a distractable, intervertebral titanium cage: a preliminary study of 5 cases. Annual Symposium of the ESVN, 21st, Book of abstracts (pp. 64–65). Presented at the 21st Annual Symposium of the European Society of Veterinary Neurology.
Chicago author-date
De Decker, Steven, Jacques Caemaert, Mulenda Tshamala, Iris Van Soens, Tim Bosmans, Ingrid Gielen, Sofie Bhatti, and Luc Van Ham. 2008. “A Surgical Treatment of Disc Associated Wobbler Syndome (DAWS) by a Distractable, Intervertebral Titanium Cage: a Preliminary Study of 5 Cases.” In Annual Symposium of the ESVN, 21st, Book of Abstracts, 64–65.
Chicago author-date (all authors)
De Decker, Steven, Jacques Caemaert, Mulenda Tshamala, Iris Van Soens, Tim Bosmans, Ingrid Gielen, Sofie Bhatti, and Luc Van Ham. 2008. “A Surgical Treatment of Disc Associated Wobbler Syndome (DAWS) by a Distractable, Intervertebral Titanium Cage: a Preliminary Study of 5 Cases.” In Annual Symposium of the ESVN, 21st, Book of Abstracts, 64–65.
Vancouver
1.
De Decker S, Caemaert J, Tshamala M, Van Soens I, Bosmans T, Gielen I, et al. A surgical treatment of disc associated wobbler syndome (DAWS) by a distractable, intervertebral titanium cage: a preliminary study of 5 cases. Annual Symposium of the ESVN, 21st, Book of abstracts. 2008. p. 64–5.
IEEE
[1]
S. De Decker et al., “A surgical treatment of disc associated wobbler syndome (DAWS) by a distractable, intervertebral titanium cage: a preliminary study of 5 cases,” in Annual Symposium of the ESVN, 21st, Book of abstracts, Rhodes, Greece, 2008, pp. 64–65.
@inproceedings{533220,
  abstract     = {The most common problems in the surgical treatment of DAWS are the difficulty of treating multiple sites of compression, implant failure and adjacent segment disease. The goals of this study were to describe the technical considerations, complications and preliminary results of 5 dogs treated with a new surgical implant. 
    Four dogs demonstrated neck pain and ambulatory ataxia/paresis. One dog demonstrated non ambulatory tetraplegia. Diagnosis was made by MRI in all dogs. The surgical procedure was performed by a standard ventral approach. The intervertebral discs of C5-C6 and C6-C7 were completely excised. The largest part of the vertebral body of C6 was removed. The lateral walls and dorsal cortex of the vertebral body were preserved. The removed bone was preserved to act as a bone graft. The implant was placed in the bony defect of C6. After placement, the titanium cage was distracted by a mechanism inherent to the implant. Subsequent, the implant was fixed by 2 screws in C5 and 2 screws in C7. In 2 dogs, self expandable monocortical screws were used. In 3 dogs, cancellous bone screws were placed monocortically. Finally, the implant was filled and covered with the bone graft to promote bony fusion. Wound closure was routinely.  Postoperative radiographs were taken in all dogs. One dog demonstrated severe tilting of C7. This was already present (but less severe) preoperatively. This dog was immediately admitted for revisional surgery. Post surgically the dogs received cage rest and a splint during 6 weeks. One dog experienced a major implant failure, with loosening of the implant, and revisional surgery 4 days postoperatively. Six months after surgery, cervical radiographs and computed tomography were performed. Correct position of the implant was demonstrated in all dogs, but displacement of the screws was present in the dogs where the cancellous bone screws were used. Bony fusion and incorporation of the implant was demonstrated in all cases. Two dogs were free of clinical signs and 3 dogs demonstrated an improvement in clinical status at the moment of study enrolment. 
    This surgical technique allows a combination of direct decompression and distraction-stabilization with bony fusion at two adjacent intervertebral disc spaces (IVDs). Although, early postsurgical implant failure is still possible, the possibility exists that the incorporation of the implant into the vertebral body decreases the incidence of implant failure after a longer period of time. Longer follow-up data and a larger patient population are necessary to determine if the standard fusion of two adjacent IVDs would decrease the incidence of adjacent segment disease.},
  author       = {De Decker, Steven and Caemaert, Jacques and Tshamala, Mulenda and Van Soens, Iris and Bosmans, Tim and Gielen, Ingrid and Bhatti, Sofie and Van Ham, Luc},
  booktitle    = {Annual Symposium of the ESVN, 21st, Book of abstracts},
  language     = {eng},
  location     = {Rhodes, Greece},
  pages        = {64--65},
  title        = {A surgical treatment of disc associated wobbler syndome (DAWS) by a distractable, intervertebral titanium cage: a preliminary study of 5 cases},
  year         = {2008},
}