Fact sheet for LDA

Dee Dee and Hallie · March 20, 2008, 10:18:36 PM

The vet who does the Laser Disc Ablation at OSU just sent me this fact sheet. He said he doesn't know of other places doing this yet (other than Dallas I guess). I wrote back to ask him why he thought that was and also if Hallie would be a candidate for this given her spinal cord thingie. Anyway this is similar to the article Papbouv and Karen posted but has a little more info.

Client / Veterinarian Information Sheet �" 2007 �" Thoracolumbar Laser Disc Ablation

   Laser disc ablation is a prophylactic procedure NOT meant to be used in place of a decompression of the spinal cord when a dog is severely paretic or weak, is paralyzed, or affected with acute signs of severe thoracolumbar pain. Candidates are included in the OSU protocol when they have had a history of TL disc disease but are recovered and virtually normal, neurologically. That means they do not have any lumbar pain and walk normally. If a dog is presented at OSU with lumbar pain, and we concur with the referring veterinarian the dog does indeed have TL disc disease, those animals will be treated conservatively for at least two weeks prior to disc ablation. We do that for two reasons: 1) the holmium laser is a pulsed laser and could possibly push more disc material into the spinal canal (physics problem) and 2) we need to make certain the ablation procedure does not cause problems in the dog if it’s already painful when it is treated, we'll never know if the procedure has caused any additional problems with pain or other neurologic deficits. Dogs to be included in this protocol must also be held off and not administered oral or parenteral corticosteroids for a minimum of 2 weeks prior to admission for disc ablation.
    Dogs are given a pre-surgical evaluation, anesthetized, and aseptically prepared for laser disc ablation. Seven needles (20 gauge, 2 ½ " spinal needles) are placed percutaneously through the skin into the center of 7 disc spaces (T10 11 to L 3 4). A fluoroscope is used to visualize placement of the needles. Then a holmium:YAG laser is used for vaporization of the nucleus pulposus by placing the laser fiber through the needle into the disc space. The laser is activated and the nucleus is vaporized/coagulated which removes / stabilizes the nucleus of the disc, in theory, so it no longer has a propensity to herniate in the future. We did document this effect over 10 years ago in trials using experimental animals.

Intra-operative radiograph of myelographic needles places in IV discs (T10-11 through L3-4)

Myelographic needles in place and laser fiber being inserted through needle into annulus

   Immediate post ablation problems have been pretty minimal: two dogs were painful (muscular pain, we think) for about 5 days (both dogs were in the same family so perhaps client perception had a little to do with this); and 3 dogs became neurologically worse (severe paresis) after the procedure. Two of these dogs were treated medically and were normal after about 10 days, and one required a decompressive procedure. One additional dog had a small skin abscess form at the needle insertion site that was responsive to drainage and antibiotic therapy.
   The procedure may be somewhat controversial in some veterinary surgeon's eyes due to the fact that not all surgeons believe in prophylactic fenestration of the thoracolumbar IV discs they may treat their cases medically until the dog needs decompression due to severe protrusion/extrusion of a disc that puts pressure on the spinal cord, or they may perform the decompression immediately, depending on the severity of signs. Some of the acute/severe herniations, however, are very "catastrophic" and animals don't recover, as you well know. Although we have had 8 recurrences from over 350 animals that have undergone the procedure so far, those dogs still recovered �" we feel the procedure has been of benefit since, conceptually, we potentially reduce the amount of disc material that could herniate or extrude without the disc ablation.
   An article was written in the Journal of the American Veterinary Medical Association and was published in the April 15, 1996, issue. (Dickey, Bartels, et al). It provides the criteria for the protocol as well as a report of 32 dogs. We have documented 262 cases with follow-up evaluations and that investigation has been published in JAVMA: Bartels, K.E., Higbee, R.G., Bahr, R.J., Galloway, D.S., Healey, T.S., Arnold, C.S., Outcome of and Complications Associated with Prophylactic Percutaneous Laser Disk Ablation in Dogs with Thoracolumbar Disk Disease: 277 cases (1992-2001), JAVMA, Vol. 222 (12): 1733-1739, June 15, 2003.
   As stated earlier, we have used the protocol on over 350 dogs and have cases treated for as long as 13 years from when we first started. It is not a 100% guarantee, however! As stated previously, we have had 8 recurrences, so far (dogs that have gone on to have herniated discs sometime after the laser procedure). That's still a positive result (<3% recurrence) compared to previous "interventional" or surgical thoracolumbar intervertebral disc fenestration procedures (20% recurrence), and without the reported complications from the open surgical fenestration technique.
   There has been one laser disc ablation case (a cocker) that had a resultant condition called "discospondylitis" or an infection of two of the seven ablated IV disc spaces. It did fine with antibiotics and a non steroidal anti inflammatory drug. It had a history of recurrent ear infections and a chronic dermatitis that sometimes potentially causes subsequent problems with surgery or with any other tissue work. We altered the protocol slightly for animals with histories of chronic skin/ear problems by administering an intravenous prophylactic dose of antibiotics prior to the laser disc ablation.
   We are constantly reviewing this procedure and emphasize the fact it is a prophylactic procedure to "informed consent" clients. It is still being "underwritten" by research funds since the laser technology is expensive. The procedure costs approximately $1500 at this point in time. As with every medical procedure, the cost may have to go up a bit, but I hope it will always be possible to provide the service for a reasonable fee. If accepted for the procedure, dogs are admitted on day one and given a complete examination by faculty surgeons. Pre-anesthetic blood work is performed, and then on day two the procedure is performed. In most instances, the dog is discharged on day three. Currently, we do not offer the procedure to dogs that have NOT had a history of back problems to be included they must have had a history of problems (back pain attributable to IV discs / or a previous TL surgery).
   I'm pleased there is interest in the procedure we feel it works well and decreases the morbidity seen from previous surgical fenestration procedures. AGAIN, this does not take the place of decompression when that is needed for severe problems due to a herniated disc. The best person to determine if laser disc ablation is a potential procedure for a dog is a referring veterinarian with the ability to perform a good neurologic exam. Clinicians at OSU can assist with making the best decision for each individual case. To be considered for this protocol, please discuss the case / situation with a member of the Small Animal Surgery faculty. They will help you in making the right decision for your dog!

Kenneth E. Bartels, DVM, MS            Robert J. Bahr, DVM, DACVR
Department of Veterinary Clinical Sciences      Veterinary Radiologist
McCasland Professor of Laser Surgery         Department of Veterinary Clinical Sciences Cohn Chair for Animal Care

Veterinary Teaching Hospital
Farm Road
Oklahoma State University
Stillwater, OK 74078

Rich · March 21, 2008, 05:54:40 AM

This sounds pretty promising if Hallie is a candidate. I'm going to see if I can find out if Iowa State is doing this or have any information on it.- they have an excellent vet school/facility.

Dee Dee and Hallie · March 21, 2008, 02:42:08 PM

Thanks Rich I'd love to hear what they say. It would be kind of a hard thing to do since the dog has to be feeling well for at least 2 weeks off meds. It's one thing to take them in for surgery when they are hurting but quite another when they are feeling fine.

I talked to our (local) vet today and she also thinks Hallie's spinal cord may not be her problem (from neuro notes and her own thinking but again only guessing). I hope she is right! I'm starting to think she is, and that we are dealing with a disc. As she said today, who knows how many doxies out there do have dilated spinal cords at some point along with their back problems. That may or may not resolve on their own and you'd never know.

The main thing though is Hallie is FINALLY acting more like herself!

She is doing so much better. That has done wonders for my psyche. Still will be confined for a few weeks but I'm getting her out for lots of stroller rides and we visit people, etc the neuro said she does not have to be strictly crated at this point, just no walks or running, etc. but she can walk around the house and go places. In fact he told me on the phone to "take her out and do something fun." And...she has officially reached a new level of being spoiled. She barks orders to me all the time now! And I am more than happy to comply.

Mike · March 21, 2008, 04:45:45 PM

And...she has officially reached a new level of being spoiled. She barks orders to me all the time now! And I am more than happy to comply.

DD, how did you manage to survive this long without being fully trained?

Dee Dee and Hallie · March 21, 2008, 07:29:45 PM

LOL Mike, I thought I was...I vuz wronk.

Roberta · March 21, 2008, 10:15:46 PM

Hi you pair good to hear from you.
How far is it from you! the place that does this.
Glad to hear she who must be obeyed is back to full voice.
Roberta

Dee Dee and Hallie · March 21, 2008, 10:47:17 PM

Hi Roberta and kids!
I didn't have any luck finding anyplace who does the one wee Amy had. This place unfortunately is a good 4 day drive. So it would have to be pretty essential to go that far. (I hope we never need to consider it!).

Yes she did another "first" last night. We had gone to visit my uncle for a bit, then we came home. I pulled into the garage and she was ready to get out of her crate when I remembered I had not returned some rented movies. So I pulled back out of the garage to go the 4 blocks to the movie rental, about 2 blocks away out of the crate comes this one loud BARK!!!! Just like she does in the house now when she is giving me what for. Scared my socks off me, she has never done that in the car, the Princess was displeased at leaving the garage when she was ready to disthrone and enter her castle.

Teresa · March 22, 2008, 05:27:21 AM

Maybe Hallie just thought you had gotten confused and she was trying to be a good little girl and help you out!
Glad to hear she is doing so much better!

Rich · March 22, 2008, 06:35:25 AM

Hi DeeDee, I wasn't able to find anything on the ISU website about LDA, but I sent them an email inquiring whether they offered it or if they knew any location in the midwest that did. I'll let you know as soon as they reply.

Dee Dee and Hallie · March 23, 2008, 11:38:45 PM

Ha yes Teresa if only they could speak english, we'd get an earful wouldn't we!

Thanks Rich. I'll be really interested to hear what you learn. I hope none of us ever need it but it's good to know all the options!

Dee Dee and Hallie · March 24, 2008, 11:04:13 AM

I just got this from Dr. Bahr at OSU. I loved reading that he also thinks she likely has a temporary spinal cord dilation!!! What was the first guy thinking??? I know we still can't know for sure with the amount of info we have but you'd think he'd at least think this was a possibility.

Since you sent your most recent e-mail to me (below), I consulted with Dr. Ken Bartels, one of the original two principle investigators of the initial investigational phase of the percutaneous laser disc ablation (PLDA) procedure here at OSU, to ask his opinion of the safety regarding doing the PLDA on your dog, Hallie, given her medical history. We both think that the procedure will benefit Hallie, but because of the fact that the original CT exam "only went up to L1 or L2", we question whether anyone knows all the facts of her case. This is especially so since the two different neurologists which you consulted had different opinions. I tend to agree with what you said the 2nd neurologist decided, that is, that a herniated disc had pinched the spinal cord enough to cause the dilation of the central canal. This is called "syrinx formation" and results from pressure placed on the cord, resulting in a temporary dilation of the central canal of the spinal cord. Because we really don't know all the facts of Hallie's case, and since you might have a 3-4 day drive to bring her to Oklahoma State University for the PLDA, it would be best for you to get all of the imaging done prior to such a trip because if good quality imaging shows a DIFFERENT problem which might contraindicate the PLDA, I would hate to see you make the long trip for nothing.

Therefore, I recommend that you get an MRI done of Hallie's entire thoracolumbar spine. I don't really know who the veterinary neurologists are in your area, nor where you actually live, but I do know the Radiologists at Washing State University in Pullman, WA, and I am familiar with their MRI philosophy enough to recommend that you seek an MRI exam from Washington State University and then have the images sent to me. I am pretty sure that they do not do the PLDA procedure there, but if they did, then that would be even better for you. If you want to have one of the Radiologists from WSU contact me for more information on the PLDA, I would be happy to talk to him/her and discuss Hallie's case.

I hope that Hallie remains asymptomatic for the next several months and that you can get more definitive information which will assist you in making your decisions.

Rich · March 24, 2008, 09:16:20 PM

Since rereading this I realized that OSU did NOT stand for Oregon State University. I got a reply from the vets at ISU saying that Oklahoma State University is the only place they know of doing this in the midwest. Is that the OSU you are referring to (I may have missed this information elsewhere.)

Dee Dee and Hallie · March 24, 2008, 11:00:39 PM

Yes, I'm sorry it is Oklahoma State. I wish it were Oregon! The only other place I've heard who does this is Dallas where Delia took Gretchen (but they weren't doing it there until long after Gretchen's surgery). I guess the reason no one else is doing it yet is the cost of the machine and the training...I sure wish it were gaining popularity!