What to expect when your pet has neurosurgery with BVNS

The goal of surgery is to remove the disc material that has “slipped” and is pressing on the spinal cord and/or nerve root, which is causing pain and/or weakness. In general, a ventral slot procedure is done to remove a herniated disc in the neck and a hemilaminectomy is done to remove ruptured disc material in the back. A ventral slot is a surgery in which a hole centered on an intervertebral disc space is cut upward through the bone of two consecutive vertebral bodies to access the bottom of the spinal canal, enabling the removal of material compressing the spinal cord, such as extruded disc material, a blood clot, a cyst, an abscess, or a mass.

Neurologic conditions can be rapidly progressive and in some cases the time between injury and surgery can be the difference between
walking and permanent paralysis, or even life and death. Advanced equipment, and highly trained, experienced staff are needed for these
delicate and complicated surgeries. The emergent nature and intricacy of these procedures can be very stressful for the dog and cat and for
the family that cares for them.

Please know that your pet is in the most caring and capable hands here at BVNS. We want to make this process as stress-free as possible.
While not all the information may apply to your pet specifically, it is our hope that this information will answer your questions and reduce
your stress level during this difficult time. We encourage you to please ask questions at anytime and let us know what more we can do to
make this process easier for you.

Before Surgery

Food should be taken away 12 hours before surgery (usually after 10pm the night before), but water is fine. Please bring all medications with you in their labeled prescription bottles the morning of your appointment.

Disk Surgery

The goal of surgery is to remove the disc material that has “slipped” and is pressing on the spinal cord and/or nerve root, which is
causing pain and/or weakness. In general, a ventral slot procedure is done to remove a herniated disc in the neck and a
hemilaminectomy is done to remove ruptured disc material in the back.

A fenestration may be performed at the remaining disc spaces that are thought to be at risk for herniation. This procedure involves
cutting a window in the outer fibrous rim of the disc, followed by extraction of the calcified or dehydrated center. This can reduce
recurrence of clinical signs of disc disease, while allowing normal motion and pain-free movement following surgery.

Other Surgeries Performed by BVNS

• Routine and emergency brain surgery for tumors and traumatic injury
• Foramen magnum decompression for caudal occipital malformation
• Ventricular peritoneal shunt placement for hydrocephalus
• Spinal cord tumor removal
• Decompression, culture, and biopsy of infectious disease processes
• Muscle and nerve biopsy

Hospitalization

The in hospital recovery period typically lasts 1-3 days. Recovery is predicted by the duration of the problem, neurologic function going into surgery, and findings on MRI or CT. After surgery, your pet generally requires supportive care which may include intravenous pain medication, muscle relaxants, stomach protectants, fluids, and occasionally anxiety medication. Your pet my also need help eliminating. Animals are discharged from the hospital once they are eating and urinating on their own and comfortable.

Communications

We will make every effort to show you and explain the results of the advanced imaging tests before surgery is performed. In the event of an emergency procedure we may not be able to review the images with you prior to surgery.

Patient Care During the Day

A full neurologic examination is performed first thing in the morning on all hospitalized patients and during the day your pet is cared for by the licensed veterinary technicians. Once examined, you will be updated as to your pet’s progress. You should expect a call with an update on your pet both by late morning after examination.

Overnight Care

Overnight, the staff of the emergency and critical care department will be caring for your pet. They are under the direct supervision of an experienced veterinarian and a BVNS neurologist or resident neurologist is always available to them by phone. You can get an update on your pet during their overnight stay with the emergency and critical care department at:

BluePearl Specialty & Emergency Pet Hospital (Rockville) at 301.637.3228.
The LifeCentre (Leesburg) at 703.777.5755.
BluePearl Richmond at 804.716.4700.
Regional Veterinary Referral Clinic (Springfield) at 703.451.8900.
BluePearl Cherokee Veterinary Emergency and Referral Center (Woodstock/Atlanta) at 678.909.1700.

The First Two Weeks Following Spinal Surgery

Your pet will require medications and occasionally nursing care and physical therapy at home to assist in their recovery. During this recovery period, your pet’s weakness, tenderness, or discomfort will slowly improve. The first few days at home you may notice that your pet may urinate and defecate less frequently, seem sore, and not eat and drink as well as before surgery. All medications should be given as prescribed. Please call if you have any questions about medications.

For the first two weeks following surgery please keep your pet crate rested. This means no running, jumping, twisting, turning, or stairs, no playing with housemates, and very limited walking. It is advised that you confine your pet to a playpen or crate and carry them outside for short, leashed walks to eliminate.

A neck harness is required for pets that have had neck surgery and is recommended for ones that have had back surgery as well. A sling can also be useful to provide stability and support until the limbs are fully functional.

The Period Between Two and Six Weeks After Spinal Surgery

We ask that you return about 10 to 14 days following surgery so we can remove the staples, evaluate your pet’s progress, and initiate a walking program consisting of progressively longer leashed walks. Please call about 5 days after surgery with an update and to schedule this no-charge appointment.

We ask that you return again at 6 weeks following surgery for a 6-week post-opertative examination. After this time, your pet can slowly return to normal activity. If your pet becomes painful or weak, restart crate rest and please call us.

Rehab

At home rehab might include hot and cold packs to the incision, or massage and range of motion exercises. If additional therapy is needed, we will refer you to a rehab facility. Please ask us for referral information.

Communicating With Your Veterinarian

Your veterinarian will receive a summary of the consultation, diagnostic tests, and surgery, and updates by phone, fax, or mail.

Please call us, your primary care veterinarian, or your local ER if your pet:

• Vomits
• Is unwilling to eat or drink for 24 hours
• Has black or persistently loose stool
• Becomes weaker or more painful
• Is extremely lethargic
• Has redness, heat, or pain around the incision
• Has not urinated for 24 hours, is persistently dribbling
• urine, or has a foul-smelling or dark-colored urine
• Has not defecated for 5 days

Gingi McLeod Age: 8 years Breed: Rottweiler Sex: F/S

At 7 months of age, Gingi was adopted by the McLeod’s from a local shelter and had been an otherwise healthy house pet. Around 11 months ago, Gingi would intermittently cry out in pain after performing certain activities, such as climbing stairs or getting into or out of the car. Gingi also started exhibiting signs of ataxia and rear limb weakness as her signs progressed.

Gingi was referred to Bush Veterinary Neurology Service where an MRI was performed. The results of the MRI showed Gingi had a condition termed Wobbler’s Disease, which resulted in cervical disc protrusions at C4-5 and C5-6. Gingi underwent a surgery called a ventral slot at C5-6 with a fenestration at C4-5. Following surgery, Gingi was sent home on strict bed rest. The McLeod’s were to perform passive range of motion exercises on all 4 limbs and to assist her into a standing position and to go outside with the aid of a help em up harness or sling a few times daily. In her initial post-op period Gingi was not able to urinate on her own and was given medication to help with bladder expression. Gingi also received hyperbaric oxygen treatments several times in the month following her surgery.

Gingi presented to Skylos Sports Medicine to start rehab therapy within a few weeks of surgery. At this time Gingi was too weak to support herself in a standing position, but would move all 4 legs in an attempt to walk with assistance. Her owners were performing passive range of motion exercises 2-4 times daily and assisting her to stand for short periods of time. They felt Gingi had some awareness of her bladder and rectum as she would often vocalize when she had to urinate or defecate. Gingi mainly lied on her side, but was able to get herself into a sternal position if she was lying on her left side. She was unable to accomplish this on her right side. She had anal tone and was able to wag her tail. Gingi had delayed withdrawal reflexes in all 4 legs, but was able to move her legs if persuaded with treats.

At Gingi’s first rehab session we spent time getting to know her and assess what would be good ways to assist her recovery that worked with her personality and with what her owners could accomplish at home as well. Therapy for her first session included; massage and manual techniques, non-thermal class IV laser and specific exercises to promote leg movement and proprioception. One such exercise involved assisting Gingi to drape her body up and over an exercise peanut and rolling her back and forth so both her front paws and rear paws would touch the floor. This is a good exercise to promote proprioception as well as support her body while stabilizing muscles engage.

The McLeod’s were sent home with various exercises, bodywork instructions, and ongoing care parameters. It required daily dedication on her owners part to provide passive range of motion, sensory work such as brushing her in specific ways and helping her body and limbs re-pattern things like sitting up and the steps it takes to accomplish this. Multiple short sessions of standing and assisted walking were also assigned. In addition, Gingi visited Skylos for rehab twice weekly.

Ventral Slot Surgery Recovery Before And After

Week 1: Gingi had made a few small improvements. Her withdrawal reflexes were stronger in all 4 limbs, she was able to remain sternal on her right side for a few moments and she attempted to stand for a bully stick. However, Gingi was too weak to support her weight by herself when trying to stand. Therapies included; massage, laser and exercises to promote leg movement, balance and proprioception.

Week 2: Gingi continued to make improvements. When taken outside, she was able to stand for a few moments and walked a small distance with little assistance. At this time, her rear legs had more strength and when she tired, Gingi tended to collapse on her front legs. As Gingi would tire rather quickly, we would exercise for a small period of time and then rest. During the second session of the week, Gingi was able to remain in a sternal position on her right side without assistance. Gingi was now also being treated for a UTI. Once a negative urine culture was obtained, the plan was to start Gingi in the underwater treadmill. Therapies included; massage, laser and exercises to promote leg movement, strength, balance and proprioception. The McLeod’s continued a lot of home exercises and mainly concentrated an assisted standing and walking.

Week 3: I was really impressed with Gingi’s improvements. The owners were doing a wonderful job with her home exercises. Gingi was able to walk around with little assistance for around one minute before she tired and tended to collapse. She was also able to stand on her own with little assistance for 30-45 seconds. Gingi was strong enough to walk over 2 inch cavaletti rails for 3 passes. Therapies included; massage, laser and exercises to promote strength, balance and proprioception. Gingi’s urine culture came back negative, so for her second session of the week, she tried the underwater treadmill. Gingi walked for a total of 6 minutes with rests every 2 minutes. She would occasionally knuckle on the left front leg, but overall, did very well.

Week 4: Gingi continued to gain strength at home and was now strong enough to potty on her own outside and no longer needed assistance with bladder expression. Another step in a positive direction that Gingi made at this time was that she was now able to stand on her own from a sit or down position with little to no assistance. She still tired rather quickly, so we would exercise in small increments. Therapies included; massage, laser, underwater treadmill and other exercises to promote strength, balance and proprioception, such as cavaletti rails, figure 8’s and assisted sit to stands.

Week 5: During this week, Gingi had a re-check appointment with the neurologist and she was very happy with Gingi’s progress. During her sessions, Gingi was able to walk around without any assistance and even walked over the 2 inch cavaletti rails on her own. Therapies included; massage, laser, underwater treadmill, assisted sit to stands, cavaletti rails and figure 8’s. Her owners continued to diligently work with her at home.

Weeks 6 and 7: Gingi developed another UTI, so she was not able to go in the underwater treadmill. Her owners felt she was a bit weaker in the rear legs, but overall, was walking well. Gingi had an ataxic gait, but was able to walk around without any assistance. Gingi’s conscious proprioception was slightly delayed, but she was able to “right” all of her paws. Therapies included; massage, laser, sit to stands and started the wobble board and balancing on proprio discs.

Ventral Slot Surgery Recovery Tool

Weeks 8 and 9: Gingi continued to do well. She would occasionally knuckle on her left front leg, but this had always appeared to be her weakest leg. This week, Gingi decided she no longer cared for the underwater treadmill and refused to walk in it. During this time, she became able to retrieve treats off of the floor without stumbling or falling. Therapies included; massage, laser and exercises to promote strength, stamina and balance. Her rehab sessions were decreased to once weekly.

Weeks 10 and 11: Gingi continued to recover her strength and was beginning to gain muscle mass. Her gait was less ataxic and she was now able to trot. Gingi’s conscious proprioception continued to improve. Therapies included; massage, laser and exercises to promote strength, stamina and balance. She was doing well her sessions were decreased to every other week.

Gingi comes twice a month for rehab therapy. She is doing well and our work is to continue building on her strength and stamina. Gingi has gained in energy, but still tires after 15 minutes of work. She has been an absolute joy to work with. Gingi has a strong will and was quite determined to walk again. Her owners are also lovely people and were dedicated to her recovery.

Ventral Slot Surgery Dog Recovery

Laura Martino-Calfo, RVT,CCRP,CCMP Dr. Faith Lotsikas, CCRT
Skylos Sports Medicine