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1.
Caudal cervical spondylomyelopathy (‘wobbler’ syndrome) is a common neurological disorder of large and giant breed dogs. Diagnostic evaluation requires radiological assessment, including plain radiography and myelography. Computed tomography can be used to give additional information on vertebral and spinal cord disease. This paper reviews plain radiographic and myelographic techniques and findings in caudal cervical spondylomyelopathy. The value of computed tomographic myelography is also reviewed. The relevance of the conventional radiological and computed tomographic findings to surgical treatment are discussed. Similarities between this condition and cervical spondylotic myelopathy in man are also examined.  相似文献   

2.
Forty‐six dogs with either cervical (C1–C5 or C6–T2) or thoracolumbar (T3–L3) acute myelopathy underwent prospective conventional computed tomography (CT), angiographic CT, myelography, and CT myelography. Findings were confirmed at either surgery or necropsy. Seventy‐eight percent of lesions were extradural, 11% were extradural with an intramedullary abnormality, 7% were intramedullary, 2% were intradural–extramedullary, and 2% had nerve root compression without spinal cord compression. Intervertebral disc herniation was the most frequent abnormality regardless of signalment or neurolocalization. Twenty‐one of 23 Hansen type I disc extrusions but none of the Hansen type II disc protrusions were mineralized. Two chondrodystrophic dogs had acute myelopathy attributable to extradural hemorrhage and subarachnoid cyst. CT myelography had the highest interobserver agreement, was the most sensitive technique for identification of compression, demonstrating lesions in 8% of dogs interpreted as normal from myelography and enabling localization and lateralization in 8% of lesions incompletely localized on myelography due to concurrent spinal cord swelling. None of the imaging techniques evaluated permitted definitive diagnosis of spinal cord infarction or meningomyelitis but myelography and CT myelography did rule out a surgical lesion in those cases. While conventional CT was adequate for the diagnosis and localization of mineralized Hansen type I disc extrusions in chondrodystrophic breeds, if no lesion was identified, plegia was present due to concurrent extradural compression and spinal cord swelling, or the dog was nonchondrodystrophic, CT myelography was often necessary for correct diagnosis.  相似文献   

3.
Osseous‐associated cervical spondylomyelopathy in dogs is characterized by both static and dynamic spinal cord compression; however, standard MRI methods only assess static compression. In humans with cervical spondylotic myelopathy, kinematic MRI is commonly used to diagnose dynamic spinal cord compressions. The purpose of this prospective, analytical study was to evaluate kinematic MRI as a method for characterizing the dynamic component of osseous‐associated cervical spondylomyelopathy in dogs. We hypothesized that kinematic MRI would allow visualization of spinal cord compressions that were not identified with standard imaging. Twelve client‐owned dogs with osseous‐associated cervical spondylomyelopathy were enrolled. After standard MRI confirmed a diagnosis of osseous‐associated cervical spondylomyelopathy, a positioning device was used to perform additional MRI sequences with the cervical vertebral column flexed and extended. Morphologic and morphometric (spinal cord height, intervertebral disc width, spinal cord width, vertebral canal height, and spinal cord area) assessments were recorded for images acquired with neutral, flexion, and extension imaging. A total of 25 compressions were seen with neutral positioning, while extension identified 32 compressions. There was a significant association between extension positioning and presence of a compressive lesion at C4‐C5 (p = 0.02). Extension was also associated with a change in the most severe site of compression in four out of 12 (33%) dogs. None of the patients deteriorated neurologically after kinematic imaging. We concluded that kinematic MRI is a feasible method for evaluating dogs with osseous‐associated cervical spondylomyelopathy, and can reveal new compressions not seen with neutral positioning.  相似文献   

4.
Eighteen Doberman pinscher dogs with clinical signs of cervical spondylomyelopathy (wobbler syndrome) underwent cervical myelography and magnetic resonance (MR) imaging. Cervical myelography was performed using iohexol, followed by lateral and ventrodorsal radiographs. Traction myelography was performed using a cervical harness exerting 9 kg of linear traction. MR imaging was performed in sagittal, transverse, and dorsal planes using a 1.5 T magnet with the spine in neutral and traction positions. Three reviewers independently evaluated the myelographic and MR images to determine the most extensive lesion and whether the lesion was static or dynamic. All reviewers agreed with the location of the most extensive lesion on MR images (100%), while the agreement using myelography was 83%. The myelogram and MR imaging findings agreed in the identification of the affected site in 13-16 dogs depending on the reviewer. MR imaging provided additional information on lesion location because it allowed direct examination of the spinal cord diameter and parenchyma. Spinal cord signal changes were seen in 10 dogs. Depending on the reviewer, two to four dogs had their lesions classified as dynamic on myelography but static on MR images. Myelography markedly underscored the severity of the spinal cord compression in two dogs, and failed to identify the cause of the signs in another. The results of this study indicated that, although myelography can identify the location of the lesion in most patients, MR imaging appears to be more accurate in predicting the site, severity, and nature of the spinal cord compression.  相似文献   

5.
Client-owned, clinically normal Doberman Pinschers (n=20), English Foxhounds (n=17), and Doberman Pinschers with clinical signs of disk-associated cervical spondylomyelopathy (DA-CSM) (n=17) were prospectively studied. All dogs underwent magnetic resonance imaging (MRI) of the cervical vertebral column. To evaluate vertebral canal stenosis, the canal occupying ratios of the spinal cord and cerebrospinal fluid (CSF)-column were calculated from C5 to C7. To evaluate the degree of spinal cord compression and the amount of canal compromise, the compression ratio, remaining spinal cord and CSF-column area, and vertebral canal and dorsoventral vertebral canal compromise ratios were calculated at the site of most severe compression. For each canal occupying ratio, there was a significant higher value (implicating less space available for the spinal cord in the vertebral canal) at the level of C7 for clinically affected Doberman Pinschers compared with clinically normal English Foxhounds. The remaining spinal cord area was significantly smaller in dogs with clinically relevant spinal cord compression compared to dogs with clinically irrelevant spinal cord compression. Relative stenosis of the caudal cervical vertebral canal occurred more often in Doberman Pinschers with DA-CSM compared to English Foxhounds and a critical degree of spinal cord compression should be reached to result in clinical signs.  相似文献   

6.
Medical records of 66 dogs that had undergone myelography, using iohexol (240 mg of iodine/ml, 0.3 to 0.5 ml/kg of body weight) during a 2-year period, were reviewed. In 3 dogs, myelography was performed twice during different anesthetic procedures. Neurologic abnormalities were more pronounced the day after myelography in dogs with caudal cervical spondylomyelopathy (P less than 0.01), meningitis (P less than 0.01), or extradural tumors (P less than 0.05). Neither anesthetic regimen nor duration of anesthesia significantly affected the frequency of complications. Seizures occurred after myelography in 6 dogs, and 1 dog had seizures after each of 2 myelographic procedures. The frequency of seizures was significantly greater in male Doberman Pinschers afflicted with caudal cervical spondylomyelopathy. Male dogs (P less than 0.01) and Doberman Pinschers (P less than 0.001) had higher prevalence of seizures. Caudal cervical spondylomyelopathy was associated with higher prevalence of seizures, compared with all other diagnoses (P less than 0.001). Seizures were significantly more prevalent when body weight was greater than or equal to 29 kg (P less than 0.001), when greater than or equal to 2 injections of contrast medium were administered (P less than 0.016), or when 2 injections of contrast medium were given at the cisterna magna (P less than 0.015). The 10% prevalence of seizures after myelography with iohexol in the study reported here is greater than in previous reports, but is lower than that reported after myelography using metrizamide.  相似文献   

7.
Objective— To evaluate the safety of the angle of insertion of bicortical implants in Doberman Pinschers affected by caudal cervical spondylomyelopathy (CCSM) using simulation on computed tomography (CT) images.
Animals— Doberman Pinschers (n=9) with dynamic spinal compression attributed to CCSM.
Methods— Dogs had CT evaluation of the cervical vertebral column. Digital images were used to evaluate the safety of bicortical implant insertion from the midline at 30, 35, and 40° inclination by drawing a line simulating implant position. Correct surgical positioning of dogs was evaluated by measuring the degree of rotation of the spine along the longitudinal axis.
Results— Insertion of an implant at 30, 35, and 40° inclination was considered safe in 42%, 59%, and 67% of selected sites. Rotation of the spine from 9° counter clockwise to 10° clockwise along the longitudinal axis occurred in 53% of the areas considered.
Conclusions— These results suggest that bicortical implants in the caudal cervical area in Doberman Pinschers affected by CCSM carry a high risk of vertebral canal and intervertebral foramina violation.
Clinical Relevance— Bicortical implants inserted at 30 and 35° in the caudal cervical area in Doberman Pinschers affected by CCSM carry a high risk of vertebral canal and intervertebral foramina violation. CT planning for individual dogs can facilitate selection of the appropriate insertion plane and vertebral column rotation needs to be considered in surgical planning.  相似文献   

8.
Objective— To describe indirect decompression by means of cervical spine locking plate (CSLP) fixation with vertebral distraction, discectomy, and cancellous block bone grafting in large breed dogs with single caudal cervical dynamic spondylotic lesions diagnosed by myelography with linear traction to the cervical spine, and contrast-enhanced computed tomography.
Study Design— Prospective clinical study.
Animals— Dogs (n=12) with caudal cervical spondylotic myelopathy because of a single dynamic, traction-responsive lesion.
Methods— Single, traction-responsive, caudal cervical spondylotic lesions were treated by vertebral distraction, discectomy, cancellous block bone grafting, and CSLP fixation. Follow-up was obtained by sequential recheck examination by the author or referring veterinarian or by telephone inquiries.
Results— Ten dogs had neurologic improvement after surgery. Indirect decompression by maintained distraction with cancellous block grafting and CSLP fixation was readily accomplished with less risk of blood loss or iatrogenic spinal cord injury than that associated with direct (ventral) decompression. There were no complications of graft intrusion, extrusion or subsidence, implant loosening, foraminal impingement, or end-plate failure. Two dogs that had satisfactory short-term recoveries developed clinical signs associated with adjacent segment disease and were euthanatized. At long-term follow-up, 8 dogs had satisfactory function, either a normal gait or one with slight to moderate proprioceptive deficits.
Conclusions— CSLP fixation with cancellous block interbody grafting is an effective and perhaps safer method of treating single-level, traction-responsive cervical spondylosis in large breed dogs.
Clinical Relevance— CSLP fixation with interbody bone grafting is a viable alternative to other techniques for treatment of single-level, traction-responsive cervical spondylosis.  相似文献   

9.
OBJECTIVE: To compare morphologic and morphometric features of the cervical vertebral column and spinal cord of Doberman Pinschers with and without clinical signs of cervical spondylomyelopathy (CSM; wobbler syndrome) detected via magnetic resonance imaging (MRI). ANIMALS: 16 clinically normal and 16 CSM-affected Doberman Pinschers. PROCEDURES: For each dog, MRI of the cervical vertebral column (in neutral and traction positions) was performed. Morphologically, MRI abnormalities were classified according to a spinal cord compression scale. Foraminal stenosis and intervertebral disk degeneration and protrusion were also recorded. Morphometric measurements of the vertebral canal and spinal cord were obtained in sagittal and transverse MRI planes. RESULTS: 4 of 16 clinically normal and 15 of 16 CSM-affected dogs had spinal cord compression. Twelve clinically normal and all CSM-affected dogs had disk degeneration. Foraminal stenosis was detected in 11 clinically normal and 14 CSM-affected dogs. Vertebral canal and spinal cord areas were consistently smaller in CSM-affected dogs, compared with clinically normal dogs. In neutral and traction positions, the intervertebral disks of CSM-affected dogs were wider than those of clinically normal dogs but the amount of disk distraction was similar between groups. CONCLUSIONS AND CLINICAL RELEVANCE: The incidence of intervertebral disk degeneration and foraminal stenosis in clinically normal Doberman Pinschers was high; cervical spinal cord compression may be present without concurrent clinical signs. A combination of static factors (ie, a relatively stenotic vertebral canal and wider intervertebral disks) distinguished CSM-affected dogs from clinically normal dogs and appears to be a key feature in the pathogenesis of CSM.  相似文献   

10.
Computed tomography (CT) myelography is used occasionally in the diagnosis of cervical spondylomyelopathy, but the type of lesion found in large- versus giant-breed dogs using this modality has not been characterized. Our purpose was to report the frequency of compressive lesions in large- and giant-breed dogs with cervical spondylomyelopathy and imaged using CT myelography. Fifty-eight dogs were retrospectively studied, 23 large-breed and 35 giant-breed dogs. Multiple sites of compression were found in 12 large-breed dogs (52.2%) compared to 30 (85.8%) giant-breed dogs. The main site of compression was at C5-6 and C6-7 in both large-breed (91.3%) and giant-breed (72.4%) dogs. The main cause and direction of compression was disc-associated and ventral in 19 (82.6%) of the large-breed dogs while osseous changes were the primary cause of compression in 27 (77.2%) of the giant-breed dogs, with most compressions being lateral (51.4%), followed by dorsolateral (14.2%). Osseous compression was observed at C7-T1 in eight giant-breed dogs (22.8%), and at T1-T2 or T2 only in five dogs (14.3%). Four of 23 large-breed dogs (17.4%), and seven (20%) of 35 giant-breed dogs had spinal cord atrophy. Therefore, giant-breed dogs often have multiple compressions, usually caused by osseous changes causing lateralized compressions. In large-breed dogs most compressions are disc-associated and located ventrally. Considering the number of giant-breed dogs with compressions at C7-T1, T1-2, and T2, it is important to include the cranial thoracic region when imaging dogs suspected of having cervical spondylomyelopathy.  相似文献   

11.
The height, width, and cross-sectional area of the vertebral canal and spinal cord along with the area ratio of spinal cord to vertebral canal in the cervical vertebra were evaluated in images obtained using computed tomography (CT). Measurements were taken at the cranial, middle, and caudal point of each cervical vertebra in eight clinically normal small breed dogs (two shih tzu, two miniature schnauzers, and four mixed breed), 10 beagles, and four German shepherds. CT myelography facilitated the delineation of the epidural space, subarachnoid space, and spinal cord except at the caudal portion of the 7th cervical vertebra. The spinal cord had a tendency to have a clear ventral border in the middle portion of the vertebral canal and lateral borders near both end plates. The height, width, and area of the vertebral canal and spinal cord in the cervical vertebra were increased as the size of dog increased. However, the ratio of the spinal cord area to vertebral canal area in the small dogs was higher than that of the larger dogs. Results of the present study could provide basic and quantitative information for CT evaluation of pathologic lesions in the cervical vertebra and spinal cord.  相似文献   

12.
Neuroaxonal dystrophy (NAD) and leukoencephalomalacia (LEM) are two neurological disorders of the rottweiler that initially present as ataxia of all four limbs. Disorders to be included in the differential diagnosis are caudal cervical spondylomyelopathy, canine distemper virus meningoencephalomyelitis, other nervous system infections or inflammations and spinal cord neoplasia. All diagnostic tests including myelography, cerebrospinal fluid analysis, electrodiagnos-tic testing and serum and cerebrospinal fluid titres for canine distemper virus are normal in NAD and LEM. There is no treatment for either disease and neurological signs progressively deteriorate. Eventually neurological deficits develop besides ataxia and these help differentiate NAD from LEM. Dogs with NAD develop head tremors and nystagmus while dogs with LEM develop conscious proprioceptive deficits and quadriparesis; the short term prognosis for NAD is better than LEM. Most dogs with LEM are euthanased because of non-ambulatory tetraparesis within one year. The histopathological lesions associated with NAD include axonal spheroids in many spinal cord and caudal brainstem nuclei and reduced numbers of Purkinje cells in the cerebellum, while in LEM, multifocal areas of demyelination and malacia of the spinal cord and brainstem are the primary histopathological lesions. Both NAD and LEM are suspected to have an autosomal recessive genetic transmission.  相似文献   

13.
Using an autogenous bone graft (obtained from the iliac crest), 4-mm cancellous bone screws, and polymethylmethacrylate, a distracted cervical spinal fusion technique was performed on 10 dogs with myelographic evidence of caudal cervical spondylomyelopathy. All dogs had evidence of dynamic soft tissue spinal cord compression, as indicated by flexion, extension, and traction myelographic views. Of the 10 dogs, 4 previously had undergone surgery by use of ventral slot or cervical disk fenestration techniques, and their neurologic status had deteriorated after the original surgery. Preoperative neurologic status of the 10 dogs included nonambulatory tetraparesis (n = 5), severe ataxia with conscious proprioceptive deficits (n = 2), and mild ambulatory ataxia with conscious proprioceptive deficits (n = 3). Five dogs had signs of various degrees of cervical pain. Clinical improvement was observed in 8 of 10 dogs--either improved neurologic status or elimination of cervical pain. Implant loosening developed in 3 dogs; 2 of them were euthanatized because of lack of neurologic improvement. Radiographic evidence of bony cervical fusion was observed during a 9- to 24-week period in 6 of the 8 surviving dogs. The distracted cervical fusion technique appears to be a valid surgical procedure to manage cervical spondylomyelopathy in those dogs in which the lesions are limited to one cervical intervertebral disk space.  相似文献   

14.
Cervical spondylomyelopathy or "wobbler syndrome" is a well-defined disorder of large-breed dogs, characterized by a compressive lesion affecting the cervical spinal cord that in many dogs may have a dynamic component. Determination of whether this dynamic component is present is important in the decision-making process as regards therapeutic intervention. Despite a significant risk of neurologic deterioration following myelography in some large dogs affected by wobbler syndrome, myelography is considered an essential part of the assessment, primarily as it allows assessment of whether a dynamic compression exists. This same neurologic deterioration is not apparent following magnetic resonance (MR) imaging; however, the use of MR imaging in the investigation of wobbler syndrome has thus far been limited by the inability to perform the traction studies required to ascertain whether a dynamic component to the spinal cord compression exists. This paper presents a technique of applying traction during MR imaging of the cervical spine to reduce a dynamic wobbler syndrome lesion.  相似文献   

15.
Contrast medium opacification of the spinal central canal after cisterna magna or lumbar puncture caudal to the 5th lumbar vertebra was an unusual observation during myelography. Incidental central canal opacification was more likely to occur in normal dogs or dogs with spinal cord pathology during lumbar puncture cranial to the 5th lumbar vertebra. Preferential contrast medium migration into the central canal, particularly if injected rapidly, may lead to deterioration in neurologic status. Placement of the spinal needle in the central canal during cisterna magna myelography was necessary to document the presence of hydromyelia. Case histories illustrating the above conditions were given and their significance discussed.  相似文献   

16.
No screening method is currently available to differentiate dogs with and without cervical spondylomyelopathy. Intravertebral and intervertebral ratios are used in horses and can predict cervical vertebral malformation. Intervertebral ratios could be a useful screening method for canine cervical spondylomyelopathy. Our purpose was to compare cervical intervertebral and intravertebral ratios in normal vs. affected Doberman pinschers. Forty dogs were studied, 27 affected and 13 normal. Cervical radiographs were obtained in all dogs. The minimum intra- and intervertebral sagittal diameter ratios were established for each cervical vertebrae and disc space from C(2) to C(7) . Comparisons were made between groups and specific vertebral body and disc levels. The effect of gender, age, and method of measurement (analog or digital radiographs) was also studied. There was no difference in either the intervertebral or intravertebral ratio between normal vs. affected dogs. The ratios decreased progressively along the cervical spine, being smallest at C(6) -C(7) and C(7) , respectively. Age, gender, and method of measurement had a significant influence on both inter- and intravertebral ratios, with smaller ratios seen as dogs aged and in male dogs. Based on our results, inter- or intravertebral ratios have no value to distinguish between clinically normal Doberman pinschers and Doberman pinschers with cervical spondylomyelopathy.  相似文献   

17.
OBJECTIVE: To evaluate progression of clinical signs and magnetic resonance imaging (MRI) findings in dogs with cervical spondylomyelopathy (wobbler syndrome) treated medically or surgically. DESIGN: Prospective cohort study. ANIMALS: 12 Doberman Pinschers. PROCEDURES: Neurologic examinations and MRI were performed before medical (n = 9) or surgical treatment (ventral slot, 3) and a minimum of 12 months later. RESULTS: Mean follow-up time was 14.5 months. Clinically, 2 dogs improved after surgical treatment and 5 improved after medical treatment. Magnetic resonance imaging of surgically treated dogs revealed adequate spinal cord decompression. Spinal cord signal changes were seen in 2 dogs before surgery, both of which had new signal changes at the same and adjacent sites during follow-up examination. One dog treated surgically developed 3 new areas of spinal cord compression. In the medically treated dogs, the severity of spinal cord compression at the time of follow-up examination was unchanged in 4 dogs, worse in 2 dogs, and improved in 3 dogs, but spinal cord atrophy was observed on transverse images. Four medically treated dogs had changes in spinal cord signal initially, but none developed new signal changes or compressions. CONCLUSIONS AND CLINICAL RELEVANCE: Medical and surgical treatment improved or stabilized the clinical condition of most dogs. Surgical treatment appeared to hasten the development of additional areas of spinal cord compression and lesions in dogs with preoperative cord changes; however, the clinical importance of these changes was not determined. The progression of pathologic MRI abnormalities was notably less in medically treated dogs, compared with surgically treated dogs.  相似文献   

18.
Cervical spondylomyelopathy or Wobbler syndrome commonly affects the cervical vertebral column of Great Dane dogs. Degenerative changes affecting the articular process joints are a frequent finding in these patients; however, the correlation between these changes and other features of cervical spondylomyelopathy are uncertain. We described and graded the degenerative changes evident in the cervical articular process joints from 13 Great Danes dogs with cervical spondylomyelopathy using MR imaging, and evaluated the relationship between individual features of cervical articular process joint degeneration and the presence of spinal cord compression, vertebral foraminal stenosis, intramedullary spinal cord changes, and intervertebral disc degenerative changes. Degenerative changes affecting the articular process joints were common, with only 13 of 94 (14%) having no degenerative changes. The most severe changes were evident between C4-C5 and C7-T1 intervertebral spaces. Reduction or loss of the hyperintense synovial fluid signal on T2-weighted MR images was the most frequent feature associated with articular process joint degenerative changes. Degenerative changes of the articular process joints affecting the synovial fluid or articular surface, or causing lateral hypertrophic tissue, were positively correlated with lateral spinal cord compression and vertebral foraminal stenosis. Dorsal hypertrophic tissue was positively correlated with dorsal spinal cord compression. Disc-associated spinal cord compression was recognized less frequently.  相似文献   

19.
OBJECTIVE: To establish the reference ranges for motor evoked potential (MEP) latency and amplitude in clinically normal Doberman Pinschers, compare the MEPs of Doberman Pinschers with and without clinical signs of cervical spondylomyelopathy (CSM; wobbler syndrome), and determine whether MEP data correlate with neurologic or magnetic resonance imaging (MRI) findings. ANIMALS: 16 clinically normal and 16 CSM-affected Doberman Pinschers. PROCEDURES: Dogs were classified according to their neurologic deficits. After sedation with acepromazine and hydromorphone, transcranial magnetic MEPs were assessed in each dog; latencies and amplitudes were recorded from the extensor carpi radialis and cranial tibial muscles. Magnetic resonance imaging was performed to evaluate the presence and severity of spinal cord compression. RESULTS: Significant differences in cranial tibial muscle MEP latencies and amplitudes were detected between clinically normal and CSM-affected dogs. No differences in the extensor carpi radialis MEP were detected between groups. There was a significant correlation (r = 0.776) between the cranial tibial muscle MEP latencies and neurologic findings. Significant correlations were also found between MRI findings and the cranial tibial muscle MEP latencies (r = 0.757) and amplitudes (r = -0.453). CONCLUSIONS AND CLINICAL RELEVANCE: Results provided a reference range for MEPs in clinically normal Doberman Pinschers and indicated that cranial tibial muscle MEP latencies correlated well with both MRI and neurologic findings. Because of the high correlation between cranial tibial muscle MEP data and neurologic and MRI findings, MEP assessment could be considered as a screening tool in the management of dogs with spinal cord disease.  相似文献   

20.
Seventeen large dogs (15 Doberman pinschers, one Labrador retriever, and one German short-haired pointer) with pain and gait abnormalities resulting from caudal cervical intervertebral disc degeneration were treated by disc fenestration. Four dogs recovered completely, two dogs appeared to have recovered but nerve root compression and pain returned 3 years later, five did not recover completely or did not improve, and six became progressively worse. In the dogs that recovered, preoperative myelograms showed that traction on or flexing the neck relieved the spinal cord compression. Such manipulation did not relieve slight persistent compression in the dogs that did not improve nor did it relieve severe compression by disc herniation or spinal canal stenosis in the dogs that became progressively worse. The return of nerve root compression after 3 years in two dogs was attributed to incomplete removal of dorsal anulus fibrosus. It was concluded that disc fenestration alone provided inadequate treatment of caudal cervical degenerative disc disease in large dogs.  相似文献   

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