Search Results (9)

The erector spinae plane (ESP) block is a widely used technique for perioperative analgesia. It involves the infiltration of anesthetics into the interfacial plane between the erector spinae muscle and the transverse processes of the vertebrae. In veterinary medicine, this technique has been adapted for different species, but there are no cadaveric studies in cats. This study describes the ultrasound-guided lumbar ESP-block technique and evaluates the spread of two volumes of dye in feline cadavers. Injections were performed at the second lumbar vertebra (L2) level using 0.6 mL/kg (high volume [HV]) and 0.4 mL/kg (low volume [LV]) of methylene blue bilaterally. After anatomical dissection, the distribution of the dye, the staining of the spinal nerve branches, and the presence of dye in the epidural space were recorded. The results demonstrated that the HV treatment provided wider longitudinal distribution, staining the dorsal branch of the spinal nerves in an average of five segments per injection, without extravasation into the epidural space. It is concluded that the HV treatment promotes efficient multisegmental spread in feline cadavers. Full article

The ultrasound-guided cervical plexus plane (US-CPP) block has proven effective in humans; yet its application in dogs remains unexplored. This study aimed to describe a novel US-CPP approach in canines. A local sonoanatomy was mapped, the injection technique was tested, and a gross anatomical dissection (GAD) was performed on one cadaver. The bilateral injectate spread and nerve staining were then evaluated via a CT scan and GAD in the six cadavers. The transducer was aligned parallel to the cervical spine, caudal to the atlas. After identifying the cleidocervical and omotransversarius muscles and the C2-C3 interfascial plane, a spinal needle was inserted in-plane, and 0.15 mL/kg of a dye-contrast solution was injected. CT imaging showed the contrast reaching the C1, C2, and C3 vertebral bodies in 3 out of 12 (3/12), 11/12, and 12/12 injections, respectively, and the C4, C5, and C6 vertebrae in 8/12, 5/12, and 1/12 injections, respectively. No contrast was detected in the epidural space. The C1, C2, C3, C4, and C5 nerves were stained in 3/12, 10/12, 8/12, 2/12, and 0/12 injections, respectively. No significant differences were observed between the groups (p > 0.05). A single US-CPP injection successfully stained the C2 and C3 nerves, indicating the potential clinical applicability, although the injected volume rarely reached C4 and C5. Full article

(1) This study evaluates the impact of the CT-guided SIRIO augmented reality navigation system on the procedural efficacy and clinical outcomes of neuroprotection in vertebral thermal ablation (RTA) for primary and metastatic bone tumors. (2) Methods: A retrospective non-randomized analysis of 28 vertebral RTA procedures was conducted, comparing 12 SIRIO-assisted and 16 non-SIRIO-assisted procedures. The primary outcomes included dose-length product (DLP) and epidural dissection time. The secondary outcomes included technical success, complication rates, and pain scores at procedural time (VAS Time 0) and three months post-procedure (VAS Time 1). The statistical analyses included t-tests, Mann–Whitney U tests, and multiple regression. (3) Results: SIRIO-assisted procedures significantly reduced DLP (307.42 mGycm vs. 460.31 mGycm, p = 2.23 × 10⁻⁸) and procedural epidural dissection time (13.48 min vs. 32.26 min, p = 2.61 × 10⁻¹²) compared to non-SIRIO-assisted procedures. Multiple regression confirmed these reductions were significant (DLP: β = −162.38, p < 0.001; time: β = −18.25, p < 0.001). Pain scores (VAS Time 1) did not differ significantly between groups, and tumor type did not significantly influence outcomes. (4) Conclusions: The SIRIO system enhances neuroprotection efficacy and safety, reducing radiation dose and procedural time during spine tumoral ablation while maintaining consistent pain management outcomes. Full article

The retrolaminar block is a regional anaesthetic technique, first developed in humans, in which the local anaesthetic is deposited directly onto the dorsal aspect of the thoracic or lumbar vertebral lamina. This study aims to evaluate the distribution of landmark-guided thoracolumbar retrolaminar injections in greyhound cadavers. Thirteen injections of contrast-dye solution were performed in eight cadavers at the level of the twelfth thoracic vertebra (T12), with either 20 mL (n = 8, high volume, HV) or 10 mL (n = 5, low volume, LV) per site. The spread of the injectate was evaluated through computed tomography and transverse anatomical dissection. The groups were compared using the Mann–Whitney U test. The median (range) of the extent of the spread was 4 (2–5) and 3 (2–4) intervertebral foramina in the LV and HV groups, respectively. The median (range) of the spread along the retrolaminar space was 3 (2–3) retrolaminar segments in the LV and 3 (2–4) in the HV group. Epidural and retroperitoneal spread was identified in seven cadavers. Following landmark-guided retrolaminar injections, the injectate spread both in the retrolaminar and paravertebral spaces, without any obvious association between the volume of injectate and the extent of the spread. Further studies are warranted to determine the clinical efficacy of the technique. Full article

Background: Horner’s syndrome (HS) classically consists of the symptom triad of miosis, ptosis, and anhidrosis. It is caused by impairment of a certain pathway in the sympathetic nervous system. It may also appear as part of the clinical signs of other diseases and syndromes, including Pancoast tumors, intradural and/or epidural tumors, thoracic outlet syndrome, syringomyelia, brachial plexus injury, and aortic dissection. Here, we report a very rare complication of vertebral column resection in children, and we present the clinical findings of a case of Horner’s syndrome with a current literature review. Case presentation: A five-year-old child with severe congenital kyphoscoliosis qualified for surgical treatment of the spinal deformity via a posterior approach, with three-column osteotomy and fusion. Results: After successful surgery, the patient presented with HS due to distraction of the sympathetic nerve trunk and, thus, innervation to the left eye. At the 4-year follow-up, the child had fully recovered. Conclusions: Pediatric HS after posterior instrumented scoliosis correction surgery with posterior vertebral column resection of the thoracic spine is very rare. This is the first reported case of HS after posterior vertebral column resection and spinal fusion for congenital kyphoscoliosis without the use of epidural analgesia. Symptom resolution may be variable and, in some cases, delayed. Full article

The proximal paravertebral nerve block is commonly used to provide anaesthesia to the flank during standing surgical procedures in adult cattle. It has been reported that additional anaesthetic infiltration may be necessary to provide complete anaesthesia. In humans as well as animal species, another technique—the ultrasound (US)-guided erector spinae plane block (ESPB)—has been described. The goal of the present study was to develop and investigate an US-guided ESPB in comparison to a blind proximal paravertebral nerve block (PPNB) in cow cadavers. In 10 cadaver specimens, injections of methylene blue-lidocaine (1:1) were performed at the level of T13, L1 and L2 vertebras, on one side doing an ESPB block and, on the other side, a PPNB. Five cadavers were injected with high (40 mL per injection for PPNB and 20 mL for ESPB) and five with low (20 and 15 mL, respectively) volumes of injectate. For the ESPB, the ultrasound probe was oriented craniocaudally, and the ventral-cranial aspect of the articular processes (T13, L1 and L2) was targeted for injection. The dye spreading was evaluated by dissection. The landmarks for US-guided injection were easily visualized; however, injections were accidentally performed at T12, T13 and L1. Nevertheless, L2 was stained in 60% of ESPBs. Epidural spreading was observed with both techniques and all volumes. Viscera puncture was reported in two PPNBs. The ESPB resulted in similar nerve staining compared to the PPNB while using a lower volume of injectate. Even better staining is expected with a T13-L2 instead of a T12-L1 ESPB approach. Further studies are warranted to evaluate the clinical efficacy. Full article

The exact pathogenesis of syringomyelia is unknown. Epidural venous distention during raised intrathoracic pressure (Valsalva) may cause impulsive movement of fluid (“slosh”) within the syrinx. Such a slosh mechanism is a proposed cause of syrinx dissection into spinal cord parenchyma resulting in craniocaudal propagation of the cavity. We sought to test the “slosh” hypothesis by epidural excitation of CSF pulse in a computer model of canine syringomyelia. Our previously developed canine syringomyelia computer model was modified to include an epidural pressure pulse. Simulations were run for: cord free of cavities; cord with small syringes at different locations; and cord with a syrinx that was progressively expanding caudally. If small syringes are present, there are peaks of stress at those locations. This effect is most pronounced at the locations at which syringes initially form. When a syrinx is expanding caudally, the peak stress is typically at the caudal end of the syrinx. However, when the syrinx reaches the lumbar region; the stress becomes moderate. The findings support the “slosh” hypothesis, suggesting that small cervical syringes may propagate caudally. However, when the syrinx is large, there is less focal stress, which may explain why a syrinx can rapidly expand but then remain unchanged in shape over years. Full article

Ultrasound-guided quadratus lumborum block (QLB) is a locoregional technique described in canine cadavers. The aim of this study was to assess a modified approach to QLB to minimise potential complications such as abdominal organ puncture. Nine canine cadavers were included and were positioned in lateral recumbency. An ultrasound-guided QLB was performed on each side. The probe was placed in the transverse position over the lumbar muscles just caudal to the last rib, and a needle was advanced in-plane from a dorso-lateral to a ventro-medial. A volume of 0.2 mL kg⁻¹ of a mixture of iomeprol and methylene blue was injected. Computed tomography (CT) and dissection were performed to evaluate the spreading. Success was defined as staining of the nerve with a length of more than 0.6 cm. Potential complications such as intra-abdominal, epidural, or intravascular spreading of the mixture were also assessed. The CT images showed a T13 to L7 vertebra distribution, with a median of 5 (3–6). Dissection showed staining of the nerves from T13 to L4, with a median of 3 (2–5). No complications were found. This modified approach to QLB is safe and shows similar results to the previous studies in canine carcass. Full article

(1) Background: Cranioplasty is a surgery to repair a skull bone defect after decompressive craniectomy (DC). If the process of dissection of the epidural adhesion tissue is not performed properly, it can cause many complications. We reviewed the effect of a silicone elastomer sheet designed to prevent adhesion. (2) Methods: We retrospectively reviewed 81 consecutive patients who underwent DC and subsequent cranioplasty at our institution between January 2015 and December 2019. We then divided the patients into two groups, one not using the silicone elastomer sheet (n = 50) and the other using the silicone elastomer sheet (n = 31), and compared the surgical outcomes. (3) Results: We found that the use of the sheet shortened the operation time by 24% and reduced the estimated blood loss (EBL) by 43% compared to the control group. Moreover, the complication rate of epidural fluid collection (EFC) in the group using the sheet was 16.7%, which was lower than that in the control group (41.7%, p < 0.023). Multivariate logistic regression analysis showed the sheet (OR 0.294, 95% CI 0.093–0.934, p = 0.039) to be significantly related to EFC. (4) Conclusions: The technique using the silicone elastomer sheet allows surgeons to easily dissect the surgical plane during cranioplasty, which shortens the operation time, reduces EBL, and minimizes complications of EFC. Full article