Last changed 26 May 2004
Edited by Sam Watson <samwtx at bajaokla dot com>
Case history contributed by James Harrell
Let me defer to Dr. Luttgen in the pamphlet "Canine Intervertebral Disk Disease" (reference 1.), for a few words on what this procedure is:
"Fenestration is the surgical procedure that creates an opening through the … disk annulus fibrosus through which nucleus pulposus can be removed, hopefully preventing disk herniation at that site in the future … The use of preventative fenestration as part of the treatment of intervertebral disk disease remains controversial. Certainly, if done poorly, numerous complications can arise, the worst being laceration of the spinal cord or aorta … If done carefully and atraumatically, fenestration can prevent future disk herniation, additional surgery, and future pain. I personally advocate preventative fenestration and believe it is a valuable service if rendered atraumatically."
Please read the entire pamplet, of course, to get the whole picture. Fenestration, also called "deflating the disks" by lay people, is usually offered to patients who are specifically at risk for future disk herniation. These are dogs who have had at least one episode of disk trouble, and who are considered likely to have another episode. During our Frieda's second back surgery, the surgeon fenestrated seven other disks that looked risky. She has not had a problem now for over a year. Still, preventative fenestration is surgery in the absence of symptoms and that is why it is controversial. In our case, she was undergoing a laminectomy for a ruptured disk and the fenestration was performed while she was under for that procedure. I have heard anecdotes of dogs being fenestrated without ever having shown signs of disk disease, and this is certainly going overboard (my opinion only).
Recently a new non-surgical method for accomplishing fenestration has been going through clinical trials at Oklahoma State University College of Veterinary Medicine. Dr. Kenneth E. Bartels and others have published the results of their trials in the Journal of the American Veterinary Medical Association (reference 3.). "Laser ablation" is a technique where the disk is penetrated by a spinal needle and an optical fiber is inserted through the needle to permit the nucleus pulposus to be burned away by laser light. After coming out of anesthesia, the dogs are able to walk. Out of 30 dogs (20 were Dachshunds) that they were able to follow for an average of 50 weeks, 4 had recurrences of back pain. 32 other dogs were treated after the main study was submitted and 1 dog had a recurrence and required surgery.
James Harrell of the dachsies@ mailing list has kindly provided us with this case history of "laser fenestration" :
FREDDY'S STORY:
My four and one half year old male Miniature Dachshund, Freddy, was in seemingly perfect health until one day when he "yelped" in pain as I picked him up. A trip to the vet brought the diagnosis of a possible pulled muscle, but the very real possibility of disk trouble. A steroid shot was given. Later the same evening, Freddy was admitted to my vet's hospital on an emergency basis. He was not using the bathroom, so to speak, and was in considerable pain. He was kept for three days-during that time he was crated and given steroids--and sent home to rest. His bowel and bladder habits were better but he still was not making progress on the pain front. He did not improve, but he did not get better over the next few days. In some ways--such as a weakness or "crossing" of his rear legs--he became worse.
After a consult with my vet, I decided to take him to the teaching hospital at Oklahoma State University in Stillwater for an exam by a surgeon who had extensive experience with disk problems in dogs. Because Freddy was not paralyzed, he gave me the option of a conservative approach--steroids and crating. However, his opinion was that Freddy's case could be better controlled with surgery--provided I could stand the cost. The price quoted was $1,000 to $1,500.
I opted for surgery. Freddy was not getting better and I feared that a continued wait might make the condition worse and, quite frankly, I could easily spend the cost of the operation on the conservative approach and still have a sick dog. The surgery was very successful.
Freddy had some mild complications--an upset stomach which delayed his release for two days--due to the extensive use of steroids but was home in a week and back to normal in two weeks following surgery. I was very careful to follow a strict crating program after surgery and it was hard to keep Freddy "under control" during the second week. He seemed to act and feel as if he had never been sick. Freddy¹s surgery cost about $1,000.
Freddy's initial problems revealed that he was at risk for back problems in the future and several people recommended that I investigate fenestration as a preventative procedure. At OSU, they were--it so happens--in the late stages of a clinical trial using a laser procedure for prevention. The process, called laser ablation, involves placing needles in the disks most susceptible to problems and "deflating" them to lessen the risk of hernia or rupture with a laser. The procedure is non-invasive and thus has the advantages of less risk to the animal and less cost to the human. Recovery time is two to three days and the success rate is good. The vets at OSU told me that of all the dogs that had a successful procedure none had developed a disk problem to present. The cost of the procedure is about $300.
Freddy had the laser ablation and was home in two days, feeling more or less normal. The vets at OSU recommend strict crating for two weeks before the dog can resume a normal life. I would add that I am going to keep in mind that Freddy did have back trouble and operate under a strict use of the preventative measures for this problem in dogs that have not had any trouble, trying to prevent jumping, weight control, etc., that is advocate by most who know the breed well.
While only time will indicate if the preventative procedure was successful, I would recommend that it--at least--be investigated. The OSU vets will not do the laser ablation on a sick dog--that is why Freddy had to have the disk treated first--and they have had good luck with the procedure. They indicated that the failure rate for traditional fenestration was about 11percent and, as noted above, so far they have a perfect record. Every vet I discussed the procedure with was positive because it is non-invasive and at least as successful as the traditional methods. In addition, I would not hesitate to have the disk surgery itself done provided it can be afforded even in a dog that is not completely down. The success rate of recovery is better and, as Freddy¹s surgeon indicated, the situation can be better managed. At any rate, both the disk surgery and the laser ablation offer additional hope that we can help our dachshund friends overcome one of the major health problems associated with their breed. Whatever course of treatment you take, my personal recommendation is not to delay treating back symptoms with the help of a qualified vet. They can become serious very quickly and restrict or eliminate treatment options.
For additional information on the laser ablation process, I would suggest writing : Oklahoma State University, College of Veterinary Medicine, Veterinary Teaching Hospital, Stillwater, OK 74078-2041. You can call (405) 744-6731 or fax (405) 744-6265 as well. At present, to my knowledge, they are the only place that is doing the laser ablation.
James Harrell
Editor's note: In February 1997 James reports that Freddy is doing fine six months after the procedure (big smiles all around!).
FREDDY'S RELAPSE IN FEBRUARY 1998
In February 1998, Jimmy Harrell wrote that Freddy had suffered a relapse of disk disease and had been evaluated by the vet and additional surgery was indicated. Originally, the diagnosis was that a non-fenestrated disk was involved. However, during the surgery it was evident that the problem disk was one which had supposedly been laser fenestrated. Apparently, in this disk the removal of nuclear material was incomplete enough that a disk rupture and ejection of nucleus occured.After removing the ejected disk material, the surgeon performed a surgical fenestration on all the previously laser fenestrated disks as a precaution.
A week after surgery Freddy would "wobble" a step or two and sit down. He retained control of bladder and bowel. The surgeon suggested that a return to mobility might take as long as six weeks and that Freddy needed rest, warm baths, and "bicycle" exercises for the legs.
As this is written, three weeks after surgery, Freddy is walking again and seems to be on the way to a full recovery. Since he was one of their research patients, the OSU Veterinary School picked up most of Freddy's expenses for this second surgery.
REFERENCES