Second surgery soon after the first
Tues, November 6, 2012
Linda asks: How many second surgeries do you see immediately following the first? We have two of them on the List right now. Some seem
as though the surgeon did not get everything the first time and others
seem that it's a second disc. Any insight you can give us as to why? With other discs that rupture closely after surgery, should there have been fenestration? Is it true that you can see if adjacent discs are degenerated on the MRI before doing surgery?
We will occasionally see dogs that will re-herniate at the same site. This typically is within the first 2-4 weeks after surgery. The rent/tear in the outside of the disk (annulus fibrosus) that allowed the center material (nucleus pulposus) to rupture and compress the spinal cord does not scar over/heal immediately after surgery. Therefore there is the potential for additional disk material to rupture and cause a step back clinically. This is why it is so important to keep them quiet immediately after surgery. Within the first 2-4 weeks following surgery there is an increased risk for herniation at the site that had recently ruptured and required surgery. (due to the rent/tear in the annulus taking that long to heal)
If a dog has another episode (consistent with a disk rupture) greater than 4 weeks after surgery it is more likely due to a different disk rather than the site where surgery was performed.
On the MRI we can see if surrounding disks are degenerative. The verdict is still out for fenestration. Some neurologists feel strongly to do fenestration and others less so. Even the disk that has herniated can be fenestrated to hypothetically decrease the chance of re-rupture from the same site. So, it is surgeon and case specific dependent.
Hope this helps.
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