Randomized Controlled Trial of Durotomy as an Adjunct to Routine Decompressive Surgery for Dogs With Severe Acute Spinal Cord Injury.

Autor:	Jeffery ND; Department of Small Animal Clinical Sciences, Texas A&M University, College Station, Texas, USA., Rossmeisl JH; Department of Small Animal Clinical Sciences, VA-MD College of Veterinary Medicine, Blacksburg, Virginia, USA., Harcourt-Brown TR; Langford Vets, Bristol, United Kingdom., Granger N; Bristol Vet Specialists, CVS Ltd, Bristol, United Kingdom., Ito D; Nihon University College of Bioresource Sciences Department of Veterinary Medicine, Fujisawa, Japan., Foss K; Department of Veterinary Clinical Medicine, University of Illinois Urbana-Champaign, Champaign, Illinois, USA., Chase D; Veterinary Specialists Aotearora, Auckland, New Zealand.
Jazyk:	angličtina
Zdroj:	Neurotrauma reports [Neurotrauma Rep] 2024 Feb 20; Vol. 5 (1), pp. 128-138. Date of Electronic Publication: 2024 Feb 20 (Print Publication: 2024).
DOI:	10.1089/neur.2023.0129
Abstrakt:	Although many interventions for acute spinal cord injury (SCI) appear promising in experimental models, translation directly from experimental animals to human patients is a large step that can be problematic. Acute SCI occurs frequently in companion dogs and may provide a model to ease translation. Recently, incision of the dura has been highlighted in both research animals and human patients as a means of reducing intraspinal pressure, with a view to improving perfusion of the injured tissue and enhancing functional recovery. Observational clinical data in humans and dogs support the notion that it may also improve functional outcome. Here, we report the results of a multi-center randomized controlled trial of durotomy as an adjunct to traditional decompressive surgery for treatment of severe thoracolumbar SCI caused by acute intervertebral disc herniation in dogs. Sample-size calculation was based on the proportion of dogs recovering ambulation improving from an expected 55% in the traditional surgery group to 70% in the durotomy group. Over a 3.5-year period, we enrolled 140 dogs, of which 128 had appropriate duration of follow-up. Overall, 65 (51%) dogs recovered ambulation. Recovery in the traditional decompression group was 35 of 62 (56%) dogs, and in the durotomy group 30 of 66 (45%) dogs, associated with an odds ratio of 0.643 (95% confidence interval: 0.320-1.292) and z-score of -1.24. This z-score indicates trial futility to reach the target 15% improvement over traditional surgery, and the trial was terminated at this stage. We conclude that durotomy is ineffective in improving functional outcome for severe acute thoracolumbar SCI in dogs. In the future, these data can be compared with similar data from clinical trials on duraplasty in human patients and will aid in determining the predictive validity of the "companion dog model" of acute SCI. Competing Interests: No competing financial interests exist. (© Nick D. Jeffery et al., 2024; Published by Mary Ann Liebert, Inc.)
Databáze:	MEDLINE
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