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

Neurotrauma Reports, 2024 · DOI: 10.1089/neur.2023.0129 · Published: January 1, 2024

Spinal Cord Injury Neurology Veterinary Medicine

Simple Explanation

This study investigates whether durotomy (incision of the dura) improves outcomes for dogs with severe spinal cord injuries (SCI) when added to standard decompressive surgery. The researchers compared dogs receiving standard surgery alone to those receiving standard surgery plus durotomy, focusing on the ability to walk again after the procedure. The results indicated that durotomy did not improve the recovery rate and might even have had negative effects, suggesting it's not a beneficial addition to standard surgery for severe SCI in dogs.

Study Duration

3.5 years

Participants

140 dogs with severe acute thoracolumbar SCI

Evidence Level

Level 1, Randomized Controlled Trial

Key Findings

1
Durotomy did not improve the rate of ambulation recovery in dogs with severe acute thoracolumbar SCI compared to traditional decompressive surgery alone.
2
The odds ratio for recovery with durotomy versus traditional surgery was 0.643 (95% CI: 0.320–1.292), indicating a trend towards worse outcomes with durotomy.
3
Exploratory analysis suggested that delays in completing surgery after presentation to the surgical clinic are associated with detrimental effects on recovery.

Research Summary

This randomized controlled trial evaluated the effectiveness of durotomy as an adjunct to traditional decompressive surgery for severe acute thoracolumbar spinal cord injury (SCI) in dogs. The study found that durotomy did not improve functional outcomes and hinted at possible negative effects, leading to early termination of the trial due to futility. The results suggest that durotomy is ineffective for improving functional outcome in dogs with severe acute thoracolumbar SCI and highlight the importance of timely decompressive surgery.

Practical Implications

Clinical Practice

Durotomy should not be routinely added to decompressive surgery for severe acute thoracolumbar SCI in dogs.

Human Translation

The findings may suggest that dural incision in human patients with SCI may not be effective. However, differences in the study designs and patient populations warrant further investigation.

Future Research

Further research should focus on identifying effective therapies for severe SCI, potentially using the companion dog model to pre-evaluate treatments before human clinical trials.

Study Limitations

1
The study was terminated early due to futility, limiting the statistical power.
2
The surgical decompression was not standardized, which may have introduced variability.
3
Recovery of pain perception and continence were not specifically recorded, limiting a full assessment of neurological recovery.

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