06/27/2023
LOOKING FOR THE IDEAL INTERBODY DEVICES TO TREAT DISC-ASSOCIATED CSM (DA-CSM)
Great study published by our friend and amazing neurosurgeon Colin Driver and colleagues. Many techniques have been proposed to treat DA-CSM including direct and indirect decompression techniques. The latter is often used when faced with a significant traction-responsive lesion. Maintenance of distraction in these cases would in theory immediately and effectively relieve the extradural spinal cord compression caused by the redundant dorsal annulus and/or ligamentum flavum, relieve the spinal cord ischemia caused by compression of the ventral spinal artery and reopen the narrowed intervertebral foramina decompressing the nerve roots/spinal nerves. Although the goal of stabilization is to treat instability in the short-term, long-term stability requires bony fusion, or the implant can fail which has been the most common cause of failure in these distraction-fusion techniques. Many reasons exist for the failure of the different techniques proposed to date including the type of interbody material used. The ideal interbody material should have an elastic modulus compatible with vertebral bone to limit the risk of crushing or perforating the adjacent endplates and conform to the shape of the endplates which varies from dog to dog as well as from individual disc space to space. Interbody material should also be biologically compatible to facilitate vertebral fusion for long-term stability. This is unlikely to be achieved with interbody material such as cement plug, washer or other metallic spacers. In this study, the authors put to the test an endplate conforming interbody device that was manufactured in titanium alloy with a micro-porous structure to try to meet these requirements and limit complications associated often seen in the use of indirect decompression technique to treat DA-CSM. For further reading: https://www.frontiersin.org/articles/10.3389/fvets.2023.1208593/full
Enjoy the reading of this great study!
Laurent Garosi
Simon Platt
PS. Image below taken from the article mentioned in this post