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184 15 Dental Equipment & Instrumentation www.vetinst.com 184 7 Spinal Surgery www.vetinst.com Surgery of the Spine Spinal surgery can be very rewarding, & is still possible to perform successfully with relatively modest equipment, but there are several critical factors to achieving a successful outcome. Making the correct diagnosis is key. Patient signalment & neurological examination should lead to gross localisation of the neurological lesion i.e. upper motor neuron vs. lower motor neuron, central vs. peripheral neuropathy, the most likely spinal segment affected i.e. C1-C5, C6-T2, T3-L3 & L4-S3, & left vs. right sided. Most patients requiring spinal surgery have spinal cord compression caused by intervertebral disc extrusion or protrusion, soft tissue hypertrophy associated with instability, spinal fracture or luxation, or neoplasia. Plain radiographs may indicate the location of a fracture, luxation or neoplasia, but are rarely sufficient to reliably identify location & lateralisation of intervertebral disc disease. Myelography can be used for precise lesion localisation & was successfully used for many years, but it comes with a number of drawbacks. These include risks & side effects associated with cisternal or lumbar puncture, & injection of contrast agents into the subarachnoid space. Over the last 10-15 years, MRI has become established as the technique of choice for imaging the spinal canal & cord, with CT +/-contrast coming a close second. Given the choice, both CT & MRI are preferable to myelography as they are safer, arguably quicker, have far fewer risks or side effects, & are much less likely to result in a false diagnosis. For example, a low volume high velocity (LVHV) disc extrusion or Fibro-Cartilaginous Embolus (FCE) cannot be definitively diagnosed using myelography, but the diagnosis can be made from good quality MR images, particularly a high field unit. This increases diagnostic accuracy, closely guides prognosis, decision making & treatment options, & potentially avoids unnecessary surgery from a misleading myelogram.