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new instrumentation also has two important potential mechanical advantages over standard pedicle screw-rod combinations. First, use of a polyaxial head on the screw allows for far greater versatility when linking the screw to the connecting rod (Fitzateur). Second, deployment of an interbody spacer (FITS) permits distraction, thereby restoring the neuroforamen and providing a conduit for fibro-osseous fusion of the interbody space. In clinical cases, the Fitzateur also provides more soft tissue
cover and superior implant-bone purchase than the predecessor technique using pins and cement.
It is clear that more objective tests to define clinical severity of DLSS need to be developed based on functional questionnaires, electrodiagnostics, kinetic and kinematic profiles and similarly more objective outcome measures following intervention. Dogs suffering pain
and disability associated with DLSS can be treated with oral medication, epidural steroid or surgical intervention, depending on the patient, on degree of compression and on severity of clinical signs. Randomised comparative trials would require large treatment cohorts to provide adequate power to discern between treatment differences and, until clinical and imaging inclusion/ exclusion criteria are established, this will be challenging.
There are very different sub-groups of clinical
cases varying from chronic osseous, discogenic
and inflammatory impingement which is apparently adequately tolerated by sedentary dogs through to mild dynamic impingement poorly tolerated by very athletic dogs. Furthermore, it is difficult to conduct unbiased randomised comparative trials with client-owned dogs. Therefore, it behoves us to focus on more rigorous case definition, developing better understanding of the correlation between clinical signs and imaging findings and being as critical and transparent as possible in outcomes analysis.
An Urban Experience

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