Professor Noel Fitzpatrick

Degenerative lumbosacral stenosis has been suspected to have a dynamic component, especially regarding encroachment of the L7 nerve roots exiting the lumbosacral foramina. Angled cross-sectional imaging of the neuroforamina has been found improve the accuracy of the diagnosis of stenosis in humans. In this anatomic study, foraminal apertures were evaluated by MRI at the entry, middle, and exit zones of the nerve roots in 30 dogs that were clinically affected by lumbosacral disease. Standard vs. oblique planar orientation and neutral vs. hyperextended positioning of the lumbosacral area were compared by measuring the median values for entry, middle, and exit zones. The neuroforaminal area acquired using oblique plane acquisition was significantly smaller than standard parasagittal measurements. Furthermore, standard parasagittal neuroforaminal dimensions in the hyperextended position were significantly smaller than standard parasagittal measurements in the neutral position. This statistical difference was even more pronounced for neuroforaminal dimension evaluated in the oblique plane and hyperextended position. Positioning of the dog during imaging has a significant effect on neuroforaminal dimension, corroborating the notion that spinal position may influence neural claudication in clinically affected patients. Reductions in neuroforaminal dimension are more evident on oblique planar image acquisition, suggesting that this approach may be more useful than parasagittal imaging as a tool for identifying subtle changes in L7 neuroforaminal dimensions in cases of canine lumbosacral stenosis.

Due to its easy preparation and that it is well tolerated, the use of autologous platelet-rich plasma (PRP) has become increasingly popular in regenerative medicine. However, there are still no clear guidelines on how it should be classified or whether the individual canine patient's clinical status can influence its quality. Objective: This study aims to show if the weight, age, sex, neutered status or breed of canine patients have any correlation with the composition of PRP. Design: A blinded count of the platelets and white blood cells (WBC) was performed from 111 samples from 92 client owned dogs undergoing treatment for degenerative joint disease (DJD). The results were analysed using Pearson correlation test, ANOVA test or Student T-test. Results: There is a positive correlation between the number of platelets and WBC in canine patients of different breeds, but there was no significant difference on the platelet number and WBC number among the different breeds. The weight of the patient is also directly correlated to the platelet number (p = 0.003) but not WBC number. WBC number was negatively correlated to the weight of the patient. The sex and age of the patient did not affect platelets and WBC number, although WBC number is increased in non-neutered male population (p = 0.003). However, it would be interesting to investigate whether the growth factors released from the platelet granules are affected by patient variables in a canine population. Conclusions: Our results show that it is possible to obtain good quality autologous PRP, irrespective of age, sex, neutered status or weight of the patient, for PRP regenerative therapy.

Abstract Objective  The aim of this study was to determine the biomechanical behaviour of a novel distraction–fusion system, consisting of an intervertebral distraction screw, pedicle locking screws and connecting rods, in the canine caudal cervical spine. Study Design  Biomechanical study in cadaveric canine cervicothoracic (C3–T3) spines ( n  = 6). Cadaveric spines were harvested, stripped of musculature, mounted on a four-point bending jig, and tested using non-destructive four-point bending loads in extension (0–100 N), flexion (0–60 N) and lateral bending (0–40 N). Angular displacement was recorded from reflective optical trackers rigidly secured to C5, C6 and C7. Data for primary and coupled motions were collected from intact spines and following surgical stabilization (after ventral annulotomy and nucleotomy) with the new implant system. Results  As compared with the intact spine, instrumentation significantly reduced motion at the operated level (C5-C6) with a concomitant non-significant increase at the adjacent level (C6-C7). Conclusion  The combination of a locking pedicle screw-rod system and intervertebral spacer provides an alternative solution for surgical distraction–stabilization in the canine caudal cervical spine and supports the feasibility of using this new implant system in the management of disc-associated cervical spondylomyelopathy in dogs. The increase in motion at C6-C7 may suggest the potential for adjacent level effects and clinical trials should be designed to address this.

Staphylococcus pseudintermedius is a commensal and opportunistic pathogen of dogs. It is mainly implicated in canine pyoderma, as well as other suppurative conditions of dogs. Although bacterial culture is routinely used for clinical diagnosis, molecular methods are required to accurately identify and differentiate S. pseudintermedius from other members of the Staphylococcus intermedius group. These methods, owing largely to their cost, are not easy to implement in nonspecialized laboratories or veterinary practices. In the current study, loop-mediated isothermal amplification (LAMP), a novel isothermal nucleic acid amplification procedure, was employed to develop a rapid, specific, and sensitive S. pseudintermedius assay. Different detection strategies, including the use of a lateral flow device, were evaluated. The assay was evaluated for cross-reactivity against 30 different bacterial species and validated on a panel of 108 S. pseudintermedius isolates, originating from different dog breeds and locations within the United Kingdom. The assay was specific, showing no cross-reactivity during in silico and in vitro testing. When tested using DNA extracts prepared directly from 35 clinical surgical site swabs, the assay could detect S. pseudintermedius in less than 15 min, with a diagnostic sensitivity of 94.6%, superior to that of a polymerase chain reaction method. The LAMP assay also had an analytical sensitivity in the order of 10(1) gene copies, and the amplified products were readily detected using a lateral flow device. The LAMP assay described in the present study is simple and rapid, opening up the possibility of its use as a diagnostic tool within veterinary practices.

The aim of this study is to describe the treatment of an infected segmental bone defect in a cat using a novel, custom‐designed titanium implant seeded with adipose‐derived stem cells (AdMSCs) to facilitate osseous ingrowth and preserve limb function. Large bone defects occur secondary to trauma, infection, or neoplasia and often result in amputation. We established a novel autologous AdMSC‐impregnated trabecular metal spacer made using 3D printing, to bridge the distal tibia and metatarsal bones in the left pelvic limb of a cat that had previously undergone right pelvic limb amputation. Six months postoperatively, there was radiographic evidence of bone growth and implant integration. A titanium spacer seeded with AdMSCs successfully encouraged bone ingrowth in a large defect site and successfully preserved limb function. However, further studies are needed to justify the use of differentiated stem cell impregnated mesh as a framework to bridge large bone defects.

Objective To describe the design principles and evolution, surgical technique, and outcome for custom constrained (uniaxial and rotating hinge) total knee replacement (TKR) in cats. Study design Retrospective case series. Animals Nine cats with traumatic stifle luxation (n = 8) or severe distal femoral deformity (n = 1) were considered suitable candidates. Methods Cats that met eligibility criteria and received a custom TKR between 2009 and 2018 by a single surgeon were included in this case series. Three generations of implant were used. Implant positioning was assessed by postoperative orthogonal radiography. Functional outcome was determined by clinical assessment, owner interview, and a feline musculoskeletal pain index questionnaire. Results Median clinical follow-up time was 12 months (range, 4-41); follow-up time was increased to 29 months (range, 22-47) when results of functional questionnaires with owner were included. Median radiographic follow-up was 12 months (range, 4-25). One cat had a catastrophic outcome. Three cats had good outcomes, and five cats had excellent outcomes. Conclusion Most cats treated with custom-built TKR achieved good to excellent outcomes. Clinical significance Custom TKR is a viable option for the treatment of severe pathologies of the feline stifle. Additional research is required to fully evaluate implant suitability.

The aim of this study was to describe a novel limb-sparing technique for the management of feline bone neoplasia using a custom-made femoral endoprosthesis in combination with a total knee replacement (TKR) prosthesis.  Two cats with distal femoral bone tumours underwent pelvic limb salvage procedures with custom-made implants designed from patient-specific computed tomography images to replace the distal femur and the stifle. In case 1, the first-generation implant was a combination of a cemented femoral endoprosthesis with a uniaxial hinged cemented TKR prosthesis. Due to aseptic loosening of the endoprosthesis, revision was performed with a second-generation femoral endoprosthesis modified with a short intramedullary peg and a lateral bone plate for immediate stability. In case 2, a third-generation endoprosthesis with an intramedullary peg and two orthogonal bone plates for immediate stability, combined with a custom-designed rotationally hinged cemented TKR prosthesis, was used. Clinical and radiographic follow-up was recorded.  After revision surgery in case 1 and with the third-generation implant in case 2, no complications were encountered. Both cats showed minor mechanical restriction of stifle range of motion and good clinical long-term outcome without local tumour recurrence.  The combination of a femoral endoprosthesis and a TKR prosthesis can be a viable alternative for distal femoral limb salvage in cats.

Background A classic sign of canine syringomyelia (SM) is scratching towards one shoulder. Using magnetic resonance imaging (MRI) we investigate the spinal cord lesion relating to this phenomenon which has characteristics similar to fictive scratch secondary to spinal cord transection. Medical records were searched for Cavalier King Charles spaniels with a clinical and MRI diagnosis of symptomatic SM associated with Chiari-like malformation (CM). The cohort was divided into SM with phantom scratching (19 dogs) and SM but no phantom scratching (18 dogs). MRI files were anonymised, randomised and viewed in EFILM ™. For each transverse image, the maximum perpendicular dimensions of the syrinx in the dorsal spinal cord quadrants were determined. Visual assessment was made as to whether the syrinx extended to the superficial dorsal horn (SDH). Results We showed that phantom scratching appears associated with a large dorsolateral syrinx that extends to the SDH in the C3-C6 spinal cord segments (corresponding to C2-C5 vertebrae). Estimated dorsal quadrant syrinx sizes based on the perpendicular diameters were between 2.5 and 9.5 times larger in dogs with phantom scratching, with the largest mean difference p-value being 0.009. Conclusion SM associated phantom scratching appears associated with MRI findings of a large syrinx extending into the mid cervical SDH. We hypothesise that damage in this region might influence the lumbosacral scratching central pattern generator (CPG). If a scratching SM affected dog does not have a large dorsolateral cervical syrinx with SDH involvement then alternative explanations for scratching should be investigated.

Background Occipitoatlantoaxial malformation (OAAM) is reported rarely in dogs and few treatment options are described. The congenital condition is thought to be associated with a proatlas re-segmentation failure resulting in malformation and malalignment of the craniovertebral junction which can result in C1 to 5 myelopathic signs. Methods Customized three-dimensional printed locking plate with trajectory screw implantation points for the stabilization of the atlantoaxial joint in a dog with OAAM. The dog was evaluated at time points 0, 2, 6 and 9 months to determine clinical outcome, degree of fusion, implant positioning and subsidence. Results New bone formation was noted 9 months after surgery, but complete fusion remained absent, although no implant failure occurred. Clinically, the dog made a good recovery and was able to exercise normally 9 months after surgery. The only residual deficit was a subtle left-sided cervical torticollis. Clinical Significance This report illustrates a management option and outcome of a dog treated with OAAM. Collaboration between clinicians and engineers provides a new dimension of care for patients with vertebral malformations.

CASE DESCRIPTION A 6-month-old male Miniature Dachshund was referred for examination and correction of a unilateral pes varus deformity. CLINICAL FINDINGS Clinical examination and diagnostic imaging revealed varus, procurvatum, and internal torsion of the distal aspect of the left tibia causing intermittent lameness. TREATMENT AND OUTCOME True spherical osteotomy performed with a dome-shaped saw allowed correction of the deformity in 3-D, and orthogonal internal plate fixation provided stabilization. No intraoperative or immediate postoperative complications developed. Outcome as judged by the clinician and the owners was satisfactory 2 weeks after surgery and excellent at each subsequent assessment. The patient remained free of clinical signs at the last follow-up 30 months after surgery.

Adipose tissue has recently gained attention as a source of mesenchymal stem cells (AdMSCs) for applications in treating degenerative joint disease in veterinary patients. This study aimed to quantify the stromal vascular fractions (SVFs) and colony forming units (CFU) of AdMSCs from the falciform and flank regions and compare dogs of different ages and weights. Fat tissue was harvested from the flank (21 dogs) and falciform regions (17 dogs). The fat tissue was enzymatically digested and the number of nucleated cells in the SVF was counted. The SVF was cultured in vitro and the cell growth was assessed by counting the CFU per gram of fat and the aspect ratio of the cells. There was no significant difference in the number of nucleated cells in the SVF from the two sites. The CFU/g of fat from falciform was 378.9 ± 293 g and from flank was 486.8 ± 517 g, and this was also insignificant. Neither age nor weight of the patient had an impact on the SVF or CFU/g. No surgical complications were reported from either of the sites. Harvesting fat for stem cell therapy for intra-articular therapy of degenerative joint disease can be an easy and fast process when obtaining the fat either from the flank or the falciform region, and it is not age or weight dependent. The harvest site for clinical canine patients can be left to the surgeon's discretion and comfort.

Abstract Objectives  The purpose of this study was to explore the trigonometric principles of the spherical osteotomy, establish guidelines for its application and test the guidelines on bone models using a new blade design. We propose a new rule of osteotomies incorporating the outlined geometric principles, and applicable to the use of spherical cuts in veterinary orthopaedic surgery. Materials and Methods  The trigonometric principles for the execution of neutral, closing and opening spherical osteotomies were explored in silico. A modification of the existing commercially available dome blade was designed and manufactured such that it facilitated the performance of spherical osteotomy with a minimized blade radius. A pilot study was performed whereby the modified dome blade was used to create spherical osteotomy in canine radial bone models. The surfaces of the osteotomy models were laser-scanned using a three-dimensional (3D) scanner; the resultant scans were imported into and analysed using a commercial 3D analysis software. The accuracy of osteotomy execution was measured as the distance between the targeted centre of osteotomy and the actual centre of osteotomy as found on the 3D scans. Results  By utilizing the geometric principles of spherical osteotomy, an accurate osteotomy position was achieved. The centre of the spherical cut performed on bone models was confirmed to be within 5% tolerance of the location as planned in silico demonstrating the accurate and relevant clinical application of geometric principles. Clinical Significance  The trigonometric guidelines for the execution of spherical osteotomy can be applied in a pre-clinical environment with accuracy. The new guidelines combined with the proposed new rule for spherical osteotomy utilizing the new blade design are translatable into clinical application, permitting the surgeon to accurately plan osteotomy application while mitigating the significant loss of bone-to-bone contact during correction of torsional deformities inherent in the principles of dome osteotomy use.

This article represents the outcome of a dialogue between a vet and a healthcare ethicist on the theme of ‘love’ in professional life. We focus on four types or varieties of love (eros, agape, philia and storge) in relation to the professional care of humans and animals. We discuss the relevance of Fromm’s core elements of love (care, responsibility, respect and knowledge) and consider the implications of these for human and animal health care practice. We present and respond to five arguments that might be waged against embracing love as a professional value in veterinary and medical practice. We argue that a moderated love can and should be reclaimed as a contemporary professional value. It is most helpfully contextualised within virtue ethics or care ethics. We suggest that love is a rich starting point from which to launch an exploration of an interprofessional humanimal clinical ethics.

Abstract This article presents the findings of a scoping review designed to identify the extent, nature and range of literature on interprofessional education (IPE) initiatives between the human health professions and veterinary medical students, which is particularly important to advance One Health education and research. Nine published articles were identified. The websites of six universities were searched in order to collect further information. Interventions vary widely with regards to their structure and delivery, their objectives, the participants involved, and outcome measures. Healthcare professional programmes focus upon interprofessional collaborative practice in the human healthcare setting. By contrast, postgraduate programmes focus upon topics under the One Health paradigm but make little mention of interprofessional collaboration. Evidence of the impact of interventions on team processes at the human, animal, and environmental interface is extremely limited. In order to enhance our understanding of what constitutes effective IPE between veterinary medical students and the human health professions, guide intervention development, and the development of outcome measures, there is a need to further explore, define, differentiate and validate some of the terms and concepts used to describe interprofessional interventions.

The number of cervical vertebrae in mammals is almost constant at seven, regardless of their neck length, implying that there is selection against variation in this number. Homebox (Hox) genes are involved in this evolutionary mammalian conservation, and homeotic transformation of cervical into thoracic vertebrae (cervical ribs) is a common phenotypic abnormality when Hox gene expression is altered. This relatively benign phenotypic change can be associated with fatal traits in humans. Mutations in genes upstream of Hox, inbreeding and stressors during organogenesis can also cause cervical ribs. The aim of this study was to describe the prevalence of cervical ribs in a large group of domestic dogs of different breeds, and explore a possible relation with other congenital vertebral malformations (CVMs) in the breed with the highest prevalence of cervical ribs. By phenotyping we hoped to give clues as to the underlying genetic causes. Twenty computed tomography studies from at least two breeds belonging to each of the nine groups recognized by the Federation Cynologique Internationale, including all the brachycephalic ‘screw‐tailed’ breeds that are known to be overrepresented for CVMs, were reviewed. The Pug dog was more affected by cervical ribs than any other breed (46%; P 

Two unrelated 8-month-old male mixed breed dogs were presented for evaluation of progressive ataxia, knuckling, and lack of pain perception in the distal limbs. Because of the similarity in age of onset, progression, and clinical findings with previously described sensory neuropathy in Border Collies, the affected dogs were screened for an FAM134B mutation and were determined to be homozygous for the mutation. Despite few phenotypic similarities with other breeds, genetic testing for specific diseases should be considered in mixed breed dogs with compatible clinical signs, especially if ancestry is unknown.