PVMA Keystone Veterinarian Spring 2021 - 17

three episodes of back pain throughout
her short life and had to be relegated
to strict crate rest for six weeks and
treatment with anti-inflammatory and
pain medications. Nugget's most recent
episode rendered her not only painful,
but ataxic with an uncoordinated pelvic
limb gait. Fortunately, Nugget eventually
recovered from this episode. Needless to
say, Nugget's owners were very nervous
about allowing her to live a normal life
and do the things that she loved such as
running both on the farm and inside the
house, and of course, playing fetch. In a
chondrodystrophic dog that has proven
to have a predisposition to back pain and
disc degeneration, these normal activities
can cause a disc herniation at any time,
which may result in paralysis.
Due to the increased risk for disc
herniation and paralysis, Nugget's owner
began to seek out ways to decrease the
likelihood of disc herniation. This is when
she discovered the PLDA procedure
and scheduled it at VRC in Malvern, PA.
General pre-anesthetic diagnostics were
performed (thoracic radiographs and
CBC/Chemistry Profile) and the procedure
was scheduled for Nugget.
With the use of fluoroscopic guidance,
20-gauge 2.5-inch or 3.5-inch-long
spinal needles (depending on patient
size) are inserted percutaneously into
the middle of each disc space from T1112 to L4-L5. Placement of the spinal
needles into the disc spaces is confirmed
with orthogonal fluoroscopic images.
An opioid is administered at this time
(Hydromorphone 0.1 mg/kg). The premeasured length of laser optical fiber
from the Ho:YAG laser is passed through
each spinal needle and held firmly where
it enters the hub, and laser light of
2-watts power at a 10-Hz repetition rate
is delivered for 40 seconds to each disc
space in turn.
Nugget was kept under observation
overnight and administered an additional
opioid (Hydromorphone 0.1 mg/kg) six
hours following the procedure. An antiinflammatory (Carprofen 2.2 mg/kg BID)
and a pain medication (Gabapentin 5
mg/kg BID) are administered for 7 days
following the procedure. Patients are
generally discharged from the hospital the
day after the procedure.

Long-term prognosis following PLDA is
good. The procedure decreases the rate
of IVDD in chondrodystrophic breeds
from 20-25% down to 3-9%.8 Typically,
two weeks of restriction from activity are
recommended before return to normal
activity. Neurologic deficits (such as
ataxia, back pain, and discomfort) are very
rare and often transient.

Nugget is Pain Free, 3 Months
Following Procedure
Approximately three months after her
PLDA procedure, Nugget is doing well;
she has had no further episodes of back
pain and she is back to running on the
farm and playing with her family. Nugget's
owners are satisfied with the procedure
as most pet owners are. In fact, 92.7%
of pet owners reported that their
satisfaction with the procedure was >9
out of 10 (1=completely dissatisfied and
10=satisfied8).
If you are interested in learning more
about PLDA, please visit: vrcmalvern.
com/percutaneous-laser-disc-ablationplda/ or call 610.647.2950 and ask to
speak with Dr. Gaemia Tracy.
About Gaemia Tracy, DVM: He earned
his undergraduate degree in Biology
at the University of Pennsylvania and
attended veterinary school at the Ohio
State University. After completing a oneyear rotating small animal medicine/
surgery internship at Carolina Veterinary
Specialists in Charlotte, NC, he was
accepted to the Neurology/Neurosurgery
residency at North Florida Neurology in
Jacksonville, FL. In 2020, he joined VRC in
Malvern, PA. Dr. Tracy's interests include
IVDD treatment and management,
Atlantoaxial instability management,
management of inflammatory CNS
disease, and seizure management.
In his personal life, Dr. Tracy enjoys
spending time with his wife and two sons,
watching and playing baseball (he has
played since he was 5 years old), and
working out/being active.

References:
1. Choy DSJ, Altman PA, Case RB, et al.
Laser radiation at various wavelengths for
decompression of intervertebral disk. Clinical
orthopaedics and related research 1991;
267:245-250
2. Gottlob C, KopchokGE, Peng S, et al.
Holmium:YAG laser ablation of human
intervertebral disc: Preliminary evaluation.
Laser Surg Med 1992; 12:86-91
3. Buchelt M, Schlangmann B, Schmolke S,
et al. High power Ho:YAG laser ablation of
intervertebral discs: Effects on ablation rates
and temperature profile. Laser Surg Med
1995; 16:179-183
4. Dickey DT, Bartels KE, Henry GA, et al. Use
of the holmium yttrium aluminum garnet
laser for percutaneous thoracolumbar
intervertebral disk ablation in dogs. J Am Vet
Med Assoc 1996; 208:1263-1267
5. Choy DS, Ascher PW, Ranu HS, et al.
Percutaneous laser disc decompression: a new
therapeutic modality. Spine1992; 17:949-956
6. Mayhew PD, McLear RC, Ziemer LS, et al.
Risk factors for recurrence of clinical signs
associated with thoracolumbar intervertebral
disk herniation in dogs: 229 cases (19942000). J Am Vet Med Assoc 2004; 225:12311236
7. Bartels KE, Higbee RG, Bahr RJ, et al.
Outcome of and complications associated
with prophylactic percutaneous laser disk
ablation in dogs with thoracolumbar disk
disease: 277 cases (1992-2001). J Am Vet Med
Assoc 2003; 222:1733-1739
8. Dugat D, Bartels KE, Payton ME. Recurrence
of disk herniation following percutaneous
laser disc ablation in dogs with a history of
thoracolumbar intervertebral disk herniation:
303 cases (1994-2011). J Am Vet Med
Assoc 2016; 249:1393-1400

Pennsylvania Veterinary Medical Association | 17
PVMA Keystone Veterinarian Spring 2021

Table of Contents for the Digital Edition of PVMA Keystone Veterinarian Spring 2021
