Bionic vet: Noel Fitzpatrick's revolutionary medicine

William Gadsby Peet explores the pioneering techniques employed by TV Supervet Professor Noel Fitzpatrick

Innovations by the orthopaedic neurosurgeon and star of Channel 4’s The Supervet, Professor Noel Fitzpatrick are starting to bring about an age where science has caught up with science fiction. Bionic spinal implants and limb replacements are no longer the fantasy of Wells or Huxley, but the everyday reality of veterinary medicine at the Supervet’s animal hospital. The case studies featured here show the evolution of thought regarding techniques which have taken place over more than a decade at Fitzpatrick Referrals, resulting in treatments never before thought possible.

And it is not just animal life that will be improved by these bionic stories, “We are in the midst of a great change in medicine,” explains Fitzpatrick, “and it is ever more apparent that surgery involving bionics and regenerative medicine should be shared among animals and humans for the greater good of all.”

Molly

Nine-year-old Cavalier King Charles, Molly was brought to the practice with a large bump on her head by owner Tania.

After a thorough examination by Dr Clare Rusbridge, Molly was immediately admitted to hospital for a CT scan of her skull. Unfortunately the CT scan showed the presence of a tumour invading the skull and pressing on the brain. Following a long discussion, Noel and Clare decided that surgical removal was Molly’s best option and that a titanium mesh reconstruction of the skull would be necessary.

A 3D model of Molly's skull with the new Titanium implant in place

Prior to Molly’s surgery Noel met with several bioengineering colleagues from the human field to discuss designing a custom-made implant for Molly.

The bioengineers created a 3D model of Molly’s skull from her CT scan, which enabled them to design both a template, and the actual 3D printed implant which would perfectly conform to Molly’s skull. Using the template, Noel removed the portion of skull containing the tumour using an ultrasonic cutter – a tool that doesn’t generate heat – to avoid damaging the sensitive brain tissue. The titanium mesh implant fitted perfectly into the gap and was secured to the remaining skull with plastic rivets.

Molly recovered well and went home three days after surgery.

Noel personally views this surgery as a seismic shift towards human medicine and veterinary medicine working together. The idea of ‘One Medicine’ is a vision that is very close to his heart and one to which he has dedicated his working life.

Lulu

Lulu was carried into the practice by her owner Charlie after she lost the use of all four legs

Lulu was immedietly given an MRI scan, which revealed the situation was even worse than Professor Fitzpatrick had initially anticipated. The spinal cord and nerves in Lulu’s lower neck were being completely squashed, meaning she was totally unable to walk.

Lulu's new bionic spine

The cause of this spinal degeneration was a genetically predisposed condition caused by an overgrowth of bone in Lulu’s neck called osseous-associated wobbler syndrome (OAWS). The overgrowth of bone squashes the spinal cord and the nerves in the lower neck, resulting in poor transmission of nerve signals between the brain and the limbs.

Noel decided that the best way to alleviate the pressure in Lulu’s neck was to remove two discs and spread apart the compressing bone using two spacer implants; the three vertebrae would then be held together using custom-made plates and rods screwed into the bone which he had invented himself.

The technique is called cervical distraction fusion – bone marrow harvested from the upper arm bones encourages permanent biological fusion of the vertebrae facilitated by the plates, rods and screws. Because the implants are custom-made and 3D printed based on Lulu’s own CT scan, they fitted like a glove, drastically reducing the risk of the screws damaging the spinal cord.

The surgery was a success and Lulu was able to go home to owner Charlie with a new bionic spine.

Peanut

One-year-old cat Peanut was born with deformed front legs and no feeling in his paws. He was able to scamper around on his badly deformed front feet but this was causing extensive wounds and infections

After a full neurological examination of Peanut, and consultation with his neurologist colleagues Colin and Anna, Noel concluded that a double forelimb amputation prosthesis procedure would give Peanut the best chance of a normal life, running around outdoors.

Peanut-part-3-NOT-Branded-1024x575 (1) copy.png

Peanut's PerFiTS – Percuaneous Fixation to the Skeleton

Noel got to work with his team of engineers, designing bespoke implants based on CT scans of Peanut, so that they would fit him perfectly. Once designed, the implants were 3D printed and individually machined down for an exact fit and coated to encourage both bone and skin to grow onto the implants once positioned. The implants – which Noel invented – are called PerFiTS devices.

Operating on Peanut, he inserted both implants in the same surgery, which involved cutting the radius and ulna bones of the forelimb to remove the carpus (wrist) and manus (paw). Despite various challenges the surgery was a success and Peanut stayed in the hospital for close monitoring and care.

Following his intensive care, Peanut was allowed home with owner Denise and has since made a full recovery, enjoying plenty of outdoor adventures on his new prosthetic legs.

Flo

Flo was brought in to Fitzpatrick Refferals with a hole in her shoulder joint

After performing x-ray, CT and MRI imaging as well as an arthroscopy to see inside Flo’s defective joint, Noel was able to confirm a deep lesion called osteochondrosis dissecans (OCD) affecting the joint surface of the head of the main arm bone (humerus).

Flo-implant-part-2-NOT-Branded-1024x560 copy.png

Flo's new bionic joint, a world first for regenerative medicine

Professor Fitzpatrick recently developed the world’s first synthetic filler for such defects, but the Holy Grail would be to grow a new joint surface made of the same cartilage cells that would have been there originally. So, with regenerative medicine opening up new horizons, Noel designed an implant that would exactly fill the hole.

The custom implant consisted of a disc of porous titanium metal similar to the honeycomb structure of bone. This was topped by a carpet-like layer of woven fabric containing polylactide, a climbing frame for cartilage cells. The polylactide was seeded with stem cells derived from Flo’s own cartilage cells, in the hope it would grow into cartilage exactly the same as that which should have been there to start with. To embed the implant, Noel drilled the hole in Flo’s shoulder deeper to receive the double-layered device and then injected more stem cells and a glue called fibrin around the implant, hoping that over 12 weeks the cells would form a new cartilage surface.

Flo recovered entirely and is now back to bouncing around as a young puppy ought to.