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Farré Mariné A, López Beltran M, Ortiz Nisa S, Luján Feliu-Pascual A. Myelo-CT imaging findings in 15 dogs with surgically-treated cervical acute compressive hydrated nucleus pulposus extrusion. Vet Radiol Ultrasound 2024; 65:187-192. [PMID: 38349181 DOI: 10.1111/vru.13331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 11/30/2023] [Accepted: 12/28/2023] [Indexed: 05/12/2024] Open
Abstract
Compressive hydrated nucleus pulposus extrusion (HNPE) is a sudden extrusion of hydrated, nondegenerated nucleus pulposus material with well-known characteristic MRI findings. The appearance of compressive HNPE during contrast-enhanced CT has already been described, but never its myelo-CT characteristics. The aim of this retrospective multicenter case series is to describe the myelo-CT findings in 15 dogs with compressive HNPE confirmed with gross surgical findings. A distinctive and consistent myelo-CT appearance of cervical compressive HNPE in dogs that included a focal extradural "seagull"-shaped extradural compression dorsal to the annulus fibrosus combined with a narrowing of the affected intervertebral disc space was found. The extruded material was hypoattenuating in the soft tissue algorithm. Myelo-CT could be a useful diagnostic tool and influence the clinical decision to address cervical compressive HNPE conservatively or surgically when MRI is not available.
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Affiliation(s)
| | | | - Sonia Ortiz Nisa
- Hospital Veterinario Universidad Católica de Valencia (UCV), Valencia, Spain
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2
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Guo S. Surgical treatment and outcome of haematomyelia with a traumatic cause in a dog and a cat. Vet Med Sci 2024; 10:e1377. [PMID: 38358058 PMCID: PMC10867873 DOI: 10.1002/vms3.1377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 01/09/2024] [Accepted: 01/29/2024] [Indexed: 02/16/2024] Open
Abstract
Two surgically treated haematomyelia cases were documented. One dog and one cat were presented for acute progressive paraplegia following a fall from height incident. Neurological examinations suggested a L4-S3 myelopathy in both cases. Radiography and magnetic resonance imaging in both cases revealed no fracture or subluxation of the spine, but well-defined intramedullary mass lesions in lower lumbar regions compatible with haemorrhage and haematoma formation. Exploratory surgeries were performed over the lesions. Dark-red friable masses were removed via myelotomy. Histopathological examinations revealed organizing haematomas at the acute to subacute stage. Postoperatively, both cases improved and regained ambulation. The dog walked normally but remained urinary and faecal incontinent 9 months after the surgery. The cat was continent and ambulatory with a paraparetic gait 5 months after the surgery. In both cases, the outcomes and the patients' quality of life were considered satisfactory by the owners.
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Spinella G, Bettella P, Riccio B, Okonji S. Overview of the Current Literature on the Most Common Neurological Diseases in Dogs with a Particular Focus on Rehabilitation. Vet Sci 2022; 9:vetsci9080429. [PMID: 36006344 PMCID: PMC9414583 DOI: 10.3390/vetsci9080429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 07/30/2022] [Accepted: 08/11/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary This paper aims to report an overview of the most common neurological diseases (intervertebral disc herniation, degenerative myelopathy, fibrocartilaginous embolism, and polyradiculoneuritis), with a main focus on rehabilitative options and outcomes, reported in recent veterinary literature. Literature seems to be positively oriented on the efficacy of the rehabilitation approach, reporting a careful and prudent choice of the protocol to be applied for the correct recovery of the patient. However, blinded, controlled, prospective studies are still necessary, above all for degenerative myelopathy, fibrocartilaginous embolism, and polyradiculoneuritis. Abstract Intervertebral disc herniation, degenerative myelopathy, fibrocartilaginous embolism and polyradiculoneuritis often affect dogs; and physiotherapy may improve the patient’s quality of life and/or reduce recovery times. The aim of this review was to evaluate the current scientific outcomes on these four neurological diseases and on their physiotherapy approaches. From the analysis of the published articles, it emerged that intervertebral disc herniation can be treated, with different rates of success, through a conservative or a surgical approach followed by physiotherapy. The literature is generally oriented toward the efficacy of the rehabilitation approach in this specific canine disease, often proposing intensive post-surgery physiotherapy for the most severe conditions with the absence of deep pain perception. When degenerative myelopathy, fibrocartilaginous embolism or polyradiculoneuritis occur, the existing literature supports the use of a physiotherapeutic approach: allowing a delay in the onset and worsening of the clinical signs in degenerative myelopathy, physical improvement, and, sometimes, complete remission during fibrocartilaginous embolism or acute idiopathic polyradiculoneuritis. However, papers on rehabilitation in dogs affected by polyradiculoneuritis are currently limited to single clinical cases and further blinded, controlled, prospective studies are still advisable for all four neurological diseases.
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Affiliation(s)
- Giuseppe Spinella
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell’Emilia, 40064 Bologna, Italy
- Correspondence: ; Tel.: +39-051-2097525
| | - Piera Bettella
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell’Emilia, 40064 Bologna, Italy
| | - Barbara Riccio
- Department of Veterinary Sciences, University of Turin, Largo Paolo Braccini 2, 10095 Grugliasco, Italy
| | - Samuel Okonji
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell’Emilia, 40064 Bologna, Italy
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Kornmayer M, Fiedler S, Rosati M, Meyer‐Lindenberg A. Compressive hydrated nucleus pulposus extrusion in a dog. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Matthias Kornmayer
- Clinic of Small Animal Surgery and Reproduction, Centre of Clinical Veterinary Science Ludwig‐Maximilians‐University Munich Germany
| | - Sonja Fiedler
- Section of Clinical & Comparative Neuropathology, Institute for Veterinary Pathology, Centre for Clinical Veterinary Medicine Ludwig‐Maximilians‐University Germany
| | - Marco Rosati
- Section of Clinical & Comparative Neuropathology, Institute for Veterinary Pathology, Centre for Clinical Veterinary Medicine Ludwig‐Maximilians‐University Germany
| | - Andrea Meyer‐Lindenberg
- Clinic of Small Animal Surgery and Reproduction, Centre of Clinical Veterinary Science Ludwig‐Maximilians‐University Munich Germany
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Gouveia D, Cardoso A, Carvalho C, Gonçalves AR, Gamboa Ó, Canejo-Teixeira R, Ferreira A, Martins Â. Influence of Spinal Shock on the Neurorehabilitation of ANNPE Dogs. Animals (Basel) 2022; 12:ani12121557. [PMID: 35739893 PMCID: PMC9219513 DOI: 10.3390/ani12121557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 12/04/2022] Open
Abstract
Acute noncompressive nucleus pulposus extrusion (ANNPE) is related to contusive spinal cord injuries, and dogs usually appear to be exercising vigorously at the time of onset. ANNPE has a characteristic peracute onset of clinical signs during exercise or following trauma, with non-progressive signs during the first 24 h and possibly signs of spinal shock. The main aim was to assess if the presence of spinal shock affects the neurorehabilitation outcomes of ANNPE dogs. This prospective controlled cohort clinical study was conducted at the Arrábida Rehabilitation Center. All of the dogs had T3−L3 injuries and were paraplegic/monoplegic with/without nociception, the study group (n = 14) included dogs with ANNPE spinal shock dogs, and the control group (n = 19) included ANNPE dogs without spinal shock. The study group was also evaluated using a new scale—the Spinal Shock Scale (SSS)—and both groups were under the same intensive neurorehabilitation protocol. Spinal shock was a negative factor for a successful outcome within less time. SSS scores > 4 required additional hospitalization days. The protocol was safe, tolerable, and feasible and accomplished 32% ambulation within 7 days, 29% in 14 days, and 29% in 30 days. The results were better than those obtained in previous studies—94% at 60 days—and 75% of the dogs without nociception recovered ambulation. Long-term follows-ups carried out 4 years later revealed a positive evolution.
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Affiliation(s)
- Débora Gouveia
- Arrábida Animal Rehabilitation Center, Arrábida Veterinary Hospital, Azeitão, 2925-538 Setúbal, Portugal; (A.C.); (C.C.); (Â.M.)
- Superior School of Health, Protection and Animal Welfare, Polytechnic Institute of Lusophony, Campo Grande, 1950-396 Lisboa, Portugal
- Correspondence:
| | - Ana Cardoso
- Arrábida Animal Rehabilitation Center, Arrábida Veterinary Hospital, Azeitão, 2925-538 Setúbal, Portugal; (A.C.); (C.C.); (Â.M.)
| | - Carla Carvalho
- Arrábida Animal Rehabilitation Center, Arrábida Veterinary Hospital, Azeitão, 2925-538 Setúbal, Portugal; (A.C.); (C.C.); (Â.M.)
| | - Ana Rita Gonçalves
- Faculty of Veterinary Medicine, Lusófona University, Campo Grande 376, 1749-024 Lisboa, Portugal; (A.R.G.); (R.C.-T.)
| | - Óscar Gamboa
- Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisboa, Portugal; (Ó.G.); (A.F.)
| | - Rute Canejo-Teixeira
- Faculty of Veterinary Medicine, Lusófona University, Campo Grande 376, 1749-024 Lisboa, Portugal; (A.R.G.); (R.C.-T.)
| | - António Ferreira
- Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisboa, Portugal; (Ó.G.); (A.F.)
- CIISA—Centro Interdisciplinar-Investigação em Saúde Animal, Faculdade de Medicina Veterinária, Av. Universidade Técnica de Lisboa, 1300-477 Lisboa, Portugal
| | - Ângela Martins
- Arrábida Animal Rehabilitation Center, Arrábida Veterinary Hospital, Azeitão, 2925-538 Setúbal, Portugal; (A.C.); (C.C.); (Â.M.)
- Superior School of Health, Protection and Animal Welfare, Polytechnic Institute of Lusophony, Campo Grande, 1950-396 Lisboa, Portugal
- Faculty of Veterinary Medicine, Lusófona University, Campo Grande 376, 1749-024 Lisboa, Portugal; (A.R.G.); (R.C.-T.)
- CIISA—Centro Interdisciplinar-Investigação em Saúde Animal, Faculdade de Medicina Veterinária, Av. Universidade Técnica de Lisboa, 1300-477 Lisboa, Portugal
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Kristiansen KV, Schmökel H, Vermeire S. Hydrated Nucleus Pulposus Extrusion in Dogs: Thoracolumbar Compared to Cervical Cases. Vet Comp Orthop Traumatol 2022; 35:152-156. [PMID: 35008122 DOI: 10.1055/s-0041-1740608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of this study was to review and describe cases of thoracolumbar (TL) hydrated nucleus pulposus extrusion (HNPE) diagnosed with magnetic resonance imaging and surgery, and compare them to cases of cervical (C) HNPE. STUDY DESIGN Retrospective, single-center study. RESULTS Thirty-six dogs met the inclusion criteria. Fifteen cases were C and 21 TL. Thirteen dogs were chondrodystrophic breeds, mean body weight was 13 kg, median age was 7.5 years, and 30/36 were male. Fewer dogs were chondrodystrophic in the C group compared with the TL group (p = 0.022). More than 90% had an acute onset, and strong activity was more often reported in the TL group. TL HNPE was more often painful, and extruded disc material more often lateralized (p = 0.017). Median Modified Frankel Score at presentation was 3 and 72.2% were non-ambulatory. More TL HNPE (11/21) were treated surgically compared with C HNPE (4/15). Treatment choice was correlated with spinal cord compression (p = 0.0075). Median Modified Frankel Score improved during hospitalization (p = 0.002) and there was no difference in outcome between C and TL HNPE or conservative and surgical treatment. Mean follow-up time was 33 days. All patients were ambulatory at follow-up. CONCLUSION This study suggests that the HNPE is not limited to the C vertebral column of dogs and can occur in the TL vertebral column as well. Dogs with TL HNPE show spinal hyperesthesia more often and extruded nucleus material is more often lateralized. Outcome is similar to what has previously been described for C HNPE.
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Affiliation(s)
- K V Kristiansen
- Spine Center and Radiology Department, Specialistdjursjukhuset, Strömsholm, Sweden
| | - H Schmökel
- Spine Center and Radiology Department, Specialistdjursjukhuset, Strömsholm, Sweden
| | - S Vermeire
- Spine Center and Radiology Department, Specialistdjursjukhuset, Strömsholm, Sweden
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Chen B, Du Z. Neurological safety of spinal surgery for nucleus pulposus removal under spinal endoscopic imaging guided by inter laminar spine. Pak J Med Sci 2021; 37:1667-1671. [PMID: 34712303 PMCID: PMC8520364 DOI: 10.12669/pjms.37.6-wit.4880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 06/10/2021] [Accepted: 07/03/2021] [Indexed: 11/15/2022] Open
Abstract
Objective To explore the technical points, approach selection and short-term clinical efficacy of PELD through the intervertebral foramina or interlaminar approach in the treatment of highly shifted LDH. Methods From September 2018 to June 2020, 19 patients with highly shifted LDH were treated with PELD in The First Hospital of Yulin. It included, 10 males and 9 females; aged 34 to 69 years, with an average of 48 years. Thirteen cases were shifted to the caudal side, and six cases were shifted to the head side. The responsible segments included L3/41 cases, L4/511 cases, and L5/S17 cases. All patients had symptoms of low back and leg pain. The Sowerby dysfunction index (ODI) was 63.5%±10.7% before surgery. The visual analogue scale of pain (VAS) was low back pain (5.2±2.1) and leg pain (7.1±2.4). 14 cases used transforaminal approach, and 5 cases used translaminar approach. Results All cases completed the operation successfully, the operation time was 60~110min, with an average of 70 minutes. The follow-up time ranged from 6 to 42 months, with an average of 20.8 months. At the last follow-up, ODI was 10.8%±6.8%, VAS back pain score (2.1±1.1) and leg pain score (1.8±0.9). Compared with preoperative, ODI and VAS scores were significantly decreased (P<0.05). The results of Mac Nab method were 14 excellent, four good, and one fair. During the follow-up period, one patient's leg pain symptoms recurred seven days after operation. No further hernia was found under intervertebral foramen. The symptoms disappeared after two weeks of symptomatic treatment such as swelling and analgesia, and he was discharged. No perioperative complications such as infection and nerve root injury occurred. Conclusion When PELD is used to treat high-displacement LDH, the choice of transforaminal approach or interlaminar approach needs to be personalized according to the LDH segment and the direction of displacement.
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Affiliation(s)
- Bin Chen
- Bin Chen, Master of Medicine, Associate Chief Physician, Department of Orthopaedics, Yulin No.2 Hospital, Yulin, 718000, Shaanxi, China
| | - Zengfeng Du
- Zengfeng Du, Master of Medicine, Associate Chief Physician, Department of Orthopaedics, The First Hospital of Yulin, Yulin, 718000, Shaanxi, China
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8
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Miranda DB, Neves Rocha Martins ÂP, Diniz R. Functional neurorehabilitation in a dog with acute non‐compressive nucleus pulposus extrusion. VETERINARY RECORD CASE REPORTS 2021. [DOI: 10.1002/vrc2.216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - Ângela Paula Neves Rocha Martins
- Functional Neurorehabilitation Department Universidade Lusófona de Humanidades e Tecnologias Campo Grande Lisboa Portugal
- Centro de Reabilitação Animal da Arrábida, Hospital Veterinário da Arrábida R. José Augusto Coelho Azeitão Portugal
| | - Renata Diniz
- RehabilitaCans Carrer de Juan Gris Palma de Mallorca Baleares‐España Spain
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9
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Cui S, Zhou Z, Chen X, Wei F, Richards RG, Alini M, Grad S, Li Z. Transcriptional profiling of intervertebral disc in a post-traumatic early degeneration organ culture model. JOR Spine 2021; 4:e1146. [PMID: 34611583 PMCID: PMC8479529 DOI: 10.1002/jsp2.1146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/19/2021] [Accepted: 03/22/2021] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION The goal of this study is to characterize transcriptome changes and gene regulation networks in an organ culture system that mimics early post-traumatic intervertebral disc (IVD) degeneration. METHODS To mimic a traumatic insult, bovine caudal IVDs underwent one strike loading. The control group was cultured under physiological loading. At 24 hours after one strike or physiological loading, RNA was extracted from nucleus pulposus (NP) and annulus fibrosus (AF) tissue. High throughput next generation RNA sequencing was performed to identify differentially expressed genes (DEGs) between the one strike loading group and the control group. Gene Ontology (GO) functional and Kyoto Encyclopedia of Genes and Genomes analyses were performed to analyze DEGs and pathways. Protein-protein interaction (PPI) network was analyzed with cytoscape software. DEGs were verified using qRT-PCR. Degenerated human IVD tissue was collected for immunofluorescence staining to verify the expression of DEGs in human disc tissue. RESULTS One strike loading resulted in significant gene expression changes compared with physiological loading. In total 253 DEGs were found in NP tissue and 208 DEGs in AF tissue. Many of the highly dysregulated genes have known functions in disc degeneration and extracellular matrix (ECM) homeostasis. ACTB, ACTG, PFN1, MYL12B in NP tissue and FGF1, SPP1 in AF tissue were verified by qRT-PCR and immunofluorescence imaging. The identified DEGs were involved in focal adhesion, ECM-receptor interaction, PI3K-AKT, and cytokine-cytokine receptor interaction pathways. Three clusters of PPI networks were identified. GO enrichment revealed that these DEGs were mainly involved in inflammatory response, the ECM and growth factor signaling and protein folding biological process. CONCLUSION Our study revealed different DEGs, pathways, biological process and PPI networks involved in post-traumatic IVD degeneration. These findings will advance the understanding of the pathogenesis of IVD degeneration, and help to identify novel biomarkers for the disease diagnosis.
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Affiliation(s)
- Shangbin Cui
- AO Research Institute DavosDavosSwitzerland
- Guangdong Provincial Key Laboratory of Orthopedics and TraumatologyThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Zhiyu Zhou
- The Seventh Affiliated Hospital of Sun Yat‐sen UniversityShenzhenChina
| | - Xu Chen
- The Seventh Affiliated Hospital of Sun Yat‐sen UniversityShenzhenChina
| | - Fuxin Wei
- The Seventh Affiliated Hospital of Sun Yat‐sen UniversityShenzhenChina
| | - R. Geoff Richards
- AO Research Institute DavosDavosSwitzerland
- Guangdong Provincial Key Laboratory of Orthopedics and TraumatologyThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | | | | | - Zhen Li
- AO Research Institute DavosDavosSwitzerland
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Debreuque M, Valin I, Prata D, De Fornel P, Thibaud JL. Case Report: Intramedullary Intervertebral Disk Extrusion in a Cat: Clinical, Computed Tomographic, High-Field Magnetic Resonance Imaging, and Outcome Findings. Front Vet Sci 2020; 7:583892. [PMID: 33134365 PMCID: PMC7579400 DOI: 10.3389/fvets.2020.583892] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/02/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Intramedullary disk extrusions has rarely been described in veterinary medicine, more especially in cats, with only two cases are reported in the veterinary literature. Diagnosis may be difficult, even though clinical presentation and imaging studies, such as MRI or CT, can present specific features. Treatment and prognosis are not clearly described. Case presentation: A 10-year-old domestic shorthair female cat was evaluated for a 12 h-history of peracute-onset of paraparesis with flaccid tail and urinary and fecal incontinence. The patellar reflexes were normal, the pelvic flexor reflexes were decreased (more markedly on the right limb) and the perianal reflex was absent. The tail was flaccid, without nociception. Abdominal palpation revealed a small urinary bladder, easily expressed. Manipulation of the lumbar vertebral column elicited marked pain. Neurological examination was consistent with a L7-caudal segments lesion. A lumbosacral MRI and CT evaluations were performed and revealed a focal intramedullary hemorrhagic lesion, with an associated vertical linear tract communicating with the L5-L6 intervertebral disk space, and a suspected intramedullary focus of mineralization. These imaging findings were highly suggestive of an L5-L6 intramedullary disk extrusion. A dorsal L5-L6 laminectomy confirmed the presence of intramedullary degenerative nucleus pulposus fragments, which were surgically removed. Rapid and progressive neurological improvement was observed post-surgery. At the 1-year follow-up, right plantigrade stance and mild paraparesis were still noticed, but jumps and voluntary tail movements were observed. Occasional urinary and fecal incontinence episodes remained. Conclusions: This is the first feline case report of an intramedullary disk herniation with long-term follow-up available. Clinical description, CT and High-Field MRI findings, surgical procedure and histological results are reported, and help describing the characteristics of this rare non-compressive category of peracute intervertebral disk extrusion. Surgical management may be considered in feline cases of intramedullary disk herniation and may be associated with a good outcome.
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Affiliation(s)
- Maud Debreuque
- MICEN VET, Créteil, France.,Service de Médecine Interne, Université de Toulouse, ENVT, Toulouse, France
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Spitzbarth I, Moore SA, Stein VM, Levine JM, Kühl B, Gerhauser I, Baumgärtner W. Current Insights Into the Pathology of Canine Intervertebral Disc Extrusion-Induced Spinal Cord Injury. Front Vet Sci 2020; 7:595796. [PMID: 33195632 PMCID: PMC7653192 DOI: 10.3389/fvets.2020.595796] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 09/30/2020] [Indexed: 11/13/2022] Open
Abstract
Spinal cord injury (SCI) in dogs is commonly attributed to intervertebral disc extrusion (IVDE). Over the last years substantial progress was made in the elucidation of factors contributing to the pathogenesis of this common canine disease. A detailed understanding of the underlying histopathological and molecular alterations in the lesioned spinal cord represents a prerequisite to translate knowledge on the time course of secondary injury processes into the clinical setting. This review summarizes the current state of knowledge of the underlying pathology of canine IVDE-related SCI. Pathological alterations in the spinal cord of dogs affected by IVDE-related SCI include early and persisting axonal damage and glial responses, dominated by phagocytic microglia/macrophages. These processes are paralleled by a pro-inflammatory microenvironment with dysregulation of cytokines and matrix metalloproteinases within the spinal cord. These data mirror findings from a clinical and therapeutic perspective and can be used to identify biomarkers that are able to more precisely predict the clinical outcome. The pathogenesis of progressive myelomalacia, a devastating complication of SCI in dogs, is not understood in detail so far; however, a fulminant and exaggerating secondary injury response with massive reactive oxygen species formation seems to be involved in this unique neuropathological entity. There are substantial gaps in the knowledge of pathological changes in IVDE with respect to more advanced and chronic lesions and the potential involvement of demyelination. Moreover, the role of microglia/macrophage polarization in IVDE-related SCI still remains to be investigated. A close collaboration of clinical neurologists and veterinary pathologists will help to facilitate an integrative approach to a more detailed understanding of the molecular pathogenesis of canine IVDE and thus to identify therapeutic targets.
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Affiliation(s)
- Ingo Spitzbarth
- Faculty of Veterinary Medicine, Institute of Veterinary Pathology, Leipzig University, Leipzig, Germany
| | - Sarah A Moore
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, Columbus, OH, United States
| | - Veronika M Stein
- Department for Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Jonathan M Levine
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, United States
| | - Bianca Kühl
- Department of Pathology, University of Veterinary Medicine Hannover, Hanover, Germany
| | - Ingo Gerhauser
- Department of Pathology, University of Veterinary Medicine Hannover, Hanover, Germany
| | - Wolfgang Baumgärtner
- Department of Pathology, University of Veterinary Medicine Hannover, Hanover, Germany
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12
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da Costa RC, De Decker S, Lewis MJ, Volk H. Diagnostic Imaging in Intervertebral Disc Disease. Front Vet Sci 2020; 7:588338. [PMID: 33195623 PMCID: PMC7642913 DOI: 10.3389/fvets.2020.588338] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/09/2020] [Indexed: 12/27/2022] Open
Abstract
Imaging is integral in the diagnosis of canine intervertebral disc disease (IVDD) and in differentiating subtypes of intervertebral disc herniation (IVDH). These include intervertebral disc extrusion (IVDE), intervertebral disc protrusion (IVDP) and more recently recognized forms such as acute non-compressive nucleus pulposus extrusion (ANNPE), hydrated nucleus pulposus extrusion (HNPE), and intradural/intramedullary intervertebral disc extrusion (IIVDE). Many imaging techniques have been described in dogs with roles for survey radiographs, myelography, computed tomography (CT), and magnetic resonance imaging (MRI). Given how common IVDH is in dogs, a thorough understanding of the indications and limitations for each imaging modality to aid in diagnosis, treatment planning and prognosis is essential to successful case management. While radiographs can provide useful information, especially for identifying intervertebral disc degeneration or calcification, there are notable limitations. Myelography addresses some of the constraints of survey radiographs but has largely been supplanted by cross-sectional imaging. Computed tomography with or without myelography and MRI is currently utilized most widely and have become the focus of most contemporary studies on this subject. Novel advanced imaging applications are being explored in dogs but are not yet routinely performed in clinical patients. The following review will provide a comprehensive overview on common imaging modalities reported to aid in the diagnosis of IVDH including IVDE, IVDP, ANNPE, HNPE, and IIVDE. The review focuses primarily on canine IVDH due to its frequency and vast literature as opposed to feline IVDH.
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Affiliation(s)
- Ronaldo C da Costa
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, United States
| | - Steven De Decker
- Department of Clinical Sciences and Services, Royal Veterinary College, London, United Kingdom
| | - Melissa J Lewis
- Department of Veterinary Clinical Sciences, Purdue University College of Veterinary Medicine, West Lafayette, IN, United States
| | - Holger Volk
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hanover, Hanover, Germany
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Fenn J, Olby NJ. Classification of Intervertebral Disc Disease. Front Vet Sci 2020; 7:579025. [PMID: 33134360 PMCID: PMC7572860 DOI: 10.3389/fvets.2020.579025] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/24/2020] [Indexed: 12/24/2022] Open
Abstract
Intervertebral disc disease (IVDD) has been recognized in dogs since the 1800s, when the first descriptions of extruded disc material within the vertebral canal were published. In the intervening time our understanding of intervertebral disc pathology in dogs and cats has increased dramatically, with many variations of IVDD described. Whilst the volume of literature and collective understanding of IVDD has expanded, there has also been scope for confusion as the definition of intervertebral disc disease, with its myriad different manifestations, becomes more complicated. A large volume of literature has aimed to combine the use of histopathology, diagnostic imaging and clinical findings to better understand the various ways in which IVDD can be classified. Much of this research has focused on the classification of mechanisms of intervertebral disc degeneration, centering around the differences between, and overlaps in, IVDD in chondrodystrophic and non-chondrodystrophic dog breeds. However, with the increasing availability of advanced imaging modalities allowing more accurate antemortem diagnosis, the concept of IVDD has expanded to include other clinical presentations that may not fit into traditional models of classification of IVDD. This review aims to provide an up to date overview of both historical and current systems of IVDD classification, highlighting the important findings and controversies underpinning them.
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Affiliation(s)
- Joe Fenn
- Department of Clinical Science and Services, Royal Veterinary College, London, United Kingdom
| | - Natasha J Olby
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
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Mari L, Behr S, Shea A, Dominguez E, Ricco C, Alcoverro E, Ekiri A, Sanchez-Masian D, De Risio L. Predictors of urinary or fecal incontinence in dogs with thoracolumbar acute non-compressive nucleus pulposus extrusion. J Vet Intern Med 2019; 33:2693-2700. [PMID: 31674064 PMCID: PMC6872617 DOI: 10.1111/jvim.15626] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 09/05/2019] [Indexed: 12/16/2022] Open
Abstract
Background Urinary (UI) and fecal (FI) incontinence occur in up to 7.5% and 32% of dogs, respectively, after thoracolumbar acute noncompressive nucleus pulposus extrusion (ANNPE). Hypotheses/Objectives To investigate clinical, diagnostic, and therapeutic predictors of UI and FI in dogs with ANNPE affecting the T3‐L3 spinal cord segments. Animals Hundred and eighty‐seven dogs with T3‐L3 ANNPE diagnosed based on clinical and MRI findings. Methods Multicenter retrospective study. Data were obtained from medical records and telephone questionnaires and analyzed by logistic regression. Results UI and FI were reported in 17 (9.1%) and 44 (23.5%) dogs, respectively. Paraplegic dogs were 3 times (95% CI = 1.25, 10.87) more likely to develop UI (P = .018) and 4 times (95% CI = 1.94, 12.56) more likely to develop FI (P = .001) compared to nonparaplegic dogs. Dogs with an intramedullary hyperintensity greater than 40% of the cross‐sectional area of the spinal cord at the same level on transverse T2‐weighted MRI images were 4 times more likely to develop UI (95% CI = 1.04, 21.72; P = .045) and FI (95% CI = 1.56, 10.39; P = .004) compared to dogs with smaller lesions. FI was 3 times (95% CI = 1.41, 7.93) more likely in dogs that were not treated with nonsteroidal anti‐inflammatory drugs (NSAIDs) after diagnosis compared to dogs administered NSAIDs (P = .006) and 2 times (95% CI = 1.12, 5.98) more likely in dogs presented with clinical signs compatible with spinal shock compared to dogs without (P = .026). Conclusion and Clinical Importance The identification of clinical, diagnostic, and therapeutic predictors of UI and FI in dogs with T3‐L3 ANNPE can help to approach these autonomic dysfunctions occurring after spinal cord injury.
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Affiliation(s)
- Lorenzo Mari
- Department of Neurology/Neurosurgery, Centre for Small Animal Studies, Animal Health Trust, Newmarket, Suffolk, UK
| | - Sebastien Behr
- Neurology/Neurosurgery Service, Willows Veterinary Centre and Referral Services, Solihull, UK
| | - Anita Shea
- Department of Neurology/Neurosurgery, Centre for Small Animal Studies, Animal Health Trust, Newmarket, Suffolk, UK
| | - Elisabet Dominguez
- Diagnostic Imaging Unit, Centre for Small Animal Studies, Animal Health Trust, Newmarket, Suffolk, UK
| | - Cristoforo Ricco
- Neurology/Neurosurgery Service, Willows Veterinary Centre and Referral Services, Solihull, UK
| | - Emili Alcoverro
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Neston, Cheshire, UK
| | - Abel Ekiri
- School of Veterinary Medicine, University of Surrey, Guildford, Surrey, UK
| | - Daniel Sanchez-Masian
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Neston, Cheshire, UK
| | - Luisa De Risio
- Department of Neurology/Neurosurgery, Centre for Small Animal Studies, Animal Health Trust, Newmarket, Suffolk, UK
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Kent M, Glass EN, Song RB, Warren JD, de Lahunta A. Anatomic description and clinical relevance of the meningovertebral ligament in dogs. J Am Vet Med Assoc 2019; 255:687-694. [DOI: 10.2460/javma.255.6.687] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Nessler J, Flieshardt C, Tünsmeyer J, Dening R, Tipold A. Comparison of surgical and conservative treatment of hydrated nucleus pulposus extrusion in dogs. J Vet Intern Med 2018; 32:1989-1995. [PMID: 30267615 PMCID: PMC6271322 DOI: 10.1111/jvim.15304] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 05/23/2018] [Accepted: 07/24/2018] [Indexed: 11/30/2022] Open
Abstract
Background Whether compressive cervical myelopathy caused by hydrated nucleus pulposus extrusion (HNPE) in dogs should be treated surgically or conservatively has been debated. Only 1 recent study has contradicted the former predominant reports of surgical treatment for HNPE. Hypothesis and method Single center retrospective study to compare the outcome of client‐owned dogs with HNPE after decompressive surgery or conservative treatment. Animals Thirty‐six dogs diagnosed with HNPE confirmed by magnetic resonance imaging (MRI). Results Eighteen of 36 dogs underwent surgery whereas 18 dogs were managed conservatively including cage rest and physiotherapy. The most common affected intervertebral disc space was C4‐5. In 3 dogs, HNPE was diagnosed at the level of T13‐L1. Median time to regain ambulation was 6.6 days (range, 0‐28 days) after surgery and 5.9 days (range, 0‐15 days) with conservative management (P = .37). Only the length of a potential intramedullary lesion in cervical HNPE detected by MRI had an influence on the prognosis to gain ambulatory status in a time period of ≤9 days (P = .0035) and on short‐term survival (P = .0011). Conclusions and clinical importance Conservative management of HNPE in the cervical as well as in the thoracolumbar region represents a reasonable alternative to surgery, showing similar favorable outcome.
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Affiliation(s)
- Jasmin Nessler
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, Hannover, Germany
| | | | - Julia Tünsmeyer
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, Hannover, Germany
| | - Ricarda Dening
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, Hannover, Germany
| | - Andrea Tipold
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, Hannover, Germany
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