Functional outcome following hemilaminectomy without methylprednisolone sodium succinate for acute thoracolumbar disk disease in 51 non-ambulatory dogs

Effect of local epidural application of methylprednisolone acetate on time to ambulation in non-ambulatory dogs with thoracolumbar intervertebral disc disease: A prospective randomised, blinded control trial

BACKGROUND

The objective of this study was to analyse the potential benefit of the epidural application of steroids on time to ambulation in non-ambulatory dogs affected by intervertebral disc disease (IVDD) treated with decompressive surgery.

METHODS

This prospective, randomised, blinded control trial involved 41 dogs with thoracolumbar disc extrusion, which were randomly allocated into two groups. In the control group, saline was locally applied after surgical decompression of the spinal cord (n = 23). In the treatment group (n = 18), local epidural application of methylprednisolone acetate (1 mg/kg) was used. Ambulation time was the primary outcome measure, defined as the ability to take 10 independent steps.

RESULTS

The median number of days to ambulation was 7 days (range: 1‒17 days) for the control group and 3 days (range: 1‒8 days) for the treatment group. One dog from the treatment group developed discospondylitis and abscess formation.

LIMITATIONS

The study's heterogeneity in dog breeds, ages and pre-existing health conditions could affect the generalisability of the findings.

CONCLUSION

Epidural methylprednisolone acetate applied locally at the time of surgery may accelerate recovery in dogs following IVDD surgery.

Prophylactic Effect of Fenestration on the Recurrence of Thoracolumbar Intervertebral Disc Disease in Dogs

Simple Summary

The prophylactic effect of fenestration on the recurrence of thoracolumbar (TL) intervertebral disc herniation (IVDH) in dogs that have been surgically decompressed has been a topic of ongoing debate in veterinary medicine. The aim of this study was to systematically review the existing literature and critically evaluate the evidence behind the application of prophylactic fenestration on the recurrence of TL IVDH in dogs. PubMed, Web of Science and Scopus electronic databases were searched to collect relevant articles. Twenty-nine articles met the inclusion criteria and were assessed for scientific quality, treatment plan, and recurrence incidence. Five articles were selected for a meta-analysis to test if the recurrence differs in animals treated with or without prophylactic fenestration. In the light of the low scientific quality and the amount of published literature on the topic, further research is needed to robustly support the prophylactic effect of fenestration on the recurrence of TL IVDH in dogs.

Abstract

This systematic review aimed to assess the effect of prophylactic fenestration (PF) on the recurrence of thoracolumbar (TL) intervertebral disc (IVD) disease in dogs. Three online databases were searched (Web of Science, MEDLINE via PubMed, SCOPUS), 115 relevant studies were thoroughly examined by the authors, 29 of which met the pre-defined inclusion criteria for this systematic review. Data about the initial treatment, the performance of PF, the incidence of recurrence, and the site of recurrence were extracted. Most of the studies were deemed to have serious to moderate risk of bias. Out of 5457 dogs, 1264 underwent prophylactic fenestration. A total of 504 cases of suspected or confirmed recurrence were recorded, in which 164 (32.54% of total recurrences and 11.02% of PF cases) were in dogs treated with PF. In order to perform quantitative analysis for the recurrence odds, we conducted a meta-analysis. Five studies were included that met the inclusion criteria. Despite a large number of relevant publications, the quality of the evidence they provide is low. This prevented us from reaching a definitive conclusion on the prophylactic effect of fenestration on recurrence in dogs surgically treated for TL IVDH.

Postoperative outcome of ambulatory dogs with intervertebral disc extrusion causing incontinence and/or tail dysfunction: 18 cases (2010-2020)

Objectives

To assess the recovery of urinary continence, faecal continence and tail function in ambulatory dogs with caudal lumbar intervertebral disc extrusion and to explore clinical factors that may be associated with recovery.

Materials and Methods

Medical records from January 2010 to December 2020 were searched to identify ambulatory dogs undergoing surgical treatment for a caudal lumbar intervertebral disc extrusion causing urinary incontinence, faecal incontinence and/or tail dysfunction. Signalment, history, presenting clinical signs, neurological examination findings, diagnostic test results, treatment and outcome were recorded for all dogs.

Results

Eighteen dogs with caudal lumbar intervertebral disc extrusion causing tail dysfunction, urinary and/or faecal incontinence were included. Urinary continence was recovered in 12 (86%) of 14 affected dogs, faecal continence recovered in nine (90%) of 10 affected dogs and tail function recovered in 13 (87%) of 15 affected dogs. Loss of tail nociception was recorded in three dogs on presentation; two made a full recovery and one showed mild persistent tail paresis.

Clinical Significance

The prognosis for functional recovery of urinary continence, faecal continence and tail function in ambulatory dogs with caudal lumbar intervertebral disc extrusion following surgical treatment is good. Larger studies are needed to identify prognostic factors associated with failure of recovery.

A Comparison Between Body Weight-Supported Treadmill Training and Conventional Over-Ground Training in Dogs With Incomplete Spinal Cord Injury

In human medicine there was no evidence registered of a significant difference in recovery between body weight-supported treadmill training (BWSTT) and conventional over-ground (COGI). There isn't any similar study in veterinary medicine. Thus, this study aimed to compare the locomotor recovery obtained in incomplete SCI (T11–L3 Hansen type I) post-surgical dogs following BWSTT or COGI protocols, describing their evolution during 7 weeks in regard to OFS classifications. At admission, dogs were blindly randomized in two groups but all were subjected to the same protocol (underwater treadmill training) for the first 2 weeks. After, they were divided in the BWSTT group (n = 10) and the COGI group (n = 10) for the next 2 weeks, where they performed different training. In both groups locomotor training was accompanied by functional electrical stimulation (FES) protocols. Results reported statistically significant differences between all OFS evaluations time-points (p < 0.001) and between the two groups (p < 0.001). In particular with focus on T1 to T3 a two-way repeated measures ANOVA was performed and similar results were obtained (p = 0.007). Functional recovery was achieved in 90% (17/19) of all dogs and 100% recovered bladder function. The BWSTT group showed 100% (10/10) recovery within a mean time of 4.6 weeks, while the COGI group had 78% (7/9) within 6.1 weeks. Therefore, BWSTT leads to a faster recovery with a better outcome in general.

Beyond the Laboratory, Into the Clinic: What Dogs with Disk Disease Have Taught Us About Photobiomodulation for Spinal Cord Injury

BACKGROUND

For spinal-cord-injured (SCI) patients, integrative medicine approaches such as photomedicine and acupuncture can renew hope and offer previously unrecognized ways to help regain function and improve quality of life.

OBJECTIVE

By understanding the mechanisms of action that these two modalities share, practitioners can better target specific attributes of spinal cord pathophysiology that are limiting recovery. Naturally occurring intervertebral disk disease (IVDD) in dogs affords unparalleled translational opportunities to develop treatment strategies involving photobiomodulation and acupuncture.

CONCLUSIONS

Insights derived through clinical trials of dogs with IVDD have the potential to raise the standard of care for both human and canine SCI patients.

Consequences of intraoperative spinal cord manipulation in dogs with thoracolumbar intervertebral disc extrusion

ABSTRACT The objective of the present study was to evaluate if extradural contact during hemilaminectomy would cause neurological deterioration in the early and/or late postoperative period in dogs with intervertebral disc extrusion. Nineteen dogs with thoracolumbar intervertebral disc extrusion underwent hemilaminectomy for spinal cord decompression and removal of extruded disc material. Meningeal contacts during surgery were quantified. Paraplegia (with nociception) and paraparesis were observed in 11/19 and 8/19 of dogs, respectively, before surgery. At the end of our study, only two (2/19) had paraplegia and one (1/19), paraparesis. There were more extradural contacts when extruded intervertebral disc material was at a ventrolateral position. Extradural contacts during surgery had no influence on neurological progression nor on time to recovery of motor function. Immediately (24 and 48 hours) after surgery, 13/19 dogs had the same neurological stage before surgery. At 7 and 90 days, 13/19 and 17/19 dogs, respectively, showed neurological improvement, compared with their preoperative stage. There was no influence of the number of extradural contacts on neurological recovery. These findings indicate that a careful inspection of the vertebral canal for removal of as much extruded disc material as possible does not cause neurologic deterioration.

Proportion recovery and times to ambulation for non-ambulatory dogs with thoracolumbar disc extrusions treated with hemilaminectomy or conservative treatment: A systematic review and meta-analysis of case-series studies

Thoracolumbar intervertebral disc extrusion is a common cause of spinal cord dysfunction in dogs. Peer-reviewed studies reporting treatment of predominantly chondrodystrophic dogs with disc extrusion with loss of ambulation with either hemilaminectomy or conservative treatment (rest, analgesics and anti-inflammatories) were evaluated in a systematic review of the literature. Generally, the level of evidence available was low with no controlled studies and only case series available. In the meta-analysis, there was a clear trend to a greater proportion of dogs recovering and returning faster to ambulation for dogs treated with hemilaminectomy than for conservatively treated dogs. The mean proportions that recovered for neurological grades 3, 4 and 5 were 93, 93 and 61% for those treated with hemilaminectomy, and 79, 62 and 10% for those treated conservatively (Grade 3 - non-ambulatory paraparetic dogs; grade 4 - paraplegic dogs with intact deep pain perception; grade 5 - paraplegic dogs without intact deep pain perception). Due to the use of case series, these results represent between-study comparisons, thereby increasing the risk of selection bias and other biases. Data presented in this review support the current recommendations for surgical management of non-ambulatory dogs with disc-extrusion, but controlled clinical studies comparing outcomes are necessary to confirm these findings.

Radiographic scoring for intervertebral disc calcification in the Dachshund

Intervertebral disc disease is a common, painful and debilitating neurological condition of dogs, causing substantial morbidity and mortality. The Dachshund is particularly susceptible to this disorder. The goal of this article is not to duplicate previously published reviews on canine intervertebral disc degeneration and degenerative diseases. Rather, the aims are threefold: (1) to reflect on selected clinical and pathophysiological aspects of intervertebral disc degeneration and disc disease that are pertinent to the Dachshund breed; (2) to review a radiographic spinal scoring scheme developed to reduce the prevalence of intervertebral disc disease in Dachshunds; and (3) to suggest further areas of research to improve upon the currently established scoring scheme in an attempt to address this breed's greatest health problem.

Traumatismo da medula espinhal em cães e gatos: estudo prospectivo de 57 casos

O traumatismo da medula espinhal é uma causa comum de disfunção neurológica em cães e gatos. Lesões nestas espécies ocorrem devido a vários tipos de acidentes, podendo ocasionar sequelas que prejudicam o paciente como animais de estimação ou lesões que comprometam a vida. O objetivo principal deste estudo foi a monitoração intensiva de animais com lesão medular atendidos entre 8/2009 e 11/2010 no Hospital Veterinário da Universidade Estadual de Londrina, estudando os fatores epidemiológicos e etiológicos, fatores de risco, segmentos medulares mais afetados, resultados dos tratamentos conservativo ou cirúrgico, relação entre o tempo de atendimento e a recuperação do animal, eficácia e efeitos colaterais do succinato sódico de metilprednisolona, complicações, sequelas e evolução do quadro. Durante este período foram acompanhados 57 animais (48 cães e nove gatos). Observou-se predominância de animais machos (68%) e domiciliados (79%). A principal causa de lesão foi o atropelamento (66%). O tempo entre o trauma e o atendimento foi menos de oito horas em 42% dos casos e mais de um dia em 51%. O segmento medular mais atingido foi o toracolombar (52%). Vinte animais foram submetidos à eutanásia após o atendimento inicial devido ao prognóstico reservado. O tratamento conservativo com repouso e/ou imobilização externa foi realizado em 29 animais e um bom resultado com esta modalidade foi obtida em 72,4% dos casos: houve recuperação funcional total em 17 (58,6%) animais e parcial em quatro (13,8%). Quatro animais não se recuperaram e quatro animais morreram. Oito pacientes foram submetidos ao tratamento cirúrgico, sendo que três animais recuperaram-se, um paciente não apresentou recuperação e quatro morreram ou foram submetidos a eutanásia devido a complicações no trans ou pós-operatório. O tratamento conservativo foi viável, principalmente em cães com lesão medular cervical.

Acquired arachnoid cyst in a cat

A 5-year-old Birman cat presented with paraparesis associated with a fracture of the third thoracic vertebra and was managed conservatively. Voluntary function was regained over the next 6 months, but the cat was referred 4 years after the trauma because of recurrence of hindlimb paresis and ataxia. Magnetic resonance imaging (MRI) showed a spinal arachnoid cyst at the level of the fourth thoracic vertebra, which was treated surgically by dorsal laminectomy and durectomy, and hindlimb function subsequently recovered. The cat re-presented 4 years later for recurrent hindlimb paresis. Myelography and computed tomography-myelography (CT-M) showed dorsolateral pooling of cerebrospinal fluid (CSF) at the previous laminectomy site. The neurological signs after the second surgery improved, but not as much as after the first surgery and the cat remained ataxic with moderate paresis. Seven months later repeat CT-M revealed an atrophic spinal cord, but negligible pooling of CSF at the previous site of the arachnoid cyst. The cat could walk, but was being treated for self-induced trauma of the left hindlimb that was thought to be related to paraesthesia. The neurological signs gradually deteriorated over 3 months and the cat was euthanased.