Extradural spinal synovial cysts in nine dogs

Retrospective evaluation of hyperproteinorrachia without pleocytosis (albuminocytologic dissociation) and survival in dogs

BACKGROUND

Hyperproteinorrachia (raised cerebrospinal fluid total protein [CSF-TP]) without pleocytosis (HP) (also known as albuminocytologic dissociation) is identified in dogs with different neurologic diseases. However, the association between survival and increased CSF-TP is unknown.

OBJECTIVES

(a) Identify conditions commonly associated with HP in dogs and (b) investigate whether higher CSF-TP concentrations or other relevant factors are associated with 1-year survival.

METHODS

This is a retrospective study that identified dogs with HP (Cisternal CSF-TP >0.30 g/L, Lumbar CSF-TP >0.45 g/L with total nucleated cell concentrations [TNCCs] and RBC counts within RIs) from 2008 to 2019: recording signalment, weight, vital parameters, inflammation, neuroanatomic localization, CSF-TP, sampling site, final diagnosis, etiologic classification, and 1-year survival. Corrected CSF-TP was calculated as CSF-TP minus 0.3 (cisternal) or 0.45 (lumbar or unknown). Descriptive statistics were produced, CSF-TP differences between groups (eg, neuroanatomic localizations) were evaluated using the Mann-Whitney U test or Kruskal-Wallis test (post-hoc testing). The Cox proportional hazards model was used for survival data. Statistical significance was set at a P < 0.05.

RESULTS

In all, 39 dogs had HP, associated with 17 conditions, including neoplasia (n = 6), meningoencephalitis of unknown origin (n = 4) (MUO), and intervertebral disc disease (n = 4) (IVDD) as the most common conditions. There was no significant difference between the CSF-TP/corrected CSF-TP between 1-year survivors and non-survivors, nor was there a difference between different neuroanatomic localizations or etiologic classifications (P > 0.05). Neoplasia, after adjustment for age, was the only variable associated with a worse survival (P = 0.01 HR: 2.08 (95% CI: 1.65-39.2). CSF-TP was not associated with age (P > 0.05).

CONCLUSIONS

HP in dogs is associated with a wide range of conditions; the most common conditions are neoplasia, MUO, and IVDD. Higher CSF-TP levels do not correlate with a worse 1-year survival; however, they do correlate with neoplastic lesions.

Spontaneous regression of extradural intraspinal cysts in a dog: a case report

Background

Extradural intraspinal cysts are fluid accumulations that appear to be associated with increased motion at vertebral joints.

Case presentation

We report the spontaneous regression of lumbar and lumbosacral cysts (presumably synovial cysts) and the unusual occurrence of an S1–2 extradural intraspinal cyst in a dog. The dog presented with lumbosacral pain. Six extradural intraspinal cysts were observed on high-field magnetic resonance imaging from L5–6 to S1-S2. The cysts between L5–6 and L7-S1 ranged from 0.12 to 0.44cm² at their largest area. The largest cyst was located at S1–2 (left), measuring 0.84 cm² at its largest view. The dog was medically managed. A follow-up magnetic resonance imaging scan was obtained 3.5 years after the first imaging. All cysts except the one at S1–2 had reduced in size. Mean reduction in size was 59.6% (35–81%).

Conclusions

In summary, we report a case with multiple extradural intraspinal cysts that underwent spontaneous regression of all but one cyst during a 3.5-year follow-up period. Whether this is a single occurrence, or is part of the natural history of these cysts in the lumbosacral region of dogs, remains to be established. Spontaneous regression of intraspinal cysts had not been described in dogs.

Principles and applications of the balanced steady-state free precession sequence in small animal low-field MRI

Magnetic resonance imaging (MRI) in small animal practice is largely based on classic two-dimensional spin-echo, inversion recovery and gradient-echo sequences which are largely limited by low spatial resolution, especially in low-field (LF)-MRI scanners. Nowadays, however, the availability of volumetric sequences can open new perspectives and enhance the diagnostic potential of this imaging modality. Balanced steady-state free precession (bSSFP) is a three-dimensional gradient-echo sequence in which image contrast is given by the ratio of T2 and T1, resulting in low soft-tissue signal, poor cerebral grey/white matter distinction and a bright signal from free fluid and fat. Such properties, along with a high signal-to-noise ratio and a very high spatial resolution deriving from acquisition of contiguous blocks of data, make this sequence perfectly suited for morphologic imaging, particularly for fluid-containing structures. Although bSSFP is widely adopted in human medical imaging, the use of this sequence in veterinary radiology is limited to anatomic studies of the inner ear and quadrigeminal cistern. This review aims to discuss the technical background of the bSSFP sequence and its possible advantageous applications in small animal LF-MRI for different specific disorders of the spine (arachnoid diverticula, small disc herniation, facet joint synovial cysts), brain (supracollicular fluid accumulation, traumatic injuries) and ligaments (complete and partial tears).

Cystic Abnormalities of the Spinal Cord and Vertebral Column

Cystic lesions of the vertebral column and spinal cord are important differential diagnoses in dogs with signs of spinal cord disease. Synovial cysts are commonly associated with degenerative joint disease and usually affect the cervical and lumbosacral regions. Arachnoid diverticulum (previously known as cyst) is seen in the cervical region of large breed dogs and thoracolumbar region of small breed dogs. This article reviews the causes, diagnosis, and treatment of these and other, less common, cystic lesions.

Lameness caused by an extradural lumbosacral foraminal synovial cyst in three German Shepherd Dogs

Three German Shepherd Dogs that were presented for investigation of chronic unilateral hindlimb lameness and pain in the lumbosacral region were diagnosed with an intraspinal, extradural synovial cyst and reactive fibrosis protruding into the foramen of the lumbosacral articulation using magnetic resonance imaging and histology. This extradural mass compressed the nerve root in the foramen and the cauda equina. During a dorsal laminectomy and unilateral partial foraminotomy, the cyst and the fibrotic tissue were removed with the aid of a 2.4 mm 30° arthroscope for visualization of the foramen. The fibrotic tissue surrounding the cysts was in all cases confluent with the annulus of the intervertebral disc. The histological examination confirmed the diagnosis of a synovial cyst in all three cases by finding inflamed synovial membrane in the samples from the wall of the cyst as well as reactive fibrosis and cartilaginous metaplasia in the surrounding tissue. The three patients improved after the surgery and were pain free during the follow-up evaluations.

Lumbosacral intraspinal extradural ganglion cyst in a cat

Case summary

A 16-year-old neutered female domestic shorthair cat was referred for chronic history of reluctance to jump, stiffness of the tail and lower back pain. Mild pelvic limb ataxia, reduced perianal reflex and lumbosacral discomfort were present on neurological examination. On magnetic resonance imaging, a well-defined rounded structure of 3 mm in diameter was identified on the right dorsal aspect of the epidural space at L7–S1, causing displacement of the cauda equina. The lesion was hyperintense to spinal cord parenchyma on T2-weighted images and hypointense on T1-weighted images, consistent with a fluid-filled structure. A Lumbosacral dorsal laminectomy was performed. A clear fluid-containing structure was identified between the right L7 nerve root and the cauda equina. Following surgical excision, histopathology confirmed the cystic nature of the lesion and revealed thick disorganised sheaths of fibrocollagenous tissue and flattened mesenchymal cells lining the luminal part of the cyst wall. A diagnosis of intraspinal ganglion cyst was made. The cat recovered uneventfully. Seven months after surgery euthanasia was performed for unrelated reasons; no neurological deficits were present.

Relevance and novel information

This is the first reported case of intraspinal ganglion cyst in a cat. Intraspinal extradural cysts should be considered among other differential diagnoses for cats with lumbosacral myelopathy/radiculopathy.

Spinal neurenteric cyst in a dog

A 2-year-old female crossbreed dog was presented with progressive ataxia and paraparesis. A T3-L3 spinal lesion was determined by neurological examination. Magnetic resonance imaging (MRI) revealed an ovoid-shaped, well-circumscribed mass affecting the spinal cord at the level of the T9 vertebra. A left hemilaminectomy and a durotomy at the level of T9 allowed discovery of an ovoid deformation of the meninges with a cystic appearance.

En bloc removal was performed and appeared to be complete. Pathological analysis showed a voluminous cystic lesion lined by a heterogeneous epithelium. Three types of epithelium were present: a pseudostratified columnar epithelium, a stratified squamous epithelium and a transitional epithelium. Mucus production, the morphology of some cells with microvilli at the apical pole and immunohistochemical assays were highly in favor of an endodermal origin of the cyst. The age of the dog, anamnesis, MRI study and histological findings were consistent with an intradural neurenteric cyst as described in humans. Total surgical removal led to a progressive clinical improvement with no recurrence at 18 months. We report an unusual intradural extramedullary cyst, called a neurenteric cyst, in a 2-year-old female crossbreed dog. This type of cyst is well-known in humans but has never been described in dogs. We propose that neurenteric cysts should be included in the differential diagnoses for tumor-like or cystic intradural lesions in the young dog. Prognosis for this type of cyst seems to be good, as total surgical removal led to a progressive clinical improvement with no recurrence at 18 months.

Ganglion cyst arising from the composite occipito-atlanto-axial joint cavity in a cat

A four-year-old, female spayed Domestic Longhaired cat was referred for evaluation with a two month history of initial inability to jump progressing to ambulatory tetraparesis. Magnetic resonance imaging studies demonstrated a cystic lesion arising from the composite occipito-atlanto-axial joint cavity and extending to the region of the occipital bone and the axis. The lesion surrounded the spinal canal, causing moderate dorsal spinal cord compression at the atlanto-occipital joint. A dynamic myelographic study demonstrated attenuation of the dorsal contrast column at the atlanto-occipital joint when the cervical spine was positioned in extension. Partial excision of the cyst capsule by a ventral approach resulted in long-term (64 months) resolution of clinical signs. Histological evaluation was consistent with a ganglion cyst. An intra-spinal ganglion cyst arising from the composite occipito-atlanto-axial joint cavity may be considered as an uncommon differential diagnosis for cats with cervical myelopathy.

Extramedullary spinal cysts in dogs

OBJECTIVE

To (1) synthesize the terminology used to classify extramedullary spinal cysts in dogs to clarify some of the commonly reported misconceptions, and (2) propose a classification scheme to limit confusion with terminology.

STUDY DESIGN

Literature review.

METHODS

An online bibliographic search was performed in January 2013 for articles relating to extramedullary spinal cysts in dogs using PubMed (http://www.pubmed.gov/) and Google Scholar (http://scholar.google.com/) databases. Only peer-reviewed clinical literature describing cystic lesions pertaining to the spinal cord and associated structures was included.

RESULTS

From 1962 to 2013, 42 articles were identified; 25 (95 dogs) reported meningeal cysts, 10 (24 dogs) described 60 extradural cysts, 3 reports (18 dogs) described discal cysts or acute compressive hydrated nucleus pulposus extrusions (HNPE). Spinal cysts were categorized by location based on cross-sectional imaging as meningeal or extradural non-meningeal. Sub-classification was then performed based on surgical findings and pathology. Meningeal cysts included arachnoid diverticulae and Tarlov (perineural) cysts. Extradural non-meningeal cysts included intraspinal cysts of the vertebral joints, ligaments and discs. Discal cysts also fit this category and have been reported extensively in humans but appear rare in dogs.

CONCLUSIONS

Extramedullary spinal cysts should be first classified according to location with a sub-classification according to pathologic and surgical findings. Previous canine cases of discal cysts appear to represent a different disease entity and the term acute compressive HNPE is therefore preferred.

Synovial Myxoma in the Vertebral Column of a Dog: MRI Description and Surgical Removal

A 12 yr old castrated male mixed-breed dog presented with a 2 wk history of progressive tetraparesis. Neurologic deficits included a short-strided choppy gait in the thoracic limbs and a long-strided proprioceptive ataxia in the pelvic limbs. Withdrawal reflexes were decreased bilaterally in the thoracic limbs. Signs were consistent with a myelopathy of the caudal cervical/cranial thoracic spinal cord (i.e., the sixth cervical [C] vertebra to the second thoracic [T] vertebra). A mass associated with the C6–C7 articular facet on the left side was identified on MRI of the cervical spinal cord. The lesion was hyperintense to spinal cord parenchyma on T2-weighted images, hypointense on T1-weighted images, and there was strong homogenous contrast enhancement. Significant spinal cord compression was associated with the lesion. The mass was removed through a C6–C7 dorsal laminectomy and facetectomy. Histopathology of the mass was consistent with a synovial myxoma of the articular facet. A postoperative MRI showed complete surgical resection. Albeit rare, synovial myxomas should be included in the list of differential diagnoses for neoplasms affecting the vertebral columns in dogs.

Surgical management of vertebral synovial cysts in a rabbit (Oryctolagus cuniculus)

CASE DESCRIPTION

An approximately 8-month-old female Miniature Lop rabbit (Oryctolagus cuniculus) was evaluated because of an acute onset of progressive paraparesis.

CLINICAL FINDINGS

The rabbit was ambulatory paraparetic, and results of neurologic examination were consistent with a myelopathy localizing to the T3-L3 spinal cord segments. Evaluation with CT myelography revealed focal extradural spinal cord compression bilaterally at the level of the articular process joints of T12-L1.

TREATMENT AND OUTCOME

A Funkquist type A dorsal laminectomy was performed at T12-L1, and the vertebral column was stabilized with pins and polymethylmethacrylate-based cement. Multiple vertebral synovial cysts were confirmed on histologic evaluation of the surgically excised tissues. The rabbit was nonambulatory with severe paraparesis postoperatively and was ambulatory paraparetic at a recheck examination 7 weeks after surgery. Fourteen weeks after surgery, the rabbit appeared stronger; it walked and hopped slowly but still fell and dragged its hindquarters when moving faster. Thirty-seven weeks after surgery, the neurologic status was unchanged.

CLINICAL RELEVANCE

Although thoracolumbar myelopathy in rabbits is commonly secondary to vertebral fracture, vertebral synovial cysts should be considered a differential diagnosis for rabbits with slowly progressive paraparesis. Decompressive surgery and stabilization can result in a good outcome for rabbits with this condition.

Cervical spinal intradural arachnoid cysts in related, young pugs

Seven related young pugs were diagnosed with cervical spinal intradural arachnoid cysts by magnetic resonance imaging (n = 6) and myelography (n = 1). All dogs were presented with skin abrasions on their thoracic limbs and non-painful neurological deficits, indicating a C1-T2 myelopathy. In all six dogs examined by magnetic resonance imaging not only the spinal arachnoid cyst but also a concomitant, most likely secondary, syringohydromyelia was confirmed. Pedigree analysis suggested a genetic predisposition for spinal arachnoid cysts in this family of pugs. Generalised proprioceptive deficits more pronounced in the thoracic limbs suggesting a focal cervical spinal cord lesion, with concomitant skin abrasions on the dorsal aspect of the thoracic limbs in a young pug, should alert veterinarians to the possibility of cervical spinal arachnoid cysts.

Equine articular synovial cysts: 16 cases

OBJECTIVE

To report the clinical findings, diagnosis, treatment and outcome of equine patients with articular synovial cysts.

STUDY DESIGN

Retrospective case series.

ANIMALS

Horses (n = 16) with articular synovial cysts.

METHODS

Horses diagnosed with articular synovial cysts (1988-2009) at 2 veterinary teaching hospitals were studied. Signalment, history, clinical signs, diagnostic methods and treatment were retrieved and telephone follow-up was obtained.

RESULTS

Sixteen horses with articular synovial cysts were identified. Lameness was the reason for referral in most (n = 9) horses. Diagnosis was based on a combination of palpation and imaging studies, including radiography, ultrasonography and/or arthrography. Excision of the cyst was performed in 8 horses. Outcome was available for 4 surgically and 2 conservatively treated horses. Lameness resolved in 3 horses treated surgically and the 4th died for unrelated reasons. The 2 conservatively treated horses performed satisfactorily for the rest of their career.

CONCLUSIONS

Equine articular synovial cysts are rare and can be associated with lameness. The cysts had a synovial lining in all horses where it was assessed. Surgical excision may be successful in resolving the lameness and allowing selected horses to return to work.

Computed tomography myelographic findings in dogs with cervical spondylomyelopathy

Computed tomography (CT) myelography is used occasionally in the diagnosis of cervical spondylomyelopathy, but the type of lesion found in large- versus giant-breed dogs using this modality has not been characterized. Our purpose was to report the frequency of compressive lesions in large- and giant-breed dogs with cervical spondylomyelopathy and imaged using CT myelography. Fifty-eight dogs were retrospectively studied, 23 large-breed and 35 giant-breed dogs. Multiple sites of compression were found in 12 large-breed dogs (52.2%) compared to 30 (85.8%) giant-breed dogs. The main site of compression was at C5-6 and C6-7 in both large-breed (91.3%) and giant-breed (72.4%) dogs. The main cause and direction of compression was disc-associated and ventral in 19 (82.6%) of the large-breed dogs while osseous changes were the primary cause of compression in 27 (77.2%) of the giant-breed dogs, with most compressions being lateral (51.4%), followed by dorsolateral (14.2%). Osseous compression was observed at C7-T1 in eight giant-breed dogs (22.8%), and at T1-T2 or T2 only in five dogs (14.3%). Four of 23 large-breed dogs (17.4%), and seven (20%) of 35 giant-breed dogs had spinal cord atrophy. Therefore, giant-breed dogs often have multiple compressions, usually caused by osseous changes causing lateralized compressions. In large-breed dogs most compressions are disc-associated and located ventrally. Considering the number of giant-breed dogs with compressions at C7-T1, T1-2, and T2, it is important to include the cranial thoracic region when imaging dogs suspected of having cervical spondylomyelopathy.

Atlantoaxial Synovial Cyst Associated with Instability in a Chihuahua

Objective. To describe an atlantoaxial degenerative cyst associated with instability.Animal. Chihuahua, male, 5 years old.Methods. Ever since colliding with a large dog two years prior to presentation, the dog suffered recurrent episodes of intractable cervical pain. Over time, the pain attacks increased in frequency and intensity. On presentation, pain was clinically localized to the high cervical region. No neurological deficits were observed. CT and MRI revealed an atlantoaxial degenerative articular cyst associated with instability, causing cervicomedullary compressive myelopathy. On MRI the cyst appeared hypointense in T1W and hyperintense in T2-weighted sequences, with rim enhancement. The dog was treated surgically by cyst fenestration and ventral stabilization using a 1.5 mm Butterfly Locking plate and cancellous bone graft placed within the atlantoaxial joint after cartilage removal. Histological examination of a sample of the cyst wall confirmed a degenerative articular cyst. The dog recovered uneventfully after surgery and remained pain free throughout the 2-year followup.Conclusion. Atlantoaxial degenerative articular cyst associated with instability is a rare finding in dogs.Clinical Relevance. The presence of an atlantoaxial degenerative articular cyst appears not to worsen the prognosis of instability treatment. Atlantoaxial fusion and cyst fenestration may provide good long-term results.

Spontaneous regression of a cervical intraspinal cyst in a dog

We report a cervical intraspinal cyst in a dog that was initially tetraparetic but spontaneously recovered completely. MRI revealed a well-demarcated intraspinal cyst located dorsally to a degenerated intervertebral disc. The location of the cyst and its signal features on MRI resembled those of discal cysts previously reported in humans. It has been reported in dogs that clinical signs of a intraspinal cyst are similar to those of intervertebral disc herniation and both conditions require surgical intervention. Unexpectedly, our case showed rapid spontaneous recovery and the follow-up MRI revealed complete resolution of the intraspinal cyst and spinal cord compression. Spontaneous recovery of degenerative intraspinal cyst may occur in dogs, similar to rare human cases as reported previously.

Ventral intraspinal cysts associated with the intervertebral disc: magnetic resonance imaging observations in seven dogs

OBJECTIVE

To report clinical and diagnostic imaging features, and outcome after surgical treatment of ventral intraspinal cysts in dogs.

STUDY DESIGN

Retrospective study.

ANIMALS

Dogs (n=7) with ventral intraspinal cysts.

METHODS

Clinical signs, magnetic resonance imaging (MRI) findings and surgical findings of 7 dogs and histologic findings (1 dog) with intraspinal cysts associated with the intervertebral disc were reviewed.

RESULTS

Ventral intraspinal cyst is characterized by: (1) clinical signs indistinguishable from those of typical disc herniation; (2) an extradural, round to oval, mass lesion with low T1 and high T2 signal intensity on MRI, compatible with a liquid-containing cyst; (3) cyst is in close proximity to the intervertebral disc; and (4) MRI signs of disc degeneration. Although the exact cause is unknown, underlying minor disc injury may predispose to cyst formation.

CONCLUSION

Intraspinal cysts have clinical signs identical to those of disc herniation. Given the close proximity of the cyst to the corresponding disc and the similarity of MRI findings to discal cysts in humans, we propose the term "canine discal cyst" to describe this observation.

CLINICAL RELEVANCE

Discal cysts should be considered in the differential choices for cystic extradural compressing lesions.

Imaging diagnosis--degenerative intraspinal cyst associated with an intervertebral disc

A 6-year-old neutered male Rottweiler had chronic episodic signs of thoracolumbar pain and inability to stand that did not improve after rest and nonsteroidal antiinflammatory medication. In magnetic resonance images, an extradural mass was identified between the spinal cord and the T13/L1 intervertebral disc; the mass was compressing the cord in a dorsoventral direction. The lesion had a low signal intensity rim that enhanced slightly after gadolinium administration, and contents with similar signal intensity to cerebrospinal fluid. The lesion was removed surgically by severing its attachments to the annulus fibrosus. The histologic diagnosis was degenerative intraspinal cyst. The origin of such cysts, and their relationship to synovial and ganglion cysts is discussed.

Lumbar spinal 'juxtaarticular' cyst in a Gordon setter

An 11-year-old Gordon setter bitch was presented with a history of progressive weakness in the right hind limb associated with pain in the lumbar spine. Neurological deficits consisted of ataxia, monoparesis, muscle atrophy and spontaneous over-knuckling of the affected limb. A large 'juxtaarticular' cyst located in a right dorsolateral position of the intervertebral foramen at L3-L4 was diagnosed by magnetic resonance imaging. The cyst was removed through a modified laminectomy. The dog recovered quickly and returned to the owners 4 days after surgery with slight neurological symptoms. During the follow-up examination 2 and 6 months later, the Setter showed normal gait and neurological examination.

Extradural spinal juxtafacet (synovial) cysts in three dogs

Three dogs were presented for investigation of spinal disease and were diagnosed with extradural spinal juxtafacet cysts of synovial origin. Two dogs that were presented with clinical signs consistent with pain in the lumbosacral region associated with bilateral hindlimb paresis were diagnosed using magnetic resonance imaging. Both cysts were solitary and associated with the L6-7 dorsal articulations; both the dogs had a transitional vertebra in the lumbosacral region. A third dog that was presented with progressive paraparesis localised to T3-L3 spinal cord segments and compression of the spinal cord at T13-L1 was diagnosed using myelography. A solitary multiloculated cyst was found at surgery. Decompressive surgery resulted in resolution of the clinical signs in all three dogs. Immunohistological findings indicated that one to two layers of vimentin-positive cells consistent with synovial origin lined the cysts.

Synovial cysts associated with cauda equina syndrome in two dogs

OBJECTIVE

To report synovial cysts associated with cauda equina syndrome in 2 dogs.

STUDY DESIGN

Clinical cases.

ANIMALS

Two German Shepherd dogs.

METHODS

After magnetic resonance imaging detection, cysts were surgically removed via dorsal laminectomy.

RESULTS

Six and 8 months after surgery, both dogs were free of clinical signs and no pain was elicited on lumbosacral joint manipulation.

CONCLUSION

Although described in dogs, cysts at the lumbosacral joint might cause compression of the cauda equina nerve roots. Radical excision of the cyst capsule can result in resolution of clinical signs.

CLINICAL RELEVANCE

Synovial cysts should be considered in the differential diagnosis of dogs with cauda equina compression syndrome when lumbosacral degenerative joint disease is present.

Potential sources of neck and back pain in clinical conditions of dogs and cats: a review

Pathological neck and back pain occurs in many medical conditions of dogs and cats. Pain may arise from a variety of structures including the intervertebral discs, facet joint capsules, dorsal root ganglia, vertebral ligaments, the vertebral periosteum, and the meninges. The source of this pain is dependent upon the type of disease process and its location within or surrounding the spinal column. Diseases can directly or indirectly stimulate pain sensors (nociceptors). Inflammatory diseases may hypersensitize these receptors or nociceptive pathways with inflammatory mediating substances such as serotonin, histamine and potassium. Diseases resulting in mechanical compression of nociceptors or nociceptive pathways may also result in neck or back pain. A thorough understanding of spinal pain occurring in dogs and cats will lead to more accurate diagnoses and treatments and may provide information regarding prognoses for various diseases. Evidence pointing to sources of spinal pain taken from scientific and clinical studies of a variety of species including humans is provided. Suspected or known sources of neck and back pain occurring in several clinical conditions of dogs and cats are discussed.