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Hirano R, Asahina R, Hirano T, Hyakkoku A, Miura R, Kunihiro T, Nakamoto Y. Outcomes of extensive hemilaminectomy with durotomy on dogs with presumptive progressive myelomalacia: a retrospective study on 34 cases. BMC Vet Res 2020; 16:476. [PMID: 33287802 PMCID: PMC7720392 DOI: 10.1186/s12917-020-02690-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 11/23/2020] [Indexed: 11/21/2022] Open
Abstract
Background Progressive myelomalacia (PMM) is a fatal complication of progressive ascending and descending necrosis of the spinal cord after acute spinal cord injury. A recent study suggested that extensive hemilaminectomy with durotomy (EHLD) at the intramedullary T2-hyperintense region which performed immediately after magnetic resonance imaging (MRI) improved the survival rate in dogs with presumptive PMM. The objective of this retrospective study was to evaluate the effects of EHLD on halting the progression of PMM in dogs presumptively diagnosed with PMM which had the interval between MRI and surgery. Results Thirty-four dogs with presumptive PMM which had undergone EHLD with the delay following MRI examination (range, 0 to 3 days) were included. The cranial side of EHLD was set depending on the delay time after MRI, MRI findings, neurological examination and intraoperative macroscopic appearance. Two weeks after surgery, the perioperative survival rate was 97% (33/34). During follow-up with a median time period of 82.5 weeks (range, 0-290 weeks), the postoperative survival rate was 91% (31/34). At the end of the follow-up period, 31 out of 34 dogs were alive without severe postoperative complications while the remaining 2 dogs died from causes not directly attributable to the surgery. There was no improvement in the pelvic limb function of all dogs. Conclusions EHLD appears to be effective in halting the progression of presumptive PMM and preventing morbidity even in dogs which had the interval between MRI and EHLD. Our algorithm of determining the range of EHLD may enable to set the appropriate ranges of EHLD in the cases which develop signs consistent with PMM after MRI examination.
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Affiliation(s)
- Ryuji Hirano
- Ukyo Animal Hospital, 12-2 Uzumasa-Kyonomichicho, Ukyo-ku, Kyoto, Japan. .,Kyoto Animal Medical Center, 550-4 Bishamoncho, Nakagyo-ku, Kyoto, Japan.
| | - Ryota Asahina
- Kyoto Animal Medical Center, 550-4 Bishamoncho, Nakagyo-ku, Kyoto, Japan.,Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto, Japan
| | - Taiyo Hirano
- Ukyo Animal Hospital, 12-2 Uzumasa-Kyonomichicho, Ukyo-ku, Kyoto, Japan
| | - Ayuko Hyakkoku
- Ukyo Animal Hospital, 12-2 Uzumasa-Kyonomichicho, Ukyo-ku, Kyoto, Japan
| | - Rino Miura
- Ukyo Animal Hospital, 12-2 Uzumasa-Kyonomichicho, Ukyo-ku, Kyoto, Japan
| | - Takuya Kunihiro
- Ukyo Animal Hospital, 12-2 Uzumasa-Kyonomichicho, Ukyo-ku, Kyoto, Japan
| | - Yuya Nakamoto
- Neuro Vets Animal Neurology Clinic, 550-4 Bishamoncho, Nakagyo-ku, Kyoto, Japan
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Boudreau E, Otamendi A, Levine J, Griffin JF, Gilmour L, Jeffery N. Relationship between Machine-Learning Image Classification of T 2-Weighted Intramedullary Hypointensity on 3 Tesla Magnetic Resonance Imaging and Clinical Outcome in Dogs with Severe Spinal Cord Injury. J Neurotrauma 2020; 38:725-733. [PMID: 33054592 DOI: 10.1089/neu.2020.7188] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Early prognostic information in cases of severe spinal cord injury can aid treatment planning and stratification for clinical trials. Analysis of intraparenchymal signal change on magnetic resonance imaging has been suggested to inform outcome prediction in traumatic spinal cord injury. We hypothesized that intraparenchymal T2-weighted hypointensity would be associated with a lower potential for functional recovery and a higher risk of progressive neurological deterioration in dogs with acute, severe, naturally occurring spinal cord injury. Our objectives were to: 1) demonstrate capacity for machine-learning criteria to identify clinically relevant regions of hypointensity and 2) compare clinical outcomes for cases with and without such regions. A total of 95 dogs with complete spinal cord injury were evaluated. An image classification system, based on Speeded-Up Robust Features (SURF), was trained to recognize individual axial T2-weighted slices that contained hypointensity. The presence of such slices in a given transverse series was correlated with a lower chance of functional recovery (odds ratio [OR], 0.08; confidence interval [CI], 0.02-0.38; p < 10-3) and with a higher risk of neurological deterioration (OR, 0.14; 95% CI, 0.05-0.42; p < 10-3). Identification of intraparenchymal T2-weighted hypointensity in severe, naturally occurring spinal cord injury may be assisted by an image classification tool and is correlated with functional recovery.
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Affiliation(s)
- Elizabeth Boudreau
- Texas A&M University College of Veterinary Medicine and Biomedical Sciences, College Station, Texas, USA
| | - Arturo Otamendi
- VCA San Francisco Veterinary Specialists, San Francisco, California, USA
| | - Jonathan Levine
- Texas A&M University College of Veterinary Medicine and Biomedical Sciences, College Station, Texas, USA
| | - John F Griffin
- Texas A&M University College of Veterinary Medicine and Biomedical Sciences, College Station, Texas, USA
| | - Lindsey Gilmour
- Texas A&M University College of Veterinary Medicine and Biomedical Sciences, College Station, Texas, USA
| | - Nicholas Jeffery
- Texas A&M University College of Veterinary Medicine and Biomedical Sciences, College Station, Texas, USA
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3
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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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4
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Nakamoto Y, Uemura T, Hasegawa H, Nakamoto M, Ozawa T. Outcomes of dogs with progressive myelomalacia treated with hemilaminectomy or with extensive hemilaminectomy and durotomy. Vet Surg 2020; 50:81-88. [PMID: 33280138 DOI: 10.1111/vsu.13514] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 05/29/2020] [Accepted: 08/16/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the ability of extensive hemilaminectomy and durotomy (EHLD) to control progressive myelomalacia (PMM) in dogs. STUDY DESIGN Retrospective clinical study. ANIMALS Twenty-eight client owned dogs that underwent EHLD (n = 10) or HL alone (n = 18). METHODS After diagnosis by MRI, dogs were immediately treated with HL alone or EHLD at the site of intramedullary hyperintensity on T2-weighted (T2W)-MRI. Medical records were retrospectively reviewed. Follow-up data were collected via telephone interviews with the referring veterinarian and a standardized questionnaire. Postoperative survival outcome between groups was compared (log-rank test) by using Cox's proportional hazard analysis with baseline characteristics entered as covariates. RESULTS The survival rate was higher in the EHLD group (P = .03) compared with the HL-alone group. Eleven of 18 dogs treated with HL survived, while seven of 18 dogs died (median, 5 days after surgery). In the EHLD group, 10 of 10 dogs survived postoperatively. Baseline characteristics were not associated with postoperative survival outcomes. According to multivariate analysis, EHLD was the independent factor associated with an increase in survival rate (P = .0002). CONCLUSION EHLD durotomy at the intramedullary hyperintense region on T2W-MRI improved the survival rate of dogs with PMM compared with dogs treated with standard HL. CLINICAL SIGNIFICANCE This study provides evidence that supports treatment with EHLD in dogs with PMM. Additional prospective studies are required.
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Affiliation(s)
- Yuya Nakamoto
- Kyoto Animal Referral Medical Center, Kyoto, Kuze-gun, Japan.,Neuro Vets Animal Neurology Clinic, 4th floor, 550-4, Bishamon-cho, Nakgyo-ku, Japan
| | - Takashi Uemura
- Kyoto Animal Referral Medical Center, Kyoto, Kuze-gun, Japan
| | - Hiroki Hasegawa
- Kyoto Animal Referral Medical Center, Kyoto, Kuze-gun, Japan
| | - Miwa Nakamoto
- Kyoto Animal Referral Medical Center, Kyoto, Kuze-gun, Japan.,Neuro Vets Animal Neurology Clinic, 4th floor, 550-4, Bishamon-cho, Nakgyo-ku, Japan
| | - Tsuyoshi Ozawa
- Kyoto Animal Referral Medical Center, Kyoto, Kuze-gun, Japan
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Takahashi F, Honnami A, Toki M, Dosaka A, Fujita Y, Hara Y, Yamaguchi S. Effect of durotomy in dogs with thoracolumbar disc herniation and without deep pain perception in the hind limbs. Vet Surg 2020; 49:860-869. [PMID: 32166788 DOI: 10.1111/vsu.13409] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 01/21/2019] [Accepted: 05/27/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To determine the effectiveness of durotomy as an adjunct to surgical decompression in dogs with thoracolumbar intervertebral disc herniation (TL-IVDH) and loss of deep pain perception (DPP) in the hind limbs. STUDY DESIGN Retrospective study. ANIMALS Dogs (n = 116) with TL-IVDH and loss of DPP treated with hemilaminectomy. METHODS Signalment, surgical site, recovery rate, incidence of progressive myelomalacia (PMM), time elapsed from onset of paraplegia of the hind limbs to surgery (TPS), and the length of area of hyperintensity of the spinal cord on magnetic resonance T2-weighted images compared with L2 vertebral body length (LHT2) were compared between dogs treated with hemilaminectomy alone and those treated with adjunct durotomy. Multivariate logistic regression analyses were used to test the association between outcomes and the external view of the spinal cord parenchyma after durotomy. RESULTS The percentage of dogs regaining ambulation was greater when durotomy was performed (56.9%) than when dogs were treated with hemilaminectomy alone (38.5%; P = .04). In the hemilaminectomy group, 14 dogs died of suspected PMM, while no PMM was detected in the durotomy group. Durotomy, breed, surgical site, and LHT2 influenced recovery. No association was detected between age, sex, body weight, and TPS and recovery. CONCLUSION Performing a durotomy in combination with decompression improved the return to function and prevented PMM in our clinical setting. CLINICAL SIGNIFICANCE Surgeons should consider durotomy in dogs with TL-IVDH and loss of DPP in hind limbs to improve surgical outcome.
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Affiliation(s)
- Fumitaka Takahashi
- YPC Tokyo Animal Orthopedic Surgery Hospital, Tokyo, Japan.,YPC Tokyo Animal Medical Imaging Center, Tokyo, Japan.,Division of Veterinary Surgery, Department of Veterinary Science, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University, Tokyo, Japan
| | - Ayaka Honnami
- YPC Tokyo Animal Orthopedic Surgery Hospital, Tokyo, Japan.,YPC Tokyo Animal Medical Imaging Center, Tokyo, Japan
| | - Minae Toki
- YPC Tokyo Animal Medical Imaging Center, Tokyo, Japan
| | - Ayako Dosaka
- Companion Animal Medical Imaging Center, Tokyo, Japan
| | - Yukihiro Fujita
- Laboratory of Surgery II, School of Veterinary Medicine, Azabu University, Kanagawa, Japan
| | - Yasushi Hara
- Division of Veterinary Surgery, Department of Veterinary Science, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University, Tokyo, Japan
| | - Shinya Yamaguchi
- YPC Tokyo Animal Orthopedic Surgery Hospital, Tokyo, Japan.,YPC Tokyo Animal Medical Imaging Center, Tokyo, Japan.,Division of Veterinary Surgery, Department of Veterinary Science, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University, Tokyo, Japan
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6
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Castel A, Olby NJ, Ru H, Mariani CL, Muñana KR, Early PJ. Risk factors associated with progressive myelomalacia in dogs with complete sensorimotor loss following intervertebral disc extrusion: a retrospective case-control study. BMC Vet Res 2019; 15:433. [PMID: 31796017 PMCID: PMC6892155 DOI: 10.1186/s12917-019-2186-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 11/22/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Progressive myelomalacia (PMM) is a usually fatal complication of acute intervertebral disc extrusion (IVDE) in dogs but its risk factors are poorly understood. The objective of this retrospective case-control study was to identify risk factors for PMM by comparing dogs with complete sensorimotor loss following IVDE that did and did not develop the disease after surgery. We also investigated whether any risk factors for PMM influenced return of ambulation. Medical records of client-owned dogs with paraplegia and loss of pain perception that underwent surgery for IVDE from 1998 to 2016, were reviewed. Dogs were categorized as PMM yes or no based on clinical progression or histopathology. Walking outcome at 6 months was established. Signalment, onset and duration of signs (categorized), steroids, non-steroidal anti-inflammatory drugs (yes or no), site of IVDE (lumbar intumescence or thoracolumbar) and longitudinal extent of IVDE were retrieved and their associations with PMM and walking outcome were examined using logistic regression. RESULTS One hundred and ninety seven dogs were included, 45 with and 152 without PMM. A 6-month-outcome was available in 178 dogs (all 45 PMM dogs and 133 control dogs); 86 recovered walking (all in the control group). Disc extrusions at the lumbar intumescence were associated with PMM (p = 0.01, OR: 3.02, CI: 1.3-7.2). Surgery performed more than 12 h after loss of ambulation was associated with PMM (OR = 3.4; CI = 1.1-10.5, p = 0.03 for 12-24 h and OR = 4.6; CI = 1.3-16.6, p = 0.02 for the > 24 h categories when compared with the ≤12 h category). Treatment with corticosteroids was negatively associated with PMM (OR: 3.1; CI: 1.3-7.6, p = 0.01). The only variable to affect walking outcome was longitudinal extent of IVDE (OR = 2.6; CI = 1.3-5.3, p = 0.006). CONCLUSION Dogs with lumbar intumescence IVDE are at increased risk of PMM. Timing of surgery and corticosteroid use warrant further investigations. PMM and recovery of walking are influenced by different factors.
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Affiliation(s)
- Aude Castel
- Department of Small Animal Clinical Sciences, University of Tennessee Veterinary Teaching Hospital, College of Veterinary Medicine, Knoxville, TN 37966-4544 USA
| | - Natasha J. Olby
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27607 USA
- Comparative Medicine Institute, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27607 USA
| | - Hongyu Ru
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27607 USA
| | - Christopher L. Mariani
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27607 USA
- Comparative Medicine Institute, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27607 USA
| | - Karen R. Muñana
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27607 USA
- Comparative Medicine Institute, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27607 USA
| | - Peter J. Early
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27607 USA
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7
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Bittermann S, Schild C, Marti E, Mirkovitch J, Schweizer D, Henke D. Analysis of blood degradation products and ferritin in the cerebrospinal fluid of dogs with acute thoracolumbar intervertebral disk extrusion, a prospective pilot study. BMC Vet Res 2019; 15:148. [PMID: 31088486 PMCID: PMC6518634 DOI: 10.1186/s12917-019-1878-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 04/23/2019] [Indexed: 11/23/2022] Open
Abstract
Background Hemorrhage in the spinal canal leads to further damage of the spinal cord influencing outcome in dogs with intervertebral disk (IVD) extrusion. The aim of the study was to evaluate blood degradation products and ferritin in the cerebrospinal fluid (CSF) of dogs with thoracolumbar IVD extrusion, and their association to clinical parameters and MRI findings. Results In the CSF of dogs with IVD extrusion, both net oxyhemoglobin absorption (NOA) and net bilirubin absorption (NBA) were significantly higher compared to the control groups of dogs with steroid responsive meningitis arteritis (SRMA) and idiopathic epilepsy (IE) (P < 0.001), but NOA compared to the idiopathic epilepsy group contaminated artificially with blood (IEc) was not (P = 0.890). Ferritin concentration was significantly higher in dogs with IVD extrusion compared to dogs with IE (P = 0.034), but not to dogs with SRMA (P = 0.526). There was no association between NOA, NBA or ferritin concentration and severity or duration of clinical signs. In dogs with a higher ferritin concentration the outcome was better (P = 0.018). In dogs with evidence of hemorrhage on MRI, NOA and NBA were significantly higher (P = 0.016, P = 0.009), but not ferritin (P = 0.0628). Conclusion and clinical importance Quantification of blood degradation products and ferritin in the CSF of dogs to assess subarachnoidal hemorrhage is feasible; however, larger case numbers are needed to evaluate the relevance of NBA and ferritin as prognostic indicators.
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Affiliation(s)
- Sophie Bittermann
- Division of Neurological Sciences, Division of Clinical Veterinary Neurology, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Laenggassstrasse 128, 3012, Bern, Switzerland.
| | - Christof Schild
- Institute of Clinical Chemistry, Inselspital, Bern University Hospital and University of Bern, INO-F3010, Bern, Switzerland
| | - Eliane Marti
- Department of Clinical Research and Veterinary Public Health, Vetsuisse Faculty, University of Bern, Laenggassstrasse 128, 3012, Bern, Switzerland
| | - Jelena Mirkovitch
- Department of Clinical Research and Veterinary Public Health, Vetsuisse Faculty, University of Bern, Laenggassstrasse 128, 3012, Bern, Switzerland
| | - Daniela Schweizer
- Division of Neurological Sciences, Division of Veterinary Radiology, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Laenggassstrasse 128, 3012, Bern, Switzerland
| | - Diana Henke
- Division of Neurological Sciences, Division of Clinical Veterinary Neurology, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Laenggassstrasse 128, 3012, Bern, Switzerland
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8
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Cook L, Drost WT. Hemorrhagic Myelomalacia in a Bichon Frise Following Lumbar Spinal Tap-A Case Report. Top Companion Anim Med 2019; 34:47-50. [PMID: 30808497 DOI: 10.1053/j.tcam.2018.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/10/2018] [Accepted: 09/11/2018] [Indexed: 11/11/2022]
Abstract
A 10-year-old spayed female Bichon Frise presented to the neurology service for back pain and pelvic limb weakness for approximately 2 months duration. Neurologic examination revealed T3-L3 and L4-S3 myelopathies with multifocal spinal pain. Magnetic resonance imaging of the vertebral column revealed multiple mild disc protrusions but no obvious cause for the neurologic deficits. Attempts to collect cerebrospinal fluid from the lumbar spine and cerebellomedullary cistern were unsuccessful. Following anesthesia, the dog was noted to be paraplegic with flaccid pelvic limb muscle tone and absent nociception. Repeat magnetic resonance imaging the following day revealed suspect hemorrhage ventral to the spinal cord cranial to the site of the lumbar spinal tap. Exploratory hemilaminectomy revealed purplish discoloration of the dura. Durotomy was performed and severe myelomalacia of the spinal cord was noted. To the author's knowledge, this is the first reported case of myelomalacia suspected secondary to lumbar spinal tap in a dog.
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Affiliation(s)
- Laurie Cook
- The Ohio State University Veterinary Medical Center, Department of Clinical Sciences, Columbus, OH, USA.
| | - Wm Tod Drost
- The Ohio State University Veterinary Medical Center, Department of Clinical Sciences, Columbus, OH, USA
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9
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Castel A, Olby NJ, Mariani CL, Muñana KR, Early PJ. Clinical Characteristics of Dogs with Progressive Myelomalacia Following Acute Intervertebral Disc Extrusion. J Vet Intern Med 2017; 31:1782-1789. [PMID: 28961348 PMCID: PMC5697170 DOI: 10.1111/jvim.14829] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 06/30/2017] [Accepted: 08/15/2017] [Indexed: 01/19/2023] Open
Abstract
Background Progressive myelomalacia (PMM) is a catastrophic disease associated with acute intervertebral disc extrusion (IVDE). Published data on the clinical characteristics of this disease are limited. Objective To describe the onset and progression of clinical signs of PMM in a large case cohort. Animals Fifty‐one dogs, 18 with histopathologically confirmed PMM, 33 presumptively diagnosed based on clinical signs and diagnostic imaging. Methods Retrospective study. Dogs with confirmed IVDE and either a histopathologic diagnosis of PMM or a high clinical suspicion were identified by medical record search. Data on nature and progression of signs were extracted. Results Twenty‐four of 51 dogs were Dachshunds. T12–T13 was the most common site of disc extrusion (12 of 56), and 18 of 55 of mid‐to‐caudal lumbar discs (between L3 and L6) were affected. Onset of PMM signs ranged from present at first evaluation (17/51) to 5 days after presentation, with 25 of 51 cases developing signs within 48 hours. Progression of signs from onset of PMM to euthanasia or death, excluding 7 cases euthanized at presentation, ranged from 1 to 13 days with 23 being euthanized within 3 days. Nonspecific systemic signs were documented in 30 of 51 dogs. Conclusion and Clinical Importance The majority of dogs developed PMM within 2 days of presentation and was euthanized within another 3 days. However, onset can be delayed up to 5 days after presentation with progression to euthanasia taking as long as 2 weeks. Mid‐to‐caudal lumbar discs might be associated with an increased risk of PMM.
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Affiliation(s)
- A Castel
- College of Veterinary Medicine, North Carolina State University, Raleigh, NC
| | - N J Olby
- College of Veterinary Medicine, North Carolina State University, Raleigh, NC.,Comparative Medicine Institute, North Carolina State University, Raleigh, NC
| | - C L Mariani
- College of Veterinary Medicine, North Carolina State University, Raleigh, NC.,Comparative Medicine Institute, North Carolina State University, Raleigh, NC
| | - K R Muñana
- College of Veterinary Medicine, North Carolina State University, Raleigh, NC.,Comparative Medicine Institute, North Carolina State University, Raleigh, NC
| | - P J Early
- College of Veterinary Medicine, North Carolina State University, Raleigh, NC
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10
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Balducci F, Canal S, Contiero B, Bernardini M. Prevalence and Risk Factors for Presumptive Ascending/Descending Myelomalacia in Dogs after Thoracolumbar Intervertebral Disk Herniation. J Vet Intern Med 2017; 31:498-504. [PMID: 28144987 PMCID: PMC5354033 DOI: 10.1111/jvim.14656] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 12/08/2016] [Accepted: 12/14/2016] [Indexed: 12/02/2022] Open
Abstract
Background Ascending/descending myelomalacia (ADMM) is a severe complication of thoracolumbar intervertebral disk herniation (TL‐IVDH) in dogs. Hypothesis/Objectives To investigate the prevalence and risk factors for ADMM in nonambulatory dogs with surgically treated TL‐IVDH. Animals Six‐hundred and fifty‐two client‐owned dogs evaluated for TL‐IVDH that underwent decompressive spinal surgery. Methods Retrospective medical record review from February 2007 through December 2015. Results Thirteen dogs developed ADMM, with an overall prevalence of 2.0%. The prevalence of ADMM was 0% in dogs with neurological signs graded 1 or 2 at admission or before magnetic resonance imaging (MRI) or surgical procedures, 0.6% in dogs with neurological signs graded 3, 2.7% in dogs with neurological signs graded 4, and 14.5% in dogs with neurological signs graded 5. Age (<5.8 years), neurological status (grade 5), site of disk herniation (L5‐L6), duration of clinical signs before becoming nonambulatory (<24 hours), detection of intramedullary T2‐weighted (T2W) hyperintensity, and a T2 length ratio >4.57 were significant risk factors in the univariate analysis for development of ADMM. Conclusions and Clinical Importance The factors identified in this study may be useful for the prediction of ADMM. Multicenter studies with a higher number of dogs with ADMM are required to confirm these data.
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Affiliation(s)
- F Balducci
- Neurology Unit, Portoni Rossi Veterinary Hospital, Zola Predosa, Bologna, Italy
| | - S Canal
- Neurology Unit, Portoni Rossi Veterinary Hospital, Zola Predosa, Bologna, Italy.,Department of Animal Medicine, Production and Health, Clinical Section, University of Padua, Legnaro, Padua, Italy
| | - B Contiero
- Department of Animal Medicine, Production and Health, Clinical Section, University of Padua, Legnaro, Padua, Italy
| | - M Bernardini
- Neurology Unit, Portoni Rossi Veterinary Hospital, Zola Predosa, Bologna, Italy.,Department of Animal Medicine, Production and Health, Clinical Section, University of Padua, Legnaro, Padua, Italy
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