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Togawa G, Lewis MJ, Devathasan D. Outcome in paraplegic dogs with or without pain perception due to thoracolumbar fibrocartilaginous embolic myelopathy or acute non-compressive nucleus pulposus extrusion. Front Vet Sci 2024; 11:1406843. [PMID: 38784658 PMCID: PMC11111901 DOI: 10.3389/fvets.2024.1406843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 04/23/2024] [Indexed: 05/25/2024] Open
Abstract
Background Fibrocartilaginous embolic myelopathy (FCEM) and acute non-compressive nucleus pulposus extrusion (ANNPE) are common causes of acute spinal cord injury in dogs. Outcome among paraplegic deep pain positive (DPP) and deep pain negative (DPN) dogs with either condition and factors influencing recovery have not been clearly established. Methods Dogs with thoracolumbar FCEM or ANNPE resulting in paraplegia presenting to university hospitals between 2012 and 2022 were retrospectively included. Diagnosis of FCEM or ANNPE was based on clinical and magnetic resonance imaging findings. Outcome was defined as successful (recovery of independent ambulation) or unsuccessful (non-ambulatory ≥3 months following diagnosis or at the time of death/euthanasia). Logistic regression analysis was performed to investigate associations between clinical or imaging variables and outcome. Results Thirty-one dogs were included. In total, 14 dogs were initially paraplegic DPP (8 FCEM, 6 ANNPE) and 17 dogs were paraplegic DPN (11 FCEM, 6 ANNPE). Outcome was available for 26 dogs (14 DPP, 12 DPN) with a median follow-up time of 182 days (range 0-2,311) including 2 dogs euthanized at the time of diagnosis; 1 of 12 DPN dogs (8.3%) regained independent ambulation, whereas 9 of 14 DPP dogs (64.3%) regained independent ambulation. DPN dogs had a significantly higher risk of not regaining independent ambulation compared with DPP dogs (OR: 47.40, 95% CI: 2.09-1073.99). No other variables were associated with outcome. Conclusion While recovery of ambulation was possible, these results confirm that the absence of pain perception is a useful negative prognostic indicator in dogs with severe thoracolumbar FCEM or ANNPE.
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Affiliation(s)
- Go Togawa
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN, United States
| | - Melissa J. Lewis
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN, United States
| | - Dillon Devathasan
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL, United States
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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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Olby NJ, da Costa RC, Levine JM, Stein VM. Prognostic Factors in Canine Acute Intervertebral Disc Disease. Front Vet Sci 2020; 7:596059. [PMID: 33324703 PMCID: PMC7725764 DOI: 10.3389/fvets.2020.596059] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/12/2020] [Indexed: 12/17/2022] Open
Abstract
Knowledge of the prognosis of acute spinal cord injury is critical to provide appropriate information for clients and make the best treatment choices. Acute intervertebral disc extrusions (IVDE) are a common cause of pain and paralysis in dogs with several types of IVDE occurring. Important prognostic considerations are recovery of ambulation, return of urinary and fecal continence, resolution of pain and, on the negative side, development of progressive myelomalacia. Initial injury severity affects prognosis as does type of IVDE, particularly when considering recovery of continence. Overall, loss of deep pain perception signals a worse outcome. When considering Hansen type 1 IVDE, the prognosis is altered by the choice of surgical vs. medical therapy. Concentration of structural proteins in the plasma, as well as inflammatory mediators, creatine kinase, and myelin basic protein in the cerebrospinal fluid (CSF) can provide additional prognostic information. Finally, cross-sectional area and length of T2 hyperintensity and loss of HASTE signal on MRI have been associated with outcome. Future developments in plasma and imaging biomarkers will assist in accurate prognostication and optimization of patient management.
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Affiliation(s)
- Natasha J. Olby
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, NC, United States
| | - Ronaldo C. da Costa
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, United States
| | - Jon M. Levine
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, United States
| | - Veronika M. Stein
- Department for Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
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Granger N, Olby NJ, Nout-Lomas YS. Bladder and Bowel Management in Dogs With Spinal Cord Injury. Front Vet Sci 2020; 7:583342. [PMID: 33263015 PMCID: PMC7686579 DOI: 10.3389/fvets.2020.583342] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/22/2020] [Indexed: 11/13/2022] Open
Abstract
Spinal cord injury in companion dogs can lead to urinary and fecal incontinence or retention, depending on the severity, and localization of the lesion along the canine nervous system. The bladder and gastrointestinal dysfunction caused by lesions of the autonomic system can be difficult to recognize, interpret and are easily overlooked. Nevertheless, it is crucial to maintain a high degree of awareness of the impact of micturition and defecation disturbances on the animal's condition, welfare and on the owner. The management of these disabilities is all the more challenging that the autonomic nervous system physiology is a complex topic. In this review, we propose to briefly remind the reader the physiology of micturition and defecation in dogs. We then present the bladder and gastrointestinal clinical signs associated with sacral lesions (i.e., the L7-S3 spinal cord segments and nerves) and supra-sacral lesions (i.e., cranial to the L7 spinal cord segment), largely in the context of intervertebral disc herniation. We summarize what is known about the natural recovery of urinary and fecal continence in dogs after spinal cord injury. In particular we review the incidence of urinary tract infection after injury. We finally explore the past and recent literature describing management of urinary and fecal dysfunction in the acute and chronic phase of spinal cord injury. This comprises medical therapies but importantly a number of surgical options, some known for decades such as sacral nerve stimulation, that might spark some interest in the field of spinal cord injury in companion dogs.
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Affiliation(s)
- Nicolas Granger
- The Royal Veterinary College, University of London, Hertfordshire, United Kingdom.,CVS Referrals, Bristol Veterinary Specialists at Highcroft, Bristol, United Kingdom
| | - Natasha J Olby
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, NC, United States
| | - Yvette S Nout-Lomas
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, United States
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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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