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Carballo O, Frederick SW, Keys DA, Moore SA, Giles JT. Preliminary evaluation of a novel method for computed tomography quantification of lumbosacral articular process displacement in dogs with and without degenerative lumbosacral stenosis. Front Vet Sci 2024; 11:1436299. [PMID: 39166171 PMCID: PMC11334160 DOI: 10.3389/fvets.2024.1436299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 07/16/2024] [Indexed: 08/22/2024] Open
Abstract
Objective This study aimed to describe the diagnostic discrimination and reliability of a novel technique for quantifying lumbosacral articular process displacement (LSAPD) on dorsal plane computed tomography (DPCT) imaging in dogs with and without degenerative lumbosacral stenosis (DLSS). Study design DPCT surveys of the lumbosacral vertebral column were performed with dogs positioned in extension and flexion. LSAPD is defined as the distance between the cranial aspects of the L7 and S1 articular processes. The LSAPD ratio is identified by dividing the LSAPD by the length of the L7 articular process. Intraclass correlation coefficients (ICCs) for intra- and inter-observer reliability were calculated, and logistic regressions were used to test for the association of LSAPD and LSAPD ratio with odds of DLSS. Significance was set at 0.05. Receiver operator characteristic (ROC) curves were calculated to determine diagnostic discrimination and optimal cutoff for LSAPD and LSAPD ratio in the diagnosis of DLSS. Results Intra- and inter-observer reliabilities were excellent for most measurements. In the current cohort, excluding covariates, the area under the curve (AUC) (95%CI) for LSAPD and LSAPD ratio measured in a flexed position were both 0.89 (0.82-0.96), suggesting potentially excellent discrimination for using this measurement as a marker for diagnosing DLSS, pending further studies. The cutoffs for flexed LSAPD and LSAPD ratio that maximizes Youden's index were ≥ 1.2 mm and ≥ 9%, respectively. When age and weight were subsequently included as covariates in a multivariable analysis, a significant relationship between LSAPD or LSAPD ratio and odds of diagnosis of DLSS was not demonstrated, suggesting the need for a larger sample size. Conclusion The results of this study suggest that measurements of LSAPD and LSAPD ratio on DPCT are feasible and reliable, although their diagnostic discrimination in DLSS should be evaluated further in future prospective studies.
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Paulus C, Brinkmeier HS, Jährig RA, Schaub KI, Büttner K, Kramer M, von Pückler K. [Long-term examinations of the lumbal disc and facet joint changes in 5 German Shepard dogs]. TIERARZTLICHE PRAXIS. AUSGABE K, KLEINTIERE/HEIMTIERE 2022; 50:400-410. [PMID: 36516841 DOI: 10.1055/a-1967-9782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECT AND PURPOSE The purpose of this first-time long-term observational study was to evaluate the changes of the caudal lumbar spine at the locations L5/6, L6/7, and L7/S1 in 5 German shepherd dogs over a 6-year time period using computed tomography (CT) and magnetic resonance imaging (MRI). The dogs had a mean age of 26 months at the time of the first examination. In addition, it was evaluated whether a breeding examination, with regard to disc degeneration, is justified in young dog. MATERIAL AND METHODS The locations L7/S1, L6/7, and L5/6 were examined in more detail with regard to their signal intensity changes, the facet joint angle changes in dorsal (dors) and transverse (trans) planes, and disc surface changes in sagittal (sag) and transverse (trans) reconstruction planes with CT and MRT in 2015 and 2021. All data were collected computer-based and analyzed statistically. Subsequently, the results were compared to the measured signal intensity and to the subjective disc degeneration grading according to Seiler used in practice. RESULTS Over the period of 6 years a significant loss of the measured signal intensity of the intervertebral discs in the transverse plane and an overall facet joint widening in the transverse plane of 0.54° as well as in the dorsal plane of 1.8° was evident. In addition, there was no evidence of a relationship between the size of the facet joint angle and the degree of disc degeneration. Furthermore, regardless of the initial degree of degeneration, the discs showed low signal intensity and higher Seiler grade during follow-up. CONCLUSION AND CLINICAL RELEVANCE The results of the present study group indicate that an inconspicuous condition of the lumbar intervertebral discs at the time of the initial breeding examination in the young dog does not allow an accurate prediction of the subsequent degree of degeneration and that there are ongoing remodeling processes at the facet joints even in healthy German shepherd dogs.
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Affiliation(s)
- Christiane Paulus
- Klinik für Kleintiere - Chirurgie der Justus-Liebig-Universität Gießen
| | | | | | | | - Kathrin Büttner
- AG Biomathematik und Datenverarbeitung der Justus-Liebig-Universität Gießen
| | - Martin Kramer
- Klinik für Kleintiere - Chirurgie der Justus-Liebig-Universität Gießen
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Lampe R, Foss KD, Hague DW, Oliveira CR, Smith R. Dynamic MRI is reliable for evaluation of the lumbosacral spine in healthy dogs. Vet Radiol Ultrasound 2020; 61:555-565. [PMID: 32574428 DOI: 10.1111/vru.12891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 03/31/2020] [Accepted: 04/02/2020] [Indexed: 11/29/2022] Open
Abstract
Magnetic resonance imaging (MRI) is commonly used to diagnose degenerative lumbosacral stenosis; however, studies show limited correlation between imaging and clinical signs. The purpose of this prospective observer agreement study was to use dynamic MRI of the lumbosacral (LS) spine of healthy dogs to determine reliable reference ranges. Twenty-two healthy large breed dogs were prospectively enrolled. MRI of the LS spine was performed in T2-weighted, T1-weighted, and T2-weighted SPACE sequences in neutral, flexed, and extended positions. Four observers performed image analyses. Measurements included LS angle, vertebral canal height and area, and LS foraminal areas. Ordinal categorical assessment of loss of fat signal in the foramina, LS compression, intervertebral disc (IVD) degeneration, spondylosis, and IVD protrusion was also performed. The majority of values were significantly larger in flexion versus neutral position, and significantly smaller in extension versus neutral position (P < .05). Subclinical compression and IVD protrusion was noted in a neutral position in 45% and 55% of dogs and in an extended position in 85% and 73% of dogs, respectively. Interobserver agreement was strong (intracluster correlation coefficient [ICC] > .5) except for the L7:LS vertebral canal area ratio (ICC ≤ .03). Intraobserver agreement was high (rho > .5) for all measurements except for the mid-L6:LS vertebral canal height ratio (rho = .38). There was poor interobserver agreement for loss of fat signal in the foramina and evidence of compression. This study provides the groundwork for future studies using dynamic MRI to evaluate dogs with signs of clinical LS disease.
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Affiliation(s)
- Rachel Lampe
- Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Kari D Foss
- Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Devon W Hague
- Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Cintia R Oliveira
- Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Rebecca Smith
- Department of Veterinary, Pathobiology, University of Illinois at Urbana-Champaign, Urbana, Illinois
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Smolders LA, Knell SC, Park B, Pozzi A, Meij BP, Steffen F. The effects of foraminotomy and intervertebral distraction on the volume of the lumbosacral intervertebral neurovascular foramen: An ex vivo study. Vet J 2020; 256:105435. [PMID: 32113586 DOI: 10.1016/j.tvjl.2020.105435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 01/26/2020] [Accepted: 01/27/2020] [Indexed: 10/25/2022]
Abstract
Degenerative lumbosacral stenosis in dogs frequently involves L7-S1 foraminal stenosis and L7 nerve root compression. Surgical techniques to decompress the L7 nerve root include foraminotomy and intervertebral distraction. The objective of this study was to compare the effect of foraminotomy and intervertebral distraction on the total, cranial, and caudal compartmental volumes of the L7-S1 intervertebral neurovascular foramen (NF). CT images were obtained from eight canine lumbosacral (L5-CD1) specimens in the following sequential conditions: native spine (1), after dorsal laminectomy and partial discectomy of L7-S1 (2), after L7-S1 foraminotomy (3), after distraction with an interbody cage between L7 and S1 (4), after cage distraction stabilized with pedicle screw-rod fixation in neutral (5) and flexed position (6). The volume of the complete NF and its cranial and caudal subcompartments were calculated using the CT images and statistically compared between conditions. P < 0.05 was considered statistically significant. The volume of the complete NF was significantly increased after foraminotomy (mean ± standard deviation (146.8 ± 26.5%, P < 0.01) and after distraction (Condition 4, 121.0 ± 19.1%; Condition 5, 116.6 ± 29.3 %; Condition 6, 119.0 ± 21.8 %; P = 0.01) with no difference between the distraction conditions. Foraminotomy induced a significantly larger increase in total NF volume compared to distraction. Foraminotomy, but not distraction, induced a significant increase in volume of the cranial subcompartment (158.2 ± 33.2 %; P < 0.01). Foraminotomy is more effective in increasing the foraminal volume and especially the cranial subcompartment, which is where the L7 nerve root traverses the NF. Hence, foraminotomy may be more effective in decompressing the L7 nerve root.
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Affiliation(s)
- L A Smolders
- Clinic for Small Animal Surgery, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057, Zurich, Switzerland.
| | - S C Knell
- Clinic for Small Animal Surgery, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057, Zurich, Switzerland
| | - B Park
- Clinic for Small Animal Surgery, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057, Zurich, Switzerland
| | - A Pozzi
- Clinic for Small Animal Surgery, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057, Zurich, Switzerland
| | - B P Meij
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM, Utrecht, The Netherlands
| | - F Steffen
- Clinic for Small Animal Surgery, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057, Zurich, Switzerland
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Worth A, Meij B, Jeffery N. Canine Degenerative Lumbosacral Stenosis: Prevalence, Impact And Management Strategies. VETERINARY MEDICINE (AUCKLAND, N.Z.) 2019; 10:169-183. [PMID: 31819860 PMCID: PMC6875490 DOI: 10.2147/vmrr.s180448] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 10/10/2019] [Indexed: 01/22/2023]
Abstract
Canine degenerative lumbosacral stenosis (DLSS) is a syndrome of low back pain with or without neurologic dysfunction associated with compression of the cauda equina. Most commonly occurring in medium- to large-breed dogs of middle to older age, German shepherd and working dogs are predisposed. Diagnosis is based on a combination of clinical signs, advanced imaging and ruling out other differential diagnoses. The volume of the intervertebral foramina at the lumbosacral junction is naturally reduced on extension but degenerative changes lead to a more marked reduction that can impinge the L7 nerve roots. Evidence is lacking on which to base decision-making for treatment of dogs with DLSS. However, surgical intervention may be indicated in dogs that do not respond to conservative management, or for dogs in which there is a requirement to work that prevents lifestyle adjustments. Improvements in electrodiagnosis and novel intra-discal treatments may improve the management of DLSS in the future.
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Affiliation(s)
- Andrew Worth
- Massey University Veterinary Teaching Hospital, School of Veterinary Science, Massey University, Palmerston North4442, New Zealand
| | - Björn Meij
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht3508 TD, The Netherlands
| | - Nicholas Jeffery
- Texas A&M Veterinary Medical Teaching Hospital, College Station, TX77845, USA
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Harcourt-Brown TR, Granger NP, Fitzpatrick N, Jeffery ND. Electrodiagnostic findings in dogs with apparently painful lumbosacral foraminal stenosis. J Vet Intern Med 2019; 33:2167-2174. [PMID: 31381186 PMCID: PMC6766485 DOI: 10.1111/jvim.15589] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 07/24/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Development of management strategies for lumbosacral stenosis in dogs is hampered by the lack of objective diagnostic criteria and outcome measures. OBJECTIVE To explore the suitability of electrodiagnostic tests as ancillary diagnostic aids, inclusion criteria, or outcome measures. SAMPLE POPULATION Sixty-one client-owned dogs with clinical signs of lumbosacral foraminal stenosis. METHODS A blinded, cross-sectional cohort study. Fifty-one dogs exhibiting apparent lumbosacral pain or pelvic limb lameness with no detected orthopedic cause had blinded review of magnetic resonance imaging (MRI), allowing classification as affected with foraminal stenosis (25 dogs), unaffected (20 dogs), or another diagnosis (6 dogs). The presence of electromyographic changes and tibial neurography variables were compared between groups. RESULTS Cord dorsum potential onset latency, F-wave onset latency (both corrected for limb length), and F-ratio were increased in dogs with lumbosacral foraminal stenosis versus those without, although there was overlap of the values between groups. The proportion of dogs with electromyographic changes was not significantly greater in MRI-affected dogs. CONCLUSION Electrophysiological testing is a useful ancillary test, either to provide stricter inclusion criteria and outcome measures or to aid clinical decision-making in equivocal cases.
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Affiliation(s)
| | | | | | - Nicholas D Jeffery
- Department of Small Animal Clinical Sciences, Texas A&M University, College Station, Texas
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Jones JC, Kimmett KL, Sharp JL, Sanders SR, Wilmoth TA. CT measures of lumbosacral paraspinal muscle size are not correlated with CT measures of lumbosacral stability in military working Labrador Retrievers. Vet Radiol Ultrasound 2019; 60:513-524. [PMID: 31155806 DOI: 10.1111/vru.12775] [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: 06/17/2018] [Revised: 05/07/2019] [Accepted: 05/09/2019] [Indexed: 11/27/2022] Open
Abstract
Management of degenerative lumbosacral stenosis in military working dogs more frequently utilizes core conditioning exercise programs. Future research on the effectiveness of these programs may benefit from an improved understanding of relationships between paraspinal muscle size and lumbosacral stability. The aim of this retrospective, secondary analysis, cross-sectional study was to test the following hypotheses related to CT measures: (a) transverse paraspinal muscle area ratios differ between hip flexion and extension, (b) lumbosacral angle and lumbosacral range of motion differ by lumbosacral angle measurement technique, and (c) transverse paraspinal muscle area ratios are correlated with CT measures of lumbosacral stability (parasagittal and parasagittal oblique foraminal area changes) regardless of hip position and with lumbosacral range of motion within each hip position. Lumbosacral CT scans in hip flexion and extension were retrieved from a previous prospective study of military working Labrador Retrievers. A single observer performed triplicate measurements of transverse paraspinal muscle area ratios, parasagittal foraminal area, and parasagittal oblique foraminal area for each hip position and another observer independently performed triplicate measurements of lumbosacral angle and lumbosacral range of motion at L7-S1 using two published techniques. Thirty-nine dogs were analyzed and significant differences were identified between hip flexion and extension for all mean transverse paraspinal muscle area ratio values (P ≤ .05). Mean lumbosacral angles also significantly differed between the published techniques in both hip flexion and extension. When comparing mean lumbosacral range of motion values, one of the published techniques produced significantly smaller values. No significant correlation was found between transverse paraspinal muscle area ratios and parasagittal foraminal area changes, parasagittal oblique foraminal area changes, or lumbosacral range of motion. These results should be considered when designing studies using these CT measures in military working dogs.
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Affiliation(s)
- Jeryl C Jones
- Department of Animal and Veterinary Sciences, Poole Agricultural Center, Clemson University, Clemson, South Carolina
| | - Krystina L Kimmett
- Department of Animal and Veterinary Sciences, Poole Agricultural Center, Clemson University, Clemson, South Carolina
| | - Julia L Sharp
- Department of Statistics, Colorado State University, Fort Collins, Colarado
| | - Samantha R Sanders
- Department of Animal and Veterinary Sciences, Poole Agricultural Center, Clemson University, Clemson, South Carolina
| | - Tiffany A Wilmoth
- Department of Animal and Veterinary Sciences, Poole Agricultural Center, Clemson University, Clemson, South Carolina
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Harris G, Ball J, De Decker S. Lumbosacral transitional vertebrae in cats and its relationship to lumbosacral vertebral canal stenosis. J Feline Med Surg 2019; 21:286-292. [PMID: 29788831 PMCID: PMC10814640 DOI: 10.1177/1098612x18774449] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
OBJECTIVES Although a clear relationship has been demonstrated between the presence of lumbosacral transitional vertebrae and the development of lumbosacral stenosis in dogs, this relationship has not been evaluated in cats. The aim of this study was to investigate the relationship between the presence of lumbosacral transitional vertebrae and lumbosacral stenosis in cats. METHODS The medical records and diagnostic imaging studies of 13 cats diagnosed with lumbosacral stenosis were retrospectively reviewed for lumbosacral abnormalities and compared with findings of 405 cats that underwent CT for reasons unrelated to spinal disease. RESULTS Clinical signs associated with lumbosacral stenosis included lumbosacral pain, low tail carriage, difficulty jumping, and urinary or faecal incontinence. Neurological signs included proprioceptive deficits, ambulatory paraparesis, pelvic limb ataxia, reduced spinal reflexes and reduced perianal reflex. Duration of clinical signs ranged from 1 day to 10 months (mean 3 months). Of the 13 cats with lumbosacral stenosis, seven (53.8%) were diagnosed with lumbosacral transitional vertebrae. In the control population of 405 cats, 24 (5.9%) were diagnosed with lumbosacral transitional vertebrae. Results indicated that lumbosacral transitional vertebrae were significantly ( P <0.0001) more prevalent in cats with lumbosacral stenosis compared with the control feline population (odds ratio 18.52, 95% confidence interval 6.1-62.1). Development of clinical signs of lumbosacral stenosis in cats with lumbosacral transitional vertebrae (mean 10.8 years) was not significantly different from that of cats without lumbosacral transitional vertebrae (mean 12.7 years). Likewise, there was no significant influence of breed ( P >0.99) or sex ( P = 0.29) on the occurrence of lumbosacral transitional vertebrae. CONCLUSIONS AND RELEVANCE Despite lumbosacral stenosis being a rare spinal condition in cats, lumbosacral transitional vertebrae can be considered a risk factor for its development.
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Affiliation(s)
- Georgina Harris
- Department of Veterinary Medicine, Cambridge University, Cambridge, UK
| | - Jessica Ball
- Department of Clinical Science and Services, The Royal Veterinary College, Hatfield, UK
| | - Steven De Decker
- Department of Clinical Science and Services, The Royal Veterinary College, Hatfield, UK
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Affiliation(s)
- S. J. Dyson
- Centre for Equine Studies Animal Health Trust Newmarket, Suffolk UK
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