1
|
Alcoverro E, Schofield I, Spinillo S, Tauro A, Ruggeri M, Lowrie M, Gomes SA. Thoracolumbar hydrated nucleus pulposus extrusion and intervertebral disc extrusion in dogs: Comparison of clinical presentation and magnetic resonance imaging findings. Vet J 2024; 306:106178. [PMID: 38906413 DOI: 10.1016/j.tvjl.2024.106178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 05/29/2024] [Accepted: 06/13/2024] [Indexed: 06/23/2024]
Abstract
Thoracolumbar hydrated nucleus pulposus extrusion (TL-HNPE) is an increasingly recognised pathology with a substantial lack of literature describing its features. The aim of this retrospective case-control study was to analyse the clinical and magnetic resonance imaging (MRI) features of dogs with TL-HNPE compared to dogs affected with thoracolumbar intervertebral disc extrusion (TL-IVDE). Data from dogs diagnosed with TL-HNPE and TL-IVDE via MRI at two referral hospitals, were retrospectively collected and compared in terms of clinical signs and MRI features. Cases diagnosed with TL-IVDE were deemed controls. The MRI features of the affected IVD space, herniated IVD material, affected overlying spinal cord and local epaxial musculature were evaluated for each group. Fifty-one cases with TL-HNPE and 105 randomly selected cases of TL-IVDE were included. Several signalment and neurological signs were identified as statistically distinct between groups in univariate analysis. Multivariate analysis identified that dogs affected with TL-HNPE were typically older, less likely to be chondrodystrophic (62.2 % vs. 91 %), more frequently experiencing a peracute onset (90.2 % vs. 61.9 %) often attributed to a suspected trauma linked with exercise (37.3 % vs. 10.5 %), being less frequently progressive (41.2 % vs. 86.5 %) and with herniated disc material less frequently lateralised (72.6 % vs. 89.5 %) than cases with TL-IVDE. MRI-identifiable intervertebral disc degeneration was found in every TL-IVDE case but only in 60 % of TL-HNPE cases. TL-HNPEs were associated to significantly less spinal cord compression and less hyperalgesia than TL-IVDE.
Collapse
Affiliation(s)
- E Alcoverro
- ChesterGates Veterinary Specialists, Chester, Cheshire CH1 6LT, UK; Anicura Ars Veterinària Hospital Veterinari, Barcelona, Catalonia 08340, Spain.
| | | | - S Spinillo
- ChesterGates Veterinary Specialists, Chester, Cheshire CH1 6LT, UK
| | - A Tauro
- ChesterGates Veterinary Specialists, Chester, Cheshire CH1 6LT, UK; Department of Clinical Sciences, College of Veterinary Medicine, NC State University, Raleigh, NC 27606, USA
| | - M Ruggeri
- ChesterGates Veterinary Specialists, Chester, Cheshire CH1 6LT, UK; Department of Clinical Sciences, College of Veterinary Medicine, NC State University, Raleigh, NC 27606, USA
| | - M Lowrie
- Dovecote Veterinary Hospital, Castle Donington, Derbyshire DE74 2LJ, UK; Movement Referrals: Independent Veterinary Specialists, Preston Brook, Cheshire WA7 3GH, UK
| | - S A Gomes
- Dovecote Veterinary Hospital, Castle Donington, Derbyshire DE74 2LJ, UK
| |
Collapse
|
2
|
Farré Mariné A, López Beltran M, Ortiz Nisa S, Luján Feliu-Pascual A. Myelo-CT imaging findings in 15 dogs with surgically-treated cervical acute compressive hydrated nucleus pulposus extrusion. Vet Radiol Ultrasound 2024; 65:187-192. [PMID: 38349181 DOI: 10.1111/vru.13331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 11/30/2023] [Accepted: 12/28/2023] [Indexed: 05/12/2024] Open
Abstract
Compressive hydrated nucleus pulposus extrusion (HNPE) is a sudden extrusion of hydrated, nondegenerated nucleus pulposus material with well-known characteristic MRI findings. The appearance of compressive HNPE during contrast-enhanced CT has already been described, but never its myelo-CT characteristics. The aim of this retrospective multicenter case series is to describe the myelo-CT findings in 15 dogs with compressive HNPE confirmed with gross surgical findings. A distinctive and consistent myelo-CT appearance of cervical compressive HNPE in dogs that included a focal extradural "seagull"-shaped extradural compression dorsal to the annulus fibrosus combined with a narrowing of the affected intervertebral disc space was found. The extruded material was hypoattenuating in the soft tissue algorithm. Myelo-CT could be a useful diagnostic tool and influence the clinical decision to address cervical compressive HNPE conservatively or surgically when MRI is not available.
Collapse
Affiliation(s)
| | | | - Sonia Ortiz Nisa
- Hospital Veterinario Universidad Católica de Valencia (UCV), Valencia, Spain
| | | |
Collapse
|
3
|
Kornmayer M, Fiedler S, Rosati M, Meyer‐Lindenberg A. Compressive hydrated nucleus pulposus extrusion in a dog. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Matthias Kornmayer
- Clinic of Small Animal Surgery and Reproduction, Centre of Clinical Veterinary Science Ludwig‐Maximilians‐University Munich Germany
| | - Sonja Fiedler
- Section of Clinical & Comparative Neuropathology, Institute for Veterinary Pathology, Centre for Clinical Veterinary Medicine Ludwig‐Maximilians‐University Germany
| | - Marco Rosati
- Section of Clinical & Comparative Neuropathology, Institute for Veterinary Pathology, Centre for Clinical Veterinary Medicine Ludwig‐Maximilians‐University Germany
| | - Andrea Meyer‐Lindenberg
- Clinic of Small Animal Surgery and Reproduction, Centre of Clinical Veterinary Science Ludwig‐Maximilians‐University Munich Germany
| |
Collapse
|
4
|
Kristiansen KV, Schmökel H, Vermeire S. Hydrated Nucleus Pulposus Extrusion in Dogs: Thoracolumbar Compared to Cervical Cases. Vet Comp Orthop Traumatol 2022; 35:152-156. [PMID: 35008122 DOI: 10.1055/s-0041-1740608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of this study was to review and describe cases of thoracolumbar (TL) hydrated nucleus pulposus extrusion (HNPE) diagnosed with magnetic resonance imaging and surgery, and compare them to cases of cervical (C) HNPE. STUDY DESIGN Retrospective, single-center study. RESULTS Thirty-six dogs met the inclusion criteria. Fifteen cases were C and 21 TL. Thirteen dogs were chondrodystrophic breeds, mean body weight was 13 kg, median age was 7.5 years, and 30/36 were male. Fewer dogs were chondrodystrophic in the C group compared with the TL group (p = 0.022). More than 90% had an acute onset, and strong activity was more often reported in the TL group. TL HNPE was more often painful, and extruded disc material more often lateralized (p = 0.017). Median Modified Frankel Score at presentation was 3 and 72.2% were non-ambulatory. More TL HNPE (11/21) were treated surgically compared with C HNPE (4/15). Treatment choice was correlated with spinal cord compression (p = 0.0075). Median Modified Frankel Score improved during hospitalization (p = 0.002) and there was no difference in outcome between C and TL HNPE or conservative and surgical treatment. Mean follow-up time was 33 days. All patients were ambulatory at follow-up. CONCLUSION This study suggests that the HNPE is not limited to the C vertebral column of dogs and can occur in the TL vertebral column as well. Dogs with TL HNPE show spinal hyperesthesia more often and extruded nucleus material is more often lateralized. Outcome is similar to what has previously been described for C HNPE.
Collapse
Affiliation(s)
- K V Kristiansen
- Spine Center and Radiology Department, Specialistdjursjukhuset, Strömsholm, Sweden
| | - H Schmökel
- Spine Center and Radiology Department, Specialistdjursjukhuset, Strömsholm, Sweden
| | - S Vermeire
- Spine Center and Radiology Department, Specialistdjursjukhuset, Strömsholm, Sweden
| |
Collapse
|
5
|
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.
Collapse
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
| | | |
Collapse
|
6
|
Nessler J, Flieshardt C, Tünsmeyer J, Dening R, Tipold A. Comparison of surgical and conservative treatment of hydrated nucleus pulposus extrusion in dogs. J Vet Intern Med 2018; 32:1989-1995. [PMID: 30267615 PMCID: PMC6271322 DOI: 10.1111/jvim.15304] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 05/23/2018] [Accepted: 07/24/2018] [Indexed: 11/30/2022] Open
Abstract
Background Whether compressive cervical myelopathy caused by hydrated nucleus pulposus extrusion (HNPE) in dogs should be treated surgically or conservatively has been debated. Only 1 recent study has contradicted the former predominant reports of surgical treatment for HNPE. Hypothesis and method Single center retrospective study to compare the outcome of client‐owned dogs with HNPE after decompressive surgery or conservative treatment. Animals Thirty‐six dogs diagnosed with HNPE confirmed by magnetic resonance imaging (MRI). Results Eighteen of 36 dogs underwent surgery whereas 18 dogs were managed conservatively including cage rest and physiotherapy. The most common affected intervertebral disc space was C4‐5. In 3 dogs, HNPE was diagnosed at the level of T13‐L1. Median time to regain ambulation was 6.6 days (range, 0‐28 days) after surgery and 5.9 days (range, 0‐15 days) with conservative management (P = .37). Only the length of a potential intramedullary lesion in cervical HNPE detected by MRI had an influence on the prognosis to gain ambulatory status in a time period of ≤9 days (P = .0035) and on short‐term survival (P = .0011). Conclusions and clinical importance Conservative management of HNPE in the cervical as well as in the thoracolumbar region represents a reasonable alternative to surgery, showing similar favorable outcome.
Collapse
Affiliation(s)
- Jasmin Nessler
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, Hannover, Germany
| | | | - Julia Tünsmeyer
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, Hannover, Germany
| | - Ricarda Dening
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, Hannover, Germany
| | - Andrea Tipold
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, Hannover, Germany
| |
Collapse
|
7
|
Ricciardi M, Campanella A, Grieco G, Zammit R. Usefulness of spinal unenhanced computed tomography and CT-myelography in the age of multidetector CT technology and magnetic resonance imaging - Preliminary considerations. Open Vet J 2018; 8:265-281. [PMID: 30148079 PMCID: PMC6102422 DOI: 10.4314/ovj.v8i3.6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 07/22/2018] [Indexed: 12/14/2022] Open
Abstract
Over the last decade, magnetic resonance imaging (MRI) and multidetector computed tomography (MDCT) have revolutionized diagnostic potential in small animal practice, providing adequate assessment of spinal diseases at levels comparable to that achieved in human radiology. T2-weighted MRI images are extremely sensitive to intramedullary parenchymal disorders, while balanced steady-state free precession sequences provide high-quality myelographic images of the spine without the need of intrathecal contrast medium administration. Multidetector computed tomography, with its near-isotropic spatial resolution and multiplanar reformatting of the acquired datasets, provides sufficient stratigraphic details of the spinal cord and the epidural space, facilitating the detection of compressive pathologies without the need of subarachnoid opacification. Nowadays, MDCT and low-field (LF) MRI have become fairly standard and available in academic institutions and private veterinary facilities, appearing to be valuable, complementary, and non-invasive diagnostic tools for imaging the spine. In this scenario, this clinical communication provides a series of preliminary observations that may help to reconsider the usefulness of CT-myelography in the light of its invasiveness and actual diagnostic advantages compared to MRI and unenhanced MDCT for the assessment of compressive and non-compressive spinal diseases in small animals.
Collapse
Affiliation(s)
- Mario Ricciardi
- Pingry Veterinary Hospital, Via Medaglie d'Oro 5, 70126 - Bari, Italy
| | - Angela Campanella
- Ospedale Veterinario Gregorio VII. Piazza di Villa Carpegna 52, 00165 - Roma, Italy
| | - Gloria Grieco
- Clinica Veterinaria Borghesiana, Via di Vermicino 96, 00133 - Roma, Italy
| | - Roberta Zammit
- Clinica Veterinaria Borghesiana, Via di Vermicino 96, 00133 - Roma, Italy
| |
Collapse
|
8
|
Borlace T, Gutierrez-Quintana R, Taylor-Brown FE, De Decker S. Comparison of medical and surgical treatment for acute cervical compressive hydrated nucleus pulposus extrusion in dogs. Vet Rec 2017; 181:625. [PMID: 28982782 DOI: 10.1136/vr.104528] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 07/13/2017] [Accepted: 09/04/2017] [Indexed: 11/03/2022]
Abstract
Although successful outcomes have been reported after medical and surgical treatment for dogs with cervical hydrated nucleus pulposus extrusion (HNPE), it is unknown which treatment option is preferred. Thirty-four dogs treated medically (n=18) or surgically (n=16) for cervical HNPE were retrospectively identified. Signalment, clinical presentation and imaging findings were compared between medically and surgically treated dogs. Medical management consisted of restricted exercise in combination with physiotherapy. Surgical treatment consisted of a ventral slot procedure. Short-term follow-up information was retrieved from re-examination visits. Long-term outcome was obtained via telephone interviews. More dogs in the surgical group demonstrated cervical hyperaesthesia on initial clinical presentation (P=0.045), otherwise there was no significant difference in signalment, clinical presentation or imaging findings between both groups. Two dogs in the medically managed group underwent surgical decompression due to an unsatisfactory response to medical management. All cases for which long-term information was available (n=30) were neurologically normal at the time of data collection. There were no significant differences for any of the short-term or long-term outcome variables between both treatment groups. This study demonstrated successful outcomes after medical or surgical treatment and suggests that both treatment modalities can be considered for dogs with cervical HNPE.
Collapse
Affiliation(s)
- Tana Borlace
- Department of Veterinary Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, UK
| | - Rodrigo Gutierrez-Quintana
- School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Frances Ellen Taylor-Brown
- Department of Veterinary Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, UK
| | - Steven De Decker
- Department of Veterinary Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, UK
| |
Collapse
|
9
|
De Decker S, Fenn J. Acute Herniation of Nondegenerate Nucleus Pulposus: Acute Noncompressive Nucleus Pulposus Extrusion and Compressive Hydrated Nucleus Pulposus Extrusion. Vet Clin North Am Small Anim Pract 2017; 48:95-109. [PMID: 28964544 DOI: 10.1016/j.cvsm.2017.08.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Acute herniation of nondegenerate nucleus pulposus material is an important and relative common cause of acute spinal cord dysfunction in dogs. Two types of herniation of nondegenerate or hydrated nucleus pulposus have been recognized: acute noncompressive nucleus pulposus extrusion (ANNPE) and acute compressive hydrated nucleus pulposus extrusion (HNPE). Spinal cord contusion plays an important role in the pathophysiology of both conditions. Sustained spinal cord compression is not present in ANNPE, whereas varying degrees of compression are present in HNPE. Although affected animals often present with severe neurologic signs, good outcomes can be achieved with appropriate treatment.
Collapse
Affiliation(s)
- Steven De Decker
- Department of Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, Hertfordshire, UK.
| | - Joe Fenn
- Department of Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, Hertfordshire, UK
| |
Collapse
|
10
|
Royaux E, Martlé V, Kromhout K, Van der Vekens E, Broeckx BJG, Van Ham L, Gielen I. Detection of compressive hydrated nucleus pulposus extrusion in dogs with multislice computed tomography. Vet J 2016; 216:202-6. [PMID: 27687953 DOI: 10.1016/j.tvjl.2016.08.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 07/19/2016] [Accepted: 08/23/2016] [Indexed: 11/28/2022]
Abstract
Compressive hydrated nucleus pulposus extrusion (HNPE) in dogs is defined as acute extradural compression by hydrated nucleus pulposus material at the level of the associated intervertebral disc. Magnetic resonance imaging (MRI) is the imaging modality of choice for diagnosis of HNPE. The aims of this study were to determine the usefulness of unenhanced computed tomography (CT) and contrast enhanced CT (CE-CT), and the sensitivity and specificity of CE-CT, for detection of compressive HNPE. Using CE-CT, HNPE was visualised as a hypodense extradural compressive lesion with rim enhancement immediately dorsal to the intervertebral disc space, with a sensitivity of 91% and a specificity of 100%. CE-CT is a useful technique to detect compressive HNPE in dogs. However, if no clear lesion is identified with CE-CT, or if additional information about intramedullary changes is required, MRI still needs to be performed.
Collapse
Affiliation(s)
- E Royaux
- Department of Small Animal Medicine and Clinical Biology, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, Merelbeke, Belgium.
| | - V Martlé
- Department of Small Animal Medicine and Clinical Biology, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, Merelbeke, Belgium
| | - K Kromhout
- Department of Veterinary Medical Imaging and Small Animal Orthopaedics, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, Merelbeke, Belgium
| | - E Van der Vekens
- Department of Veterinary Medical Imaging and Small Animal Orthopaedics, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, Merelbeke, Belgium
| | - B J G Broeckx
- Laboratory of Pharmaceutical Biotechnology, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, Ghent, Belgium
| | - L Van Ham
- Department of Small Animal Medicine and Clinical Biology, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, Merelbeke, Belgium
| | - I Gielen
- Department of Veterinary Medical Imaging and Small Animal Orthopaedics, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, Merelbeke, Belgium
| |
Collapse
|
11
|
da Costa RC, Cook LB. Cystic Abnormalities of the Spinal Cord and Vertebral Column. Vet Clin North Am Small Anim Pract 2015; 46:277-93. [PMID: 26706913 DOI: 10.1016/j.cvsm.2015.10.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
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.
Collapse
Affiliation(s)
- Ronaldo C da Costa
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210-1089, USA.
| | - Laurie B Cook
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210-1089, USA
| |
Collapse
|
12
|
Hydrated nucleus pulposus extrusion in dogs: correlation of magnetic resonance imaging and microsurgical findings. Acta Vet Scand 2015; 57:58. [PMID: 26407812 PMCID: PMC4583177 DOI: 10.1186/s13028-015-0151-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 09/16/2015] [Indexed: 11/11/2022] Open
Abstract
Background Magnetic resonance imaging (MRI) patterns of canine cervical hydrated nucleus pulposus extrusion (HNPE) have been described by a few reports, but the correlation between microsurgical and MRI features has never been investigated. The aim of this study was to compare the MRI features of HNPE with microsurgical findings and cytological outcomes and also to investigate the anatomical and pathophysiological aspects of the disease. Methods A prospective clinical study was conducted in 36 dogs suffering from HNPE. The diagnosis was based on high-field MRI findings of ventral extradural lesions, adjacent to the dorsal aspect of intervertebral discs, characterised by high signal intensity in T2-weighted sequences and hypointensity in T1-weighted sequences. MRI images were analysed with regard to the intervertebral space involved, the grading of spinal cord compression, the signal intensity and distribution of the material, and the thickness and signal intensity of the involved discs. All patients underwent microsurgical decompression and direct observations were recorded and films of the surgical procedure analysed. Results The majority of patients had acute onset of clinical signs (78 %), the patient did not exhibit signs of pain in 75 % of dogs and neurological deficits varied from slight tetraparesis (33 %) to tetraplegia (28 %). The localization of the extruded disc material was ventral relative to the dorsal longitudinal ligament that was lifted dorsally and appeared intact at the site of compression. Direct microsurgical observations of the HNPE sites showed that extruded disc material was collected within the fibres of the dorsal longitudinal ligament. The consistency was gelatinous in 42 %, water-like in 33 %, and lumpy liquid in 25 % of cases. Cytological samples did not detect the presence of inflammation, bacteria, fungi, neoplastic cells or foreign material. Conclusions Microsurgical features of HNPE suggest that the extruded disc is collected within the fibres of the dorsal longitudinal ligament and this may explain the typical MRI appearance of this disease. Further pathophysiological studies are needed to investigate why the cervical nucleus pulposus extrusion appears to occur without obvious trauma. Electronic supplementary material The online version of this article (doi:10.1186/s13028-015-0151-x) contains supplementary material, which is available to authorized users.
Collapse
|
13
|
Kang BJ, Jung Y, Park S, Lee K. Discal cysts of the cervical spine in two dogs. J Vet Sci 2015; 16:543-5. [PMID: 26040615 PMCID: PMC4701748 DOI: 10.4142/jvs.2015.16.4.543] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 04/22/2015] [Accepted: 04/30/2015] [Indexed: 11/20/2022] Open
Abstract
Discal cysts, which lie directly over intervertebral discs, are rare. Two old dogs with tetraparesis were referred to our facility. In both animals, magnetic resonance imaging revealed intraspinal extradural cystic mass lesions that were dorsal to degenerative intervertebral discs at the C3-C4 level. These lesions had low signal intensity on T1-weighted images, and high signal intensity on T2-weighted images. A ventral slot approach was used to perform surgical decompression, after which the symptoms improved remarkably. Discal cysts should be included in the differential diagnosis of dogs with cervical pain and tetraparesis. One effective treatment for discal cysts is surgical intervention.
Collapse
Affiliation(s)
- Byung-Jae Kang
- College of Veterinary Medicine, Kangwon National University, Chuncheon 24341, Korea
| | - Yechan Jung
- College of Veterinary Medicine, Chonbuk National University, Iksan 54596, Korea.,Office of Research Management, Korea University, Seoul 02841, Korea
| | - Sangjun Park
- College of Veterinary Medicine, Chonbuk National University, Iksan 54596, Korea
| | - Kichang Lee
- College of Veterinary Medicine, Chonbuk National University, Iksan 54596, Korea
| |
Collapse
|
14
|
Severity of spinal cord dysfunction and pain associated with hydrated nucleus pulposus extrusion in dogs. Vet Comp Orthop Traumatol 2014; 27:313-8. [PMID: 24992451 DOI: 10.3415/vcot-13-06-0076] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 05/08/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify the severity of neurological deficits, presence of signs of cervical pain, and the site of intervertebral disc space extrusion in 21 dogs diagnosed via magnetic resonance imaging (MRI) with a hydrated nucleus pulposus extrusion (HNPE) and compare those findings to dogs with other compressive cervical myelopathies. METHODS Medical records and MRI findings were reviewed in dogs that were presented to two veterinary hospitals between 2006 and 2012 and subsequently diagnosed by MRI to have a HNPE (n = 21) or other compressive cervical myelopathies originating from the intervertebral disc (n = 174). Information obtained included signalment, severity of neurological deficits, presence of signs of neck pain, and site of HNPE. The severity of clinical neurological spinal cord dysfunction was determined for each dog in both groups using the Frankel scoring system (0-4). The MRI were reviewed for confirmation of diagnosis and site of HNPE. An ANOVA was used to compare age between groups and a Mann-Whitney test for pairwise comparisons of the Frankel score between groups. Values of p <0.05 were considered statistically significant. RESULTS Significantly more severe Frankel scores and less severe signs of cervical pain detected on palpation were observed in dogs with a HNPE as compared to dogs with other compressive myelopathies. The sites of HNPE were C3-C4 (8/21), C4-C5 (12/21), and C5-C6 (1/21). CLINICAL SIGNIFICANCE Dogs affected with HNPE have more severe clinical neurological deficits and less severe signs of cervical pain as compared to dogs with other compressive cervical myelopathies.
Collapse
|
15
|
Lowrie ML, Platt SR, Garosi LS. Extramedullary spinal cysts in dogs. Vet Surg 2014; 43:650-62. [PMID: 24798122 DOI: 10.1111/j.1532-950x.2014.12200.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 03/01/2014] [Indexed: 12/19/2022]
Abstract
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.
Collapse
Affiliation(s)
- Mark L Lowrie
- Davies Veterinary Specialists, Higham Gobion, Hertfordshire, England
| | | | | |
Collapse
|
16
|
Beltran E, Dennis R, Doyle V, de Stefani A, Holloway A, de Risio L. Clinical and magnetic resonance imaging features of canine compressive cervical myelopathy with suspected hydrated nucleus pulposus extrusion. J Small Anim Pract 2012; 53:101-7. [PMID: 22250580 DOI: 10.1111/j.1748-5827.2011.01166.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe clinical and magnetic resonance imaging features in dogs with compressive cervical myelopathy due to acute suspected hydrated nucleus pulposus extrusion. DESIGN Retrospective case series. ANIMALS Ten dogs with compressive cervical myelopathy caused by acute suspected hydrated nucleus pulposus extrusion. MATERIALS AND METHODS Medical records and magnetic resonance images of dogs evaluated from 2005 through 2010 were reviewed. The inclusion criteria were clinical signs compatible with cervical myelopathy, magnetic resonance imaging of the spine performed within 48 hours after onset, magnetic resonance imaging findings consistent with compressive suspected hydrated nucleus pulposus extrusion, complete medical records and follow-up information. RESULTS Six dogs were presented with acute onset tetraplegia and four dogs with acute onset of nonambulatory tetraparesis. Compromised respiratory function was present in three dogs. Compressive suspected hydrated nucleus pulposus extrusion was found on magnetic resonance imaging at the C4-C5 (n=6), C3-C4 (n=3) and C5-C6 (n=1) intervertebral disc spaces. Seven dogs underwent surgical treatment and three dogs were treated conservatively. All dogs except one regained ambulatory status within two weeks after the onset, and had a favourable outcome. CLINICAL SIGNIFICANCE Compressive myelopathy caused by acute suspected hydrated nucleus pulposus extrusion has not been reported previously and, even though neurological deficits can be severe on presentation, outcome is favourable.
Collapse
Affiliation(s)
- E Beltran
- Department of Veterinary Neurology, The Animal Health Trust, Newmarket, Suffolk, UK
| | | | | | | | | | | |
Collapse
|