TRAUMATIC SUBARACHNOID-PLEURAL FISTULA IN A DOG

Subarachnoid-pleural fistula is a rare occurrence in humans as a result of trauma or spinal surgery. Such fistulas commonly remain undiagnosed until sufficient cerebrospinal fluid accumulates in the pleural space to cause respiratory distress. We describe a subarachnoid-pleural fistula in a dog that occurred subsequent to blunt trauma sustained during a fall, with concurrent acute, traumatic intervertebral disc rupture. The extruded disc material penetrated the dura mater, allowing communication between the subarachnoid space and the extrapleural thoracic cavity. Radiographic, myelographic, and computed tomographic (CT) findings are reviewed. Abnormalities noted during myelography included an intradural-extramedullary lesion at T11-T12, with epidural leakage of contrast medium from the region of T12 extending cranially. In images from myelography and CT there was extravasation of contrast medium extending from the subarachnoid and epidural space into the extrapleural thoracic cavity.     

CERVICAL VERTEBRAL FUSION AND CONCURRENT INTERVERTEBRAL DISC EXTRUSION IN FOUR DOGS

Cervical vertebral fusion was noted radiographically in four dogs presented for signs of cervical spinal cord compression. Ventral extradural spinal cord compression was seen on myelography at intervertebral disc spaces adjacent to the fused vertebrae in two dogs and at a site removed in two dogs. At surgery, no intervertebral disc space was found in the area of fusion. No other instances of cervical vertebral fusion were identified in reviewing radiographs of 1225 other dogs with cervical intervertebral disc extrusion evaluated at our hospital. Clinical signs resolved in all dogs after surgical removal of extruded intervertebral disc material. Information from these four dogs suggest vertebral fusion may predispose adjacent discs to herniation.     

Acute non-ambulatory tetraparesis attributable to cranial cervical intervertebral disc disease in a cat

A 10-year-old domestic longhair cat was presented for acute non-ambulatory tetraparesis. Clinicopathologic diagnostics revealed no abnormalities. Cervical myelogram revealed an extradural compressive lesion consistent with intervertebral disc disease of the C2-C3 intervertebral disc space. Ventral slot decompression confirmed the presence of extruded intervertebral disc material into the vertebral canal of the C2-C3 intervertebral space. The patient succumbed to cardiorespiratory arrest 3 days postoperatively.     

Common difficulties with myelographic diagnosis of acute intervertebral disc prolapse in the dog

Surgical treatment of acute intervertebral disc prolapse (Hansen type 1) normally requires myelography to accurately localise the lesion. When performing or interpreting myelograms in dogs with this condition, a number of problems may arise that have not been emphasised by existing radiology texts. Technical problems include difficulties injecting the contrast medium, poor distribution of contrast medium and incorrect radiographic views; pathoanatomical problems include atypical displacement of disc material and spinal cord swelling. These problems, and ways of avoiding them, are described.     

Surgical treatments for intervertebral disc disease.

Surgical treatments for intervertebral disc disease are useful for animals with gradually progressive, severely acute, or recurrent lesions. Surgical patients require a diligent neuroradiographic evaluation to confirm location and severity of the discopathy and rule out conditions unrelated to disc disease. Although controversial, some surgeons advocate fenestration for recurrent pain or mild ataxia associated with a noncompressive lesion. Decompressive procedures are recommended for treatment and prognostication of compressive disc-associated myelopathy. Foraminotomy is reserved for patients with lateralizing extrusions confirmed with myelography or newer imaging modalities (CT, MRI). Future treatments for animals may include chemonucleolysis or various discectomy procedures currently performed in humans with symptomatic disc disease.     

CONTRAST ENHANCEMENT OF EXTRADURAL COMPRESSIVE MATERIAL ON MAGNETIC RESONANCE IMAGING

Gadolinium‐enhancement of compressive extradural material is detected occasionally with magnetic resonance (MR) imaging in dogs. Our goal was to characterize contrast enhancement of extradural compressive material associated with intervertebral disc herniation, and to evaluate the association between enhancement and histopathologic findings and the onset of clinical signs. Ninety‐three dogs with a total of 99 lesions diagnosed as intervertebral disc herniation on MR imaging were assessed. Images were evaluated for lesion location, type of herniation, degree of compression, intramedullary T2‐weighted (T2W) intensities, and contrast enhancement. In 23 dogs, surgically removed compressive material was evaluated histopathologically for hemorrhage, inflammation, neovascularization, fibroplasia, fibrosis, mineralization, necrosis, and chronicity. Contrast enhancement of extradural compressive material, meninges, and both the compressive materials and meninges was present in 51.5%, 39.4%, and 17.2% of lesions, respectively. Extradural enhancement occurred more frequently in extrusions than protrusions (P=0.001). Meningeal enhancement and more severe neurologic deficits were significantly associated with a shorter duration of clinical signs (P=0.04 and 0.01, respectively). Intramedullary T2W hyperintensities, present with 44.4% of lesions, were associated with more severe neurologic deficits (P=0.001). Lesions with extradural enhancement were more often considered subacute to chronic in duration and more frequently associated with hemorrhage compared with nonenhancing material; however, no statistically significant association was established between contrast enhancement and histopathologic findings. Contrast enhancement of extradural compressive material and the meninges was found to be common with intervertebral disc herniation, and should not be interpreted as a specific sign of a mass lesion such as neoplasia.     

Rupture of the dura mater in two dogs caused by the peracute extrusion of a cervical disc

A rupture of the dura mater caused by the peracute extrusion of a cervical disc was diagnosed by myelography in two dogs. In both cases traction on the cervical spine resulted in contrast medium entering the ruptured intervertebral disc from the subarachnoid space. Both dogs became suddenly tetraparetic and unable to ambulate during vigorous exercise, but regained the ability to walk without surgical treatment.     

IMAGING DIAGNOSIS—CT MYELOGRAPHY IN A DOG WITH INTRAMEDULLARY INTERVERTEBRAL DISC HERNIATION

A 5‐year‐old Chihuahua was examined for peracute pain and paraparesis. Neuroanatomic localization was consistent with a symmetric T3‐L3 myelopathy. Computed tomography (CT) of the T9‐L5 vertebrae was normal. Myelography disclosed attenuation of the subarachnoid space from T11 to L1, consistent with spinal cord swelling. CT following the myelogram disclosed a focal area of intramedullary iodinated contrast medium at T13‐L1. At surgery, intervertebral disc material was removed from the spinal cord. Based on the findings in this patient, intramedullary disc herniation should be considered a cause for focal intramedullary contrast medium accumulation.     

Lymphocytic ganglioneuritis secondary to intervertebral disc extrusion in a dog

This study presents a case of lymphocytic ganglioneuritis in a dog secondary to intervertebral disc extrusion that mimicked a peripheral nerve sheath tumour on magnetic resonance imaging. A four‐year‐old spayed female dachshund with lumbar pain was imaged via magnetic resonance. A tubular, space‐occupying, contrast‐enhancing lesion was noted in the right intervertebral foramen at L6 to L7. This was presumed to represent focal enlargement of the right sixth lumbar spinal nerve. A right‐sided haemilaminectomy was performed at L6 to L7 and material that grossly resembled extruded nucleus pulposus was removed. The right L6 dorsal root ganglion, dorsal nerve root and proximal spinal nerve were severely enlarged and a partial thickness biopsy was collected from the dorsal root ganglion. Results of histopathological examination of the submitted tissue samples were consistent with extruded disc material and lymphocytic ganglioneuritis. To the author's knowledge, this is the first published report of lymphocytic ganglioneuritis secondary to intervertebral disc disease in a dog.     

Incidence of seizures associated with iopamidol or iomeprol myelography in dogs with intervertebral disk disease: 161 cases (2000–2002)

Objective – To compare the incidence of seizures in dogs with intervertebral disk disease after iopamidol or iomeprol myelography, and to assess whether the incidence of seizures differed between the 2 agents when severity of neurological deficits, location of cord compression, duration of anesthesia, site of myelogram, volume of contrast, and concentration of contrast were evaluated. Design – Retrospective study. Setting – Veterinary teaching hospital. Animals – One hundred and sixty‐one client‐owned dogs with intervertebral disk disease. Interventions – Subarachnoid injection of contrast medium. Measurements and Main Results – One hundred and sixty‐one dogs with intervertebral disk disease were subjected to myelography using iopamidol (n=74) or iomeprol (n=87). Cranial myelography was performed in 31 dogs, caudal myelography in 125 and both cranial and caudal myelography in 5. Seizures occurred in 23 of 161 (14%) dogs. There was no significant difference overall between iopamidol and iomeprol myelography. However, in dogs with thoracolumbar disk extrusion and paraplegia, seizures occurred more frequently after caudal myelography using iopamidol compared with iomeprol. Conclusions – Both iomeprol and iopamidol are suitable for myelography in dogs. Iomeprol is recommended for caudal myelography in paraplegic dogs with thoracolumbar disk extrusion due to the higher incidence of seizures in this group when iopamidol was used.     

MYELOGRAPHY VS. COMPUTED TOMOGRAPHY IN THE EVALUATION OF ACUTE THORACOLUMBAR INTERVERTEBRAL DISK EXTRUSION IN CHONDRODYSTROPHIC DOGS

Myelography and/or computed tomography (CT) are commonly used to evaluate acute intervertebral disk extrusion in chondrodystrophic dogs. The purpose of this study was to evaluate the sensitivity of myelography and two different CT protocols in determining level and lateralization of acute thoracolumbar intervertebral disk extrusion in comparison with surgical findings, investigate interobserver variability, and determine examination duration times. Results of conventional CT, helical CT, and myelography were compared with surgical findings in 19 chondrodystrophic dogs with acute thoracolumbar intervertebral disk extrusion. Agreement among investigators was determined for different imaging modalities, and examination times were recorded. In the diagnosis of level of disk extrusion there was agreement of myelography, conventional CT, and helical CT with surgical findings in 94.7%, 100%, and 94.7% of dogs, respectively ( P =0.144). In the diagnosis of level and lateralization of disk extrusion there was agreement of myelography, conventional CT, and helical CT with surgical findings in 78.9%, 87.4%, and 85.3% of dogs, respectively ( P =0.328). Interobserver agreement was very good for all imaging modalities (myelography κ=0.87; conventional CT κ=0.86; helical CT κ=0.95). There were significant differences in median examination duration times between helical CT (4 min), conventional CT (8 min), and myelography (32 min) ( P <0.001). Both helical and conventional CT appear to be accurate for evaluation of acute thoracolumbar intervertebral disk extrusion in chondrodystrophic dogs and are faster to perform than myelography.     

CANINE CERVICAL DISCOGRAPHY

A technique was developed to perform cervical discography in dogs. The radiographic appearance of 70 normal canine cervical discograms was established. No clinical effects were detected when the contrast medium was injected into the discs. No abnormalities were found in subsequent pathologic examinations. In four dogs with cervical disc disease, dorsal and lateral ruptures of the annulus fibrosus were detected by discography. When combined with myelography, discography allowed differentiation between various causes of spinal compression at intervertebral spaces.     

Usefulness of myelography with multiple views in diagnosis of circumferential location of disc material in dogs with thoracolumber intervertebral disc herniation

The usefulness of myelography with multiple views (lateral, ventrodorsal, left and right oblique view) in the diagnosis of the exact circumferential location of herniated disc material around the spinal cord in 80 dogs diagnosed with thoracolumbar intervertebral disc herniation at surgery was assessed by comparison of clinical and surgical findings. The circumferential location of the compressing mass was diagnosed in 94% of dogs on myelography. The oblique view was of more benefit than the ventrodorsal view in diagnosing the circumferential distribution of the compressing mass. Only the oblique view contributed to a diagnosis of lateralization of the compressing mass in 45% of dogs. Fourteen percent of dogs had clinical lateralization contralateral to myelographic lateralization. The myelographic localization agreed with the surgical localization in 97% of dogs with regard to the exact location of herniated disc material. The presence of clinical lateralization contralateral to myelographic lateralization and a high proportion of agreement of myelographic and surgical localization documents that myelography with multiple views is useful and essential to accurately determine the circumferential location of disc material around the spinal cord.     

THORACOLUMBAR INTRADURAL DISC HERNIATION IN EIGHT DOGS: CLINICAL,LOW‐FIELD MAGNETIC RESONANCE IMAGING,AND COMPUTED TOMOGRAPHIC MYELOGRAPHY FINDINGS

Intradural disc herniation is a rarely reported cause of neurologic deficits in dogs and few published studies have described comparative imaging characteristics. The purpose of this retrospective cross sectional study was to describe clinical and imaging findings in a group of dogs with confirmed thoracolumbar intradural disc herniation. Included dogs were referred to one of four clinics, had acute mono/paraparesis or paraplegia, had low field magnetic resonance imaging (MRI) and/or computed tomographic myelography, and were diagnosed with thoracolumbar intradural disc herniation during surgery. Eight dogs met inclusion criteria. The prevalence of thoracolumbar intradural disc herniation amongst the total population of dogs that developed a thoracolumbar intervertebral disc herniation and that were treated with a surgical procedure was 0.5%. Five dogs were examined using low‐field MRI. Lesions that were suspected to be intervertebral disc herniations were observed; however, there were no specific findings indicating that the nucleus pulposus had penetrated into the subarachnoid space or into the spinal cord parenchyma. Thus, the dogs were misdiagnosed as having a conventional intervertebral disc herniation. An intradural extramedullary disc herniation (three cases) or intramedullary disc herniation (two cases) was confirmed during surgery. By using computed tomographic myelography (CTM) for the remaining three dogs, an intradural extramedullary mass surrounded by an accumulation of contrast medium was observed and confirmed during surgery. Findings from this small sample of eight dogs indicated that CTM may be more sensitive for diagnosing canine thoracolumbar intradural disc herniation than low‐field MRI.     

METRIZAMIDE MYELOGRAPHY OF THE EQUINE CERVICAL SPINE

Case histories of 14 horses with pelvic limb ataxia requiring myelography were reviewed. Because differential diagnosis requires radiography, comparisons of lesion location, radiographic techniques, and lesion patterns were studied. Survey radiography and myelography were performed under general anesthesia, with recumbent-lateral and flexed-lateral views of the carnial and caudal cervical spine. Metrizamide was the myelographic contrast medium. Assessment of radiography as a diagnostic aid for cervical vertebral instability and cervical stenotic myelopathy was made through the comparison of survey radiographs and myleograms, in nonflexed and flexed positions, using these criteria: width of dorsal and ventral columns of contrast medium, compression of intervertebral disc spaces, presence or absence of bone proliferation at articular facets, remodeling secondary to vertebral instability. Radiography was an adequate diagnostic aid for cervical vertebral instability and cervical stenotic myelopathy. Distribution of lesions showed C_3–4 most common, with C_2–3 and C_4–5 following.     

THE RADIOLOGICAL DIAGNOSIS OF THORACOLUMBAR DISC DISEASE IN THE DACHSHUND

The accuracy of survey radiographs in the diagnosis of acute thoracolumbar disc disease in 36 Dachshunds was determined by comparison with lumbar myelographic findings using iohexol. The value of making radiographs immediately after injection of contrast medium and the effectiveness of oblique radiographs in determining the exact circumferential distribution of extruding or protruding disc material were assessed. The presence of a double contrast medium column, resistance to injection and the presence of cerebrospinal fluid flow during needle placement was also evaluated. The location of the affected disc was accurately determined on survey radiographs in only 26 dogs. The myelographic technique used in this study resulted in the correct intervertebral space being identified, together with the exact circumferential distribution of disc material, in 35 dogs. Survey radiographs alone are inadequate for localization of protruding or extruding disc material.     

THE COMPUTED TOMOGRAPHIC APPEARANCE OF ACUTE THORACOLUMBAR INTERVERTEBRAL DISC HERNIATIONS IN DOGS

The appearance of herniated intervertebral disc material in the thoracolumbar vertebral canal was evaluated in 23 dogs using computed tomography (CT). The images were then compared with the myelographic and surgical findings. The normal spinal cord, outlined by epidural fat over intervertebral disc spaces, was of intermediate attenuation on transverse CT images. Herniated disc material was identified in all animals as a heterogeneous hyperattenuating extradural mass. The attenuation of the disc material increased with the degree of mineralization. In seven dogs, the herniated material was only slightly more attenuating than the spinal cord. In these dogs, small fragments of mineralized disc material and significant hemorrhage were found in the epidural space at surgery. In dogs with a long standing history of disc herniations, disc material identified in the vertebral canal had a more hyperattenuating and homogeneous appearance than recently herniated disc material. We conclude that mineralized, herniated disc material and hemorrhage can be identified quickly and safely in dogs using CT.     

Intervertebral disc extrusion in six cats

Existing reports concerning intervertebral disc disease (IVDD) have focused almost exclusively on dogs, although a small number of individual case reports of IVDD of cats has been published. The medical records of six cats with IVDD were reviewed. Radiographic studies confirmed narrowed intervertebral disc spaces, mineralised intervertebral discs, and one or more extradural compressive lesions of the spinal cord in each cat. All disc extrusions were located in the thoracolumbar region. Surgical decompression of the spinal cord was achieved in all cats by means of hemilaminectomy and removal of compressive extradural material confirmed to be degenerative disc material. Good to excellent neurological recovery was noted in five of the six cats included in this report. Based on this review, it appears that IVDD of cats has many similarities to IVDD of dogs, and that healthy cats with acute intervertebral disc extrusion(s) respond favourably to surgical decompression of the spinal cord.     

A comparison of hemilaminectomy (with concomitant disc fenestration) and dorsal laminectomy for the treatment of thoracolumbar disc protrusion in dogs.

The techniques of hemilaminectomy (with concomitant disc fenestration) and dorsal laminectomy were compared statistically in two groups of 30 dogs with thoracolumbar disc disease. On presentation all the dogs were unable to walk and were graded 1 to 3 according to their degree of neurological dysfunction. Nineteen had a previous history of thoracolumbar pain or hindlimb paresis. Radiography showed a narrowed disc space or extruded calcified disc material in 52 of the dogs and lumbar myelography revealed an extradural mass in 57; 24 of the dogs had clinical or myelographic lateralisation of signs. Hemilaminectomy significantly improved the ability to retrieve protruded disc material compared with dorsal laminectomy, and the removal of protruded disc material significantly improved the degree of recovery. Fenestration significantly reduced the recurrence of thoracolumbar disc disease.     

The difference of contrast effects of myelography in normal dogs: comparison of iohexol (180 mgI/ml), iohexol (240 mgI/ml) and iotrolan (240 mgI/ml)

The contrast effects of three different contrast media preparations (iohexol 180 mgI/ml, iohexol 240 mgI/ml and iotrolan 240 mgI/ml) in conventional and CT myelography were compared. Three beagle dogs were used and the study employed a cross-over method (total of 9) for each contrast media. The result of CT myelography showed that the contrast effect of iohexol (180 mgI/ml), which had low viscosity, was highest in cranial sites, and the contrast effect of high-viscosity iotrolan (240 mgI/ml) was highest in caudal sites 5 min after injection of the contrast media preparations. This shows that the diffusion of contrast media preparations in the subarachnoid space is influenced by viscosity. The results of conventional myelography also showed that the diffusion of contrast media preparations is influenced by viscosity. Therefore, it is important to identify the location of spinal lesions in veterinary practice, and low viscosity contrast medium preparation with wide spread contrast effects is considered suitable for myelography.