Intramedullary spinal cord damage associated with intervertebral disk material in a dog

Intervertebral disk extrusions into the spinal cord are rarely reported in veterinary medicine, and only necropsy findings are described in previous reports. It is hypothesized that a disk lesion results in forceful injection of disk material into the spinal cord. In the 3-year-old Miniature Doberman Pinscher of our report, acute clinical signs and results of magnetic resonance imaging were consistent with this disease and helped determine the extent and character of the lesions. Alteration in the appearance of the nucleus pulposus was important in determining that intervertebral disk disease may have been present in this dog. However, a definitive diagnosis of intramedullary disk extrusion can be made only via histologic examination of a biopsy specimen or at necropsy. The dog improved substantially after surgical decompression of the spinal cord, and histologic findings in a biopsy specimen of material found within the spinal cord were consistent with mature degenerate intervertebral disk material.     

Fibrocartilaginous embolic myelopathy in a calf.

A 5-month-old Angus heifer with a history of acute hindlimb paresis that quickly progressed to lateral recumbency was necropsied. Gross lesions included a 6-cm segment of gray to brown discoloration and softening of the right ventrolateral spinal cord between T2 and T3. Microscopically, there was liquefactive necrosis of ventrolateral white and gray matter, and multiple intravascular emboli partially or completely occluded many intralesional and adjacent spinal and meningeal arteries and veins. Emboli were alcian blue positive, consistent with fibrocartilage of the nucleus pulposus of the intervertebral disk. No gross abnormalities were detected in the vertebrae or intervertebral disks. Fibrocartilaginous embolic myelopathy appears to be very rare in cattle; however, it should be considered in cases of acute, nonprogressive spinal cord dysfunction.     

Acute pelvic limb paralysis induced by a lumbar fibrocartilaginous embolism in a sow

A diagnosis of fibrocartilaginous embolism was made in a mature mixed-breed sow with a history of an acute onset of pelvic limb paralysis. Within a single section of lumbar spinal cord, there was severe focally-extensive infarction of the right ventral gray horn. Within affected white matter, there was dilatation of multiple myelin sheaths with concurrent axonal swelling. A smaller focus of infarction was present on the contralateral side. Arteries at the periphery of both lesions contained a blue-gray material with staining characteristics similar to that evidenced by the nucleus pulposus present within intervertebral discs. Grossly, no abnormalities were present within the vertebral column.     

Structural Changes in Thoracolumbar Disks Following Lateral Fenestration A Study of the Radiographic, Histologic, and Histochemical Changes in the Chondrodystrophoid Dog

Lateral fenestrations of intervertebral disks T12–13 through L2–3 were performed on 16 1-year-old chondrodystrophoid dogs. The disks of five dogs were fenestrated by removing the core of disk material with a 20 gauge spinal needle, six were fenestrated in the same manner with a 14 gauge spinal needle, and five were fenestrated with a 14 gauge spinal needle and a tartar scraper. Forty-two of 48 disks had radiographic evidence of narrowing following surgery. Microscopic examination of the disks indicated that the nucleus pulposus was nonreactive tissue and that fenestration did not incite an inflammatory response that resulted in dissolution of the nucleus pulposus. Results of histochemical analyses of the fenestrated disks were not different from those of control disks. The only effects observed during a 24 week period following fenestration were disruption of the annulus fibrosus and nucleus pulposus by the fenestration device, removal of varying amounts of the nucleus pulposus, and vascular and fibrous tissue invasion of the lateral annulus fibrosus. These findings suggest that the effectiveness of fenestration is governed by the amount of nucleus pulposus removed.     

Cerebrospinal fluid from a 6-year-old dog with severe neck pain

A 6-year-old, intact female, Labrador Retriever/Terrier cross was presented to the University Veterinary Hospital, University College Dublin with a 3-week history of therapy-resistant cervical pain and intermittent fever. Physical examination findings included marked cervical pain resulting in neck extension and vocalization. Examination of the CSF revealed mild pleocytosis (total nucleated cells = 0.009 x 10(9)/L, reference interval <0.005 x 10(9)/L). Cytocentrifuged preparations of the CSF were of low cellularity, containing predominantly macrophages and occasional small lymphocytes. Several small- to medium-sized fragments of a slightly granular, amorphous, eosinophilic substance were observed. The majority of mononuclear cells were located within this material, in small groups of 3-13 cells. The amorphous foamy material stained positive with Luxol fast blue, suggestive of myelin-like material. The dog was euthanized and postmortem examination revealed intervertebral disk protrusion between C2 and C3. Hematoxylin- and Luxol fast blue-stained histopathologic sections of brain and spinal cord revealed only mild hemorrhage. The extracellular material in the CSF of this dog may have been caused by myelin degeneration or leakage of phospholipids from damaged cells. Because no histologic evidence of demyelination was observed with the disk extrusion, the myelin-like material in this case was thought to be the product of phospholipid breakdown from damaged cellular membranes. Three cases of dogs with spinal cord disease and myelin-like material in the CSF have been reported previously. The clinical significance of this finding is still unknown.     

MAGNETIC RESONANCE IMAGING FEATURES OF EXTRADURAL HEMATOMAS ASSOCIATED WITH INTER VERTEBRAL DISC HERNIATION IN A DOG

Myelography and magnetic resonance imaging (MRI) were performed on a 4-year-old neutered female Rottweiler with bilateral pelvic limb paresis. On the myelogram, there was extradural spinal cord compression at the level of the T11-12 intervertebral disc. Inadvertent placement of epidural contrast medium also allowed identification of a 1-cm circular filling defect in the epidural space dorsal to the compressed spinal cord. MRI showed partial loss of the nucleus pulposus signal of the T11-12 disc, a focal signal void within the vertebral canal at T11 compatible with a free disc fragment, and extradural masses compressing the spinal cord at T10-11 and T11-12. Hemorrhage within the masses was confirmed on T2*-weighted images. A mixture of hematoma and mineralized disc material was found at surgery, and there was no histopathologic evidence of neoplasia. In this article, the appearance on MRI of hemorrhage associated with intervertebral disc herniation is discussed.     

Acute intervertebral disc extrusion in a cat: clinical and MRI findings

A 5 year old, neutered male, domestic shorthaired cat had acute left hemiparesis and Horner's syndrome. Magnetic resonance imaging (MRI) revealed a loss of the normal signal from the nucleus pulposus of the intervertebral disc at C3/4, narrowing of the ventral subarachnoid space and slight dorsal displacement of the spinal cord and a focal hyperintense lesion affecting the left side of the spinal cord at the same level. The presumptive diagnosis was focal spinal cord oedema associated with intervertebral disc extrusion. A traumatic aetiology was suspected. The cat was treated conservatively and improved gradually over a period of 6 months.     

Intramedullary Intervertebral Disk Extrusion in a Cat

Intervertebral disk extrusion is rarely reported in the cat. In this case, the clinical, radiologic, and magnetic resonance imaging findings of an acute intramedullary intervertebral disk extrusion in a 5-year-old domestic shorthaired cat are described. Radiographically, there was mineralized disk material within the vertebral canal. On magnetic resonance images, the disk material was found to be within the spinal cord. A linear disk trail extending from the disk space into the spinal cord may be specific for intramedullary disk extrusion.     

Hansen type I disk disease at T1-2 in a dachshund

A 7-year-old Dachshund was presented with chronic left thoracic limb lameness and acute neurological deficits to the hind limbs following trauma. A lesion was suspected between C7 and T2 on the basis of neurological examinations. Radiography and myelography identified a calcified intervertebral disk at C7-T1 and an extradural unilateral compressive lesion at T1-2. Computed tomography scans of the cranial thoracic spine revealed extrusion of disk material from the T1-2 intervertebral space resulting in marked spinal cord compression. Intervertebral disk disease is rarely reported at this location. The neurological condition deteriorated after a second myelogram, which was done to examine the thoracolumbar spine. A modified dorsal decompression of T1-2 was performed. The dog was euthanased due to further neurological deterioration 8 days after surgery.     

Hydrated nucleus pulposus herniation in seven dogs

The clinical signs, magnetic resonance imaging (MRI) findings, treatment and follow-up in seven dogs with hydrated nucleus pulposus extrusion (HNPE) are reported. All dogs had tetraparesis or tetraplegia. T2-weighted MRI revealed extradural hyperintense homogeneous material compressing the cervical spinal cord. After conservative treatment (five dogs) or surgical decompression (two dogs), all dogs returned to ambulatory function within 1 month. Follow-up MRI in conservatively treated dogs revealed complete disappearance of the extruded material. Histopathological examination of surgical specimens confirmed that the retrieved material was extruded nucleus pulposus with evidence of early degeneration.     

Cervical vertebral canal endoscopy in a horse with cervical vertebral stenotic myelopathy

A 3-year-old Thoroughbred gelding presented with a history of neurological signs, including incoordination in his hindlimbs, of about 7 months' duration. On initial examination, the horse exhibited ataxia and paresis in all limbs with more severe deficits in the hindlimbs. Cervical radiographs displayed severe osteoarthritis of the articular processes between C5 and C6. On subsequent cervical myelography the dorsal contrast column was reduced by 90% at the level of the intervertebral space between C5 and C6. Cervical vertebral canal endoscopy, including epidural (epiduroscopy) and subarachnoid endoscopy (myeloscopy), was performed under general anaesthesia. A substantial narrowing of the subarachnoid space at the level between C6 and C7 was seen during myeloscopy, while no compression was apparent between C5 and C6. Epiduroscopy showed no abnormalities. After completion of the procedure, the horse was subjected to euthanasia and the cervical spinal cord submitted for histopathological examination. Severe myelin and axon degeneration of the white matter was diagnosed at the level of the intervertebral space between C6 and C7, with Wallerian degeneration cranially and caudally, indicating chronic spinal cord compression at this site. Myeloscopy was successfully used to identify the site of spinal cord compression in a horse with cervical vertebral stenotic myelopathy, while myelography results were misleading.     

Treatment of thoracolumbar spinal cord compression associated with Histoplasma capsulatum infection in a cat

CASE DESCRIPTION: A 7-year-old domestic shorthair cat with a 2-month history of decreased appetite and weight loss was examined because of paraparesis of 1 week's duration that had progressed to paraplegia 3 days earlier. CLINICAL FINDINGS: Neurologic examination revealed normo- to hyperreflexia and absence of deep pain sensation in the hind limbs and thoracolumbar spinal hyperesthesia. Neuro-anatomically, the lesion was located within the T3 through L3 spinal cord segments. Biochemical analysis and cytologic examination of CSF revealed no abnormalities. Radiography revealed narrowing of the T11-12 intervertebral disk space and intervertebral foramen suggestive of intervertebral disk disease. Myelography revealed an extradural mass centered at the T12-13 intervertebral disk space with extension over the dorsal surfaces of T11-13 and L1 vertebral bodies. TREATMENT AND OUTCOME: A right-sided hemilaminectomy was performed over the T11-12, T12-13, and T13-L1 intervertebral disk spaces, and a space-occupying mass was revealed. Aerobic bacterial culture of samples of the mass yielded growth of a yeast organism after a 10-day incubation period; histologically, Histoplasma capsulatum was identified. Treatment with itraconazole was initiated. Nineteen days after surgery, superficial pain sensation and voluntary motor function were evident in both hind limbs. After approximately 3.5 months, the cat was ambulatory with sling assistance and had regained some ability to urinate voluntarily. CLINICAL RELEVANCE: In cats with myelopathies that have no overt evidence of fungal dissemination, differential diagnoses should include CNS histoplasmosis. Although prognosis associated with fungal infections of the CNS is generally guarded, treatment is warranted and may have a positive outcome.     

Fecal incontinence associated with epidural spinal hematoma and intervertebral disk extrusion in a dog

CASE DESCRIPTION: A 7-year-old castrated male Great Dane was evaluated because of a 2-month history of fecal incontinence. CLINICAL FINDINGS: On the basis of the presence of paraparesis and apparently normal spinal reflexes, the neurologic signs were localized in the region of the third thoracic to the third lumbar spinal cord segments. On the basis of the findings of magnetic resonance imaging, a presumptive diagnosis of a compressive intervertebral disk extrusion with secondary hemorrhage and epidural hematoma formation was made. TREATMENT AND OUTCOME: A right-sided hemil-aminectomy was performed (centered at the T13-L1 intervertebral space) to further characterize the lesion and decompress the spinal cord. The histopathologic diagnosis was extruded intervertebral disk material with chronic hemorrhage and inflammation. Three weeks after surgery, there was complete resolution of the dog's fecal incontinence and moderate improvements in its hind limb function. CLINICAL RELEVANCE: Thoracolumbar spinal cord injuries can result in upper motor neuron fecal incontinence in ambulatory dogs. Epidural spinal hematomas may develop secondary to intervertebral disk herniations and cause spinal cord compression resulting in neurologic deficits.     

Intervertebral disc extrusion and spinal decompression in a binturong (Arctictis binturong).

A 10-yr-old binturong (Arctictis binturong) developed an acute onset of hind limb paralysis. Neurological examination revealed sensorimotor paraplegia. Myelography and computed tomography demonstrated a ventrolateral extradural compression of the spinal cord centered over the L3-L4 intervertebral disc space. Spinal decompression was performed via hemilaminectomy and excision of degenerate nucleus pulposus, confirmed by histopathologic examination. The binturong regained slight motor function by day 8 postoperatively but succumbed to pancreatitis 19 days postoperatively.     

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.     

MAGNETIC RESONANCE IMAGING OF CANINE DEGENERATIVE LUMBAR SPINE DISEASES

Degenerative lumbar spine diseases, i.e., sacrolumbar stenosis, intervertebral disk degeneration and protrusion and spondylosis deformans of the canine lumbar spine were studied in eleven canine patients and three healthy controls using radiography and 0.02 T and 0.04 T low field magnetic resonance imaging. The T1 and T2 weighted images were obtained in sagittal and transverse planes. The loss of hydration of nucleus pulposus, taken as a sign of degeneration in the intervertebral disks, could be evaluated in both T1 and T2 weighted images. As a noninvasive method magnetic resonance imaging gave more exact information about the condition of intervertebral disks than did radiography. Sacrolumbar stenosis and compression of the spinal cord or cauda equina and surrounding tissue could be evaluated without contrast medium.     

Posterior paralysis due to fibrocartilaginous embolism in two weaner pigs.

Acute posterior paralysis in two weaner pigs was attributed to ischemic infarction of the lumbar spinal cord due to fibrocartilaginous emboli. These arterial and venous emboli were assumed to have originated from the nucleus pulposus of one or more intervertebral discs. There was no indication of an initiating factor in either instance, although some form of trauma may have been involved. Lesions were not grossly evident and were limited to one or two lumbar segments. Although it appears to be a rare occurrence, fibrocartilaginous embolism of the spinal cord should be considered in cases of acute paralysis in pigs particularly when gross lesions are absent.     

Probable lumbar acute non-compressive nucleus pulposus extrusion in a cat with acute onset paraparesis

A spinal cord lesion localised caudal to the L6 spinal segment was diagnosed in a 2-year-old female spayed domestic longhair cat with acute onset paraparesis. Magnetic resonance imaging findings were consistent with an acute, non-compressive nucleus pulposus extrusion of the L5-L6 intervertebral disc. The cat was successfully managed with supportive care, including cage confinement.     

Effect of Disk Fenestration on Sagittal Kinematics of the Canine C5-C6 Intervertebral Space

OBJECTIVE: To determine the effect that ventral intervertebral disk fenestration has on the sagittal range of motion about the C5-C6 intervertebral space. STUDY DESIGN: A repeated measures in vitro mechanical study of spinal range of motion under controlled loading conditions before and after fenestration. SAMPLE POPULATION: A total of 10 canine cervical vertebral specimens (C4-C7) collected from clinically normal animals within 12 hours of euthanasia. METHODS: Specimens were loaded as cantilever beams fixed at C7. Weights (1 to 5 kg) were progressively applied to C4 to produce flexion or extension in the sagittal plane. Radiographs were taken at each load, 3 times before and 3 times after fenestration of the C5-C6 disk. The positions of radiodense markers embedded in the vertebrae were used to calculate flexion and extension angles and range of motion. RESULTS: Range of motion (difference between flexion and extension) and flexion and extension angles (individually) significantly increased after fenestration (P < .0001). CONCLUSION: Ventral fenestration produces sagittal instability of the C5-C6 disk space. CLINICAL RELEVANCE: In surgical fusion of caudal cervical intervertebral spaces in dogs, radiographically normal disks adjacent to the affected space are often fenestrated to facilitate distraction before surgical stabilization. This study shows that ventral fenestration produces instability of a caudal cervical intervertebral space in the model used. Such instability may contribute to the development of the secondary instability ("domino lesions") seen in some surgically treated dogs.