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.     

Endoscope‐Assisted Thoracolumbar Lateral Corpectomy

Objective: To report an endoscope‐assisted lateral approach to expose the intervertebral foramen and disk and perform lateral corpectomy of thoracolumbar disks in dogs. Study Design: Cadaver study. Animals: Fresh canine cadavers (n=6). Methods: A thoracic (T10–T11) and a lumbar (L3–L4) lateral approach were made on 6 fresh canine mixed breed cadavers. Through a limited skin incision, musculature was dissected and retracted using a neurosurgical self‐retaining retractor and lateral corpectomy performed. The approach and bone removal, both performed under endoscopic control, were assessed. Results: The foramen and intervertebral disk were clearly observed in all specimens without any iatrogenic injury of the ventral and dorsal nerve branches. Access to the foramen was possible in all specimens; in the thoracic area the head of the rib was always partially excised to observe the intervertebral disk medially. Lateral corpectomy was easily performed in all cadavers and spinal cord observation was good. Extension to foraminotomy or mini hemilaminectomy could easily be performed through the same limited approach. Conclusion: Endoscopic exploration provided a good viewing of the intervertebral disk and/or foramen. An endoscope‐assisted thoracolumbar lateral corpectomy could effectively be performed through a limited approach to the thoracolumbar disks and allowed good ventral spinal cord assessment.     

ACCURACY OF SURVEY RADIOGRAPHIC DIAGNOSIS OF INTERVERTEBRAL DISC PROTRUSION IN DOGS

To assess the diagnostic accuracy of survey radiography for canine thoracolumbar intervertebral disc protrusion, survey radiographs (lateral and ventrodorsal) of 64 dogs with surgically-confirmed thoracolumbar intervertebral disc protrusion, 51 dogs with negative myelograms and 29 dogs with various spinal conditions other than disc protrusion were reviewed by three independent observers who were unaware of any clinical information. There were marked differences in observer performance for diagnosis of intervertebral disc protrusion, although there were no significant differences in intraobserver diagnostic accuracy for small vs. large dogs. Accuracy of observers for determining sites of intervertebral disc protrusion using survey radiography was in the range 51-61%. All observers had low accuracy for identification of second sites of intervertebral disc protrusion. The most useful radiographic sign, narrowed intervertebral space, had only moderate sensitivity (range 64-69%) and moderate predictive value (range 63-71%) for intervertebral disc protrusion. Vacuum phenomenon was an infrequent but accurate sign of intervertebral disc protrusion. Recognition of multiple radiographic signs of intervertebral disc protrusion at one site was associated with increased accuracy of diagnosis. No observer was accurate enough to justify attempting targeted surgical treatment of intervertebral disc protrusion without myelography.     

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.     

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.     

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.     

Intervertebral disc protrusion in a cat

A case of prolapsed intervertebral disc at C_5–6 is described in an adult cat with a history of quadriparesis and two episodes of quadriplegia in a two year period. Plain radiographs showed no abnormality, there was no narrowing of the intervertebral space, but the protrusion was detected by myelography. Severe degeneration was found in the spinal cord.     

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.     

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.     

Cranial thoracic disc protrusions in three German Shepherd dogs

Although intervertebral disc degeneration can occur at any level of the spine, cervical and thoraco-lumbar discs are more commonly affected. The presence of the inter-capital ligament between the rib heads results in an extremely low incidence of cranial thoracic intervertebral disc herniation. In this case series, the clinical, radiological, and surgical findings, as well as the post-operative outcome, in three German Shepherd dogs with T2–T3 disc protrusions is reported. These dogs had chronic progressive paraparesis and lumbar myelography and post-myelographic computerised tomography revealed ventrolateral, extra-dural spinal cord compressions over the T2–T3 intervertebral disc. All animals exhibited transient deterioration in their clinical signs and one developed unilateral Horner’s syndrome following T2–T3 hemi-dorsal laminectomy. Subsequently two of the dogs improved progressively and neurological dysfunction had completely resolved by 2 months. To the authors’ knowledge, this is the first case series describing T2–T3 disc protrusions in the dog.     

Original surgical treatment of thoracolumbar subarachnoid cysts in six chondrodystrophic dogs

Background

Subarachnoid cysts are rare conditions in veterinary medicine, associated with spinal cord dysfunction. Most of the 100 cases of subarachnoid cysts described since the first report in 1968 were apparently not true cysts. Reported cysts are usually situated in the cervical area and occur in predisposed breeds such as the Rottweiler. The purpose of this retrospective study, from May 2003 to April 2012, was to describe the distinctive features of thoracolumbar spinal subarachnoid cysts, together with their surgical treatment and outcome in 6 chondrodystrophic dogs.

Results

Five Pugs and 1 French Bulldog were examined. Images suggestive of a subarachnoid cyst were obtained by myelography (2/6) and computed tomography myelography (4/6), and associated disc herniation was observed in 3/6 dogs. A hemilaminectomy was performed. The protruding disc eventually found in 5/6 dogs was treated by lateral corpectomy. The ventral leptomeningeal adhesions observed in all dogs after durotomy were dissected. No or only mild post-operative neurological degradation was observed. Follow-up studies (7 months to 4 years) indicated good outcome and no recurrence.

Conclusions

All the thoracolumbar subarachnoid cysts described in these 6 chondrodystrophic dogs were associated with leptomeningeal adhesions. Good results seemed to be obtained by dissecting and removing these adhesions. A protruding disc, found here in 5/6 dogs, needs to be ruled out and can be treated by lateral corpectomy.     

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.     

Spinal cord injury resulting from incorrect microchip placement in a cat

A 2-year-old, male neutered domestic shorthair cat was presented for investigation of an acute onset of tetraparesis immediately following the implantation of a pet identification microchip. A left-sided C6-T2 spinal segment localisation was suspected from the neurological examination, with spinal cord trauma being the primary differential diagnosis. Myelography demonstrated obliteration of the contrast columns by the microchip at the C5-C6 intervertebral disc space. A dorsal laminectomy was undertaken and the microchip was successfully removed. Eleven months after the surgery, the cat was able to weight bear in all limbs but with mild residual paresis in the left thoracic limb.     

Partial lateral corpectomy of the thoracolumbar spine in 51 dogs: assessment of slot morphometry and spinal cord decompression

Objective: To report slot morphometry, degree of spinal decompression, and factors influencing decompression after partial lateral corpectomy (PLC) of the thoracolumbar spine in dogs with intervertebral disc disease. Study Design: Case series. Animals: Dogs (n=51) with predominantly ventrally located spinal cord compression. Methods: PLC (n=60) were performed. Spinal cord compression was determined by computed tomographic (CT) myelography (n=46), myelography (n=2) or magnetic resonance imaging (n=3). Postsurgical CT images were used to evaluate slot dimensions and orientation, and spinal cord decompression. The influence of age, body weight, breed, breed type (chondrodystrophic, nonchondrodystrophic), disc location, lateralization and mineralization, presurgical compression, slot morphometry, and surgeon on degree of decompression were evaluated. Results: Mean slot depth was 64.1% of vertebral body width; mean height, 43.0% of vertebral body height; mean cranial extension, 29.5%; median caudal extension, 22.0% vertebral body length; mean angulation from horizontal, 6.3°. Decompression was satisfactory in 90% of sites after PLC (58% complete, 32% good). None of the analyzed factors significantly influenced decompression. All lumbar spine PLC resulted in complete or good decompression compared with 83% after thoracic PLC (P=.052). Deeper slots tended to allow more complete decompression (P=.058). Conclusions: Thoracolumbar PLC results in satisfactory decompression in most cases with a better outcome in the lumbar spine than the thoracic spine. Achieving a slot depth equal to 2/3 of vertebral body width might facilitate complete decompression.     

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.     

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.     

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.     

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.     

Partial percutaneous discectomy for treatment of thoracolumbar disc protrusion: retrospective study of 331 dogs

OBJECTIVES: To determine retrospectively the prognosis and outcome for dogs diagnosed with thoracolumbar intervertebral disc disease treated with partial percutaneous discectomy (PPD). METHODS: Three hundred and thirty-one dogs presenting with symptoms of thoracolumbar intervertebral disc disease from 1998 to 2003 were treated with PPD. Diagnosis and location of intervertebral disc disease was confirmed by clinical examination, radiography, myelography and magnetic resonance imaging. PPD was performed via fluoroscopy-guided removal of a 5 mm bore cylinder out of the central intervertebral space. RESULTS: Clinical success after surgery was achieved in 159 (88.8 per cent) grade II to IV patients and 58 (38.2 per cent) grade V patients. The mean (sd) time from percutaneous discectomy to first improvement was 8.3 (13.2) days. CLINICAL SIGNIFICANCE: The PPD approach to the thoracolumbar spine involves minor trauma (yielding rapid recovery) and less pain, and produces results comparable with open fenestration. Consequently, this simple minimal invasive technique can be recommended as an alternative to the technique of fenestration and can be easily performed in addition to open surgical decompression techniques or prophylactically. However, it is not a replacement for surgical treatment in dogs with thoracolumbar disc disease that require removal of disc fragments causing spinal cord or nerve root compression.     

Degenerative spinal disease in large felids.

Degenerative spinal disorders, including intervertebral disc disease and spondylosis, seldom occur in domestic cats. In contrast, a retrospective study of 13 lions (Panthera leo), 16 tigers (Panthera tigris), 4 leopards (Panthera pardis), 1 snow leopard (Panthera uncia), and 3 jaguars (Panthera onca) from the Knoxville Zoo that died or were euthanatized from 1976 to 1996 indicated that degenerative spinal disease is an important problem in large nondomestic felids. The medical record, radiographic data, and the necropsy report of each animal were examined for evidence of intervertebral disc disease or spondylosis. Eight (three lions, four tigers, and one leopard) animals were diagnosed with degenerative spinal disease. Clinical signs included progressively decreased activity, moderate to severe rear limb muscle atrophy, chronic intermittent rear limb paresis, and ataxia. The age at onset of clinical signs was 10-19 yr (median = 18 yr). Radiographic evaluation of the spinal column was useful in assessing the severity of spinal lesions, and results were correlated with necropsy findings. Lesions were frequently multifocal, included intervertebral disc mineralization or herniation with collapsed intervertebral disc spaces, and were most common in the lumbar area but also involved cervical and thoracic vertebrae. Marked spondylosis was present in the cats with intervertebral disc disease, presumably subsequent to vertebral instability. Six of the animals' spinal cords were examined histologically, and five had acute or chronic damage to the spinal cord secondary to disc protrusion. Spinal disease should be suspected in geriatric large felids with decreased appetite or activity. Radiographic evaluation of the spinal column is the most useful method to assess the type and severity of spinal lesions.