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.     

Diffusion tensor imaging-based quantitative analysis of the spinal cord in Pembroke Welsh Corgis with degenerative myelopathy

Canine degenerative myelopathy (DM) is a progressive neurodegenerative disease of the spinal cord. The diagnosis is based on the observation of clinical signs, genetic testing, and exclusion of other spinal cord diseases, and a definitive diagnosis of DM can only be confirmed by postmortem histopathological findings. The aim of this study was to investigate the diagnostic ability of diffusion tensor imaging (DTI) for DM. Eight DM-affected Pembroke Welsh Corgis, thirteen dogs with thoracolumbar intervertebral disk herniation (IVDH), and six healthy control dogs were included. All dogs were scanned using a 3.0-T MRI system. Apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values were calculated for each intervertebral disk level slice between T8–T9 and L2–L3 intervertebral disk levels, and the entire area of the thoracolumbar spinal cord between T8–T9 and L2–L3 intervertebral disk levels (T8–L3 region). The ADC and FA values of the T8–L3 region were significantly lower in the DM group than in the IVDH group. The ADC values for the T8–L3 region had a moderate negative correlation with clinical duration (r_s= −0.723, P=0.043); however, the FA values of other intervertebral disk levels and T8–L3 region had no correlation with clinical durations. The measurement of DTI indices can be used to quantitatively assess neurodegeneration and may have diagnostic value for DM. In particular, the ADC value of the T8–L3 region may aid in making a non-invasive premortem diagnosis of DM.     

Equine intervertebral disk disease: A case report

Intervertebral disk disease is common in humans and dogs but is rarely reported in horses. In this case report, we describe an 11-year-old American Saddlebred gelding with a 2-month history of pain and progressive neurological abnormalities (ataxia, conscious proprioceptive deficits involving all four limbs, toe dragging, and restricted neck flexion) while being worked as a Saddleseat show horse. Radiographs of the cervical spine showed a loss of the intervertebral disk space at C₆–C₇. At necropsy, nearly complete loss of the intervertebral disk at C₆–C₇ was seen, with marked eburnation and subchondral sclerosis of the adjacent vertebral endplates that were confirmed by histopathology. Many of the marrow spaces of the affected vertebral bodies were filled with cartilage and others contained variable amounts of fibrous connective tissue (myelofibrosis). To our knowledge, these pathological lesions are rarely reported in the literature and appear to represent a chronic, end-stage phase of cervical vertebral stenosis.     

Evaluation of T2‐weighted versus short‐tau inversion recovery sagittal sequences in the identification and localization of canine intervertebral disc extrusion with low‐field magnetic resonance imaging

Sagittal T2‐weighted sequences (T2‐SAG) are the foundation of spinal protocols when screening for the presence of intervertebral disc extrusion. We often utilize sagittal short‐tau inversion recovery sequences (STIR‐SAG) as an adjunctive screening series, and experience suggests that this combined approach provides superior detection rates. We hypothesized that STIR‐SAG would provide higher sensitivity than T2‐SAG in the identification and localization of intervertebral disc extrusion. We further hypothesized that the parallel evaluation of paired T2‐SAG and STIR‐SAG series would provide a higher sensitivity than could be achieved with either independent sagittal series when viewed in isolation. This retrospective diagnostic accuracy study blindly reviewed T2‐SAG and STIR‐SAG sequences from dogs (n = 110) with surgically confirmed intervertebral disc extrusion. A consensus between two radiologists found no significant difference in sensitivity between T2‐SAG and STIR‐SAG during the identification of intervertebral disc extrusion (T2‐SAG: 92.7%, STIR‐SAG: 94.5%, P = 0.752). Nevertheless, STIR‐SAG accurately identified intervertebral disc extrusion in 66.7% of cases where the evaluation of T2‐SAG in isolation had provided a false negative diagnosis. Additionally, one radiologist found that the parallel evaluation of paired T2‐SAG and STIR‐SAG series provided a significantly higher sensitivity than T2‐SAG in isolation, during the identification of intervertebral disc extrusion (T2‐SAG: 78.2%, paired T2‐SAG, and STIR‐SAG: 90.9%, P = 0.017). A similar nonsignificant trend was observed when the consensus of both radiologists was taken into consideration (T2‐SAG: 92.7%, paired T2‐SAG, and STIR‐SAG = 97.3%, P = 0.392). We therefore conclude that STIR‐SAG is capable of identifying intervertebral disc extrusion that is inconspicuous in T2‐SAG, and that STIR‐SAG should be considered a useful adjunctive sequence during preliminary sagittal screening for intervertebral disc extrusion in low‐field magnetic resonance.     

Gross anatomical study of the thoracolumbar primary dorsal branches and their course from the spinal cord to the skin in the cat

The course of spinal nerves and the corresponding cutaneous areas are fundamental for numerous therapeutic approaches used in complementary veterinary medicine. Positive effects of these methods are primarily based on segmental reflex arcs which are associated with the course of the spinal nerves. In this morphological study, the lateral cutaneous branches of the thoracolumbar dorsal branches from Th9 to L7 were examined in cats with special regard to their anatomical course. A four-layer dissection was carried out to reveal the course of nerves between the intervertebral foramina and their point of entry into the skin, starting in the dorsal midline. Dorsal branch courses and covered distances were documented and measured in each layer. The covered distance was evaluated by the Caudal Shift Index (CSI_n) on both body sides and within each layer. The ‘back region’ was used as relative dimensional unit, describing the distance between the cranial tips of two consecutive spinous processes. Overall, the mean CSI_n for dorsal branches of Th9 to L7 amounted to three back regions from the intervertebral foramen to the skin entry point of a dorsal nerve branch. This provides therapists with clues and should be put into practice, by extending the treatment area up to three segments caudally from the nerve exit point. Furthermore, the results of this study present new data on inferred lumbar dermatomes in cats, data which until now have only been transferred from other species. These results may serve as an anatomical foundation for manual therapies.     

The use of electrical stimulation to guide epidural and intrathecal needle advancement at the L5‐L6 intervertebral space in dogs

ObjectiveTo determine the minimal electrical threshold (MET) necessary to elicit appropriate muscle contraction when the tip of an insulated needle is positioned epidurally or intrathecally at the L_5-6 intervertebral space (phase-I) and to determine whether the application of a fixed electrical current during its advancement could indicate needle entry into the intrathecal space (phase-II) in dogs.Study designProspective, blinded study.AnimalsThirteen (phase-I) and seventeen (phase-II) dogs, scheduled for a surgical procedure where L_5-6 intrathecal administration was indicated.MethodsUnder general anesthesia, an insulated needle was first inserted into the L_5-6 epidural space and secondly into the intrathecal space and the MET necessary to obtain a muscular contraction of the pelvic limb or tail at each site was determined (phase-I). Under similar conditions, in dogs of phase-II an insulated needle was inserted through the L_5-6 intervertebral space guided by the use of a fixed electrical current (0.8 mA) until muscular contraction of the pelvic limb or tail was obtained. Intrathecal needle placement was confirmed by either free flow of cerebrospinal fluid (CSF) or myelography.ResultsThe current required to elicit a motor response was significantly lower (p < 0.0001) when the tip of the needle was in the intrathecal space (0.48 ± 0.10 mA) than when it was located epidurally (2.56 ± 0.57). The use of a fixed electrical stimulation current of 0.8 mA resulted in correct prediction of intrathecal injection, corroborated by either free flow of CSF (n = 12) or iohexol distribution pattern (n = 5), in 100% of the cases.Conclusion and clinical relevanceNerve stimulation may be employed as a tool to distinguish epidural from intrathecal insulated needle position at the L_5-6 intervertebral space in dogs. This study demonstrates the feasibility of using an electrical stimulation test to confirm intrathecal needle position in dogs.     

Spontaneous lumbar intervertebral disc protrusion in cats: literature review and case presentations

Reports on intervertebral disc disease in cats are rare in the veterinary literature. It has been postulated that intervertebral disc protrusion is a frequent finding during necropsy in cats, without having any clinical relevance (King and Smith 1958, King & Smith 1960a, King & Smith 1960b). However, a total of six cases with disc protrusions and clinically significant neurological deficits have been reported over the past decade. (Heavner 1971, Seim & Nafe 1981, Gilmore 1983, Littlewood et al 1984, Sparkes & Skerry 1990, Bagley et al 1995). As in dogs, there are also two types of intervertebral disc disease in cats: Hansen's type I (extrusion), and type II (herniation). Cervical spinal cord involvement was more commonly recognised in cats than the lumbar or the thoraco lumbar area. Cats over 15 years were mainly affected (King & Smith 1958, King & Smith 1960a, King & Smith 1960b). We describe two cats with lumbar intervertebral disc protrusions. Emphasis is placed on differential diagnoses, treatment and follow-up.     

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.     

EVALUATION OF MAGNETIC RESONANCE IMAGING GUIDELINES FOR DIFFERENTIATION BETWEEN THORACOLUMBAR INTERVERTEBRAL DISK EXTRUSIONS AND INTERVERTEBRAL DISK PROTRUSIONS IN DOGS

Four MRI variables have recently been suggested to be independently associated with a diagnosis of thoracolumbar intervertebral disk extrusion or protrusion. Midline intervertebral disk herniation, and partial intervertebral disk degeneration were associated with intervertebral disk protrusion, while presence of a single intervertebral disk herniation and disk material dispersed beyond the boundaries of the intervertebral disk space were associated with intervertebral disk extrusion. The aim of this retrospective, cross‐sectional study was to determine whether using these MRI variables improves differentiation between thoracolumbar intervertebral disk extrusions and protrusions. Eighty large breed dogs with surgically confirmed thoracolumbar intervertebral disk extrusions or protrusions were included. Randomized MRI studies were presented on two occasions to six blinded observers, which were divided into three experience categories. During the first assessment, observers made a presumptive diagnosis of thoracolumbar intervertebral disk extrusion or protrusion without guidelines. During the second assessment they were asked to make a presumptive diagnosis with the aid of guidelines. Agreement was evaluated by Kappa‐statistics. Diagnostic accuracy significantly improved from 70.8 to 79.6% and interobserver agreement for making a diagnosis of intervertebral disk extrusion or intervertebral disk protrusion improved from fair (κ = 0.27) to moderate (κ = 0.41) after using the proposed guidelines. Diagnostic accuracy was significantly influenced by degree of observer experience. Intraobserver agreement for the assessed variables ranged from fair to excellent and interobserver agreement ranged from fair to moderate. The results of this study suggest that the proposed imaging guidelines can aid in differentiating thoracolumbar intervertebral disk extrusions from protrusions.     

Lumbosacral myelography in dogs--a safer technique

In search of a safer myelographic technique, we performed myelography via the lumbosacral intervertebral space. Eight dogs, in which the backflow of cerebrospinal fluid was observed, received contrast media via the lumbosacral intervertebral space. The subarachnoid contrast columns were successfully observed in 6 dogs. During and after examination, no physiological changes or neurological signs were observed. We recommend that the lumbosacral intervertebral space be selected first before implementing the conventional lumbar myelography.     

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.     

Anatomy of a dinosaur—Clarification of vertebrae in vertebrate anatomy

The flat-end surfaces of dinosaur vertebral centra led to the presumption that intervertebral discs occupied the space between their vertebrae. A set of fused hadrosaur vertebrae allowed that hypothesis to be tested. The Tyrannosaurus rex responsible for this pathology did not escape unscathed. It left behind a tooth crown that had fractured. Fragments of that tooth were scattered through the intervertebral space, evidencing that there was no solid structure to impede its movement. That eliminates the possibility of an intervertebral disc and instead proves the presence of an articular space, similar to that in modern reptiles, but at variance to what is noted in birds. While avian cervical vertebral centra appear to be separated by diarthrodial joints, the preponderance of their thoracic vertebral centra is not separated by synovial joints.     

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.     

7例犬椎间盘疝出疾病的磁共振影像诊断

为明确不同类型的椎间盘疝出疾病的磁共振影像(MRI)特点,本文对7例犬椎间盘疝出病例的诊治过程进行总结,通过一般检查、神经学检查和MRI扫描,诊断为椎间盘疝出。其中有3例为椎间盘突出,2例为椎间盘脱出,2例为椎间盘膨出。主要的MRI表现为椎间盘退变,T2加权像上的椎间盘信号降低,脊髓、硬膜囊不同程度的受压和变形。这些结果表明MRI扫描可对椎间盘组织是否发生退变以及椎间突出的程度进行准确判断,在犬椎间盘疝出的诊断与治疗中有极高的应用价值。     

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.     

CLINICAL AND MAGNETIC RESONANCE IMAGING CHARACTERISTICS OF THORACOLUMBAR INTERVERTEBRAL DISK EXTRUSIONS AND PROTRUSIONS IN LARGE BREED DOGS

Treatment recommendations differ for dogs with intervertebral disk extrusion vs. intervertebral disk protrusion. The aim of this retrospective, cross‐sectional study was to determine whether clinical and magnetic resonance imaging (MRI) variables could be used to predict a diagnosis of thoracolumbar intervertebral disk extrusion or protrusion in dogs. Dogs were included if they were large breed dogs, had an MRI study of the thoracolumbar or lumbar vertebral column, had undergone spinal surgery, and had the type of intervertebral disk herniation (intervertebral disk extrusion or protrusion) clearly stated in surgical reports. A veterinary neurologist unaware of surgical findings reviewed MRI studies and recorded number, location, degree of degeneration and morphology of intervertebral disks, presence of nuclear clefts, disk space narrowing, extent, localization and lateralization of herniated disk material, degree of spinal cord compression, intraparenchymal intensity changes, spondylosis deformans, spinal cord swelling, spinal cord atrophy, vertebral endplate changes, and presence of extradural hemorrhage. Ninety‐five dogs were included in the sample. Multivariable statistical models indicated that longer duration of clinical signs (P = 0.01), midline instead of lateralized disk herniation (P = 0.007), and partial instead of complete disk degeneration (P = 0.01) were associated with a diagnosis of intervertebral disk protrusion. The presence of a single intervertebral herniation (P = 0.023) and dispersed intervertebral disk material not confined to the disk space (P = 0.06) made a diagnosis of intervertebral disk extrusion more likely. Findings from this study identified one clinical and four MRI variables that could potentially facilitate differentiating intervertebral disk extrusions from protrusions in dogs.     

COMPUTED TOMOGRAPHY OF THE NORMAL CANINE LUMBOSACRAL SPINE: A MORPHOLOGIC PERSPECTIVE

The lumbosacral spine of six normal dogs weighing 4.5 to 24.5kg was imaged by computed tomography in 5.0 mm & 10.0 mm transverse planes. The vertebral canal and thecal sac (including emerging nerve roots not distinguished as separate structures from the spinal cord) were measured along dorsoventral and transverse dimensions at cranial, middle and caudal levels within each vertebra from transverse tomographic images. Linear measurements were standardized to the dorsoventral dimension of the L₆ vertebral midbody to permit comparison and averaging of the vertebral and thecal sac dimensions among different sized dogs. The dorsoventral and transverse vertebral canal size progressively increased from cranial to caudal within each vertebra from L₁?L₆ (p ≤ 0.05). The transverse dimension of the thecal sac image increased caudally within each vertebra from L₁?L₄ (p ≤ 0.05). The vertebral canal dorsoventral and transverse dimensions were largest in the midlumbar area (p ≤ 0.05). The transverse, but not the dorsoventral, imaged dimension of the thecal sac peaked in the L₄ vertebra (p ≤ 0.05). The dorsoventral thecal sac image was observed to fill the vertebral canal in the cranial and middle vertebral levels in vertebrae L₁ through L₅ in over 60% of these normal dogs. However, epidural fat could almost always be seen lateral to the thecal sac regardless of what lumbar vertebra or vertebral level was imaged. Cranial to the lumbosacral junction, the dorsal intervertebral disk margin was almost always concave relative to the thecal sac. However, at the L₇-S₁ junction, some dogs had flat or even slightly convex dorsal intervertebral disk margins. The dorsal and ventral longitudinal ligaments and the ligamentum flavum could not be identified as distinct structures on the 5.0 mm transverse tomographic images.     

The use of a nerve stimulation test to confirm sacrococcygeal epidural needle placement in cats

ObjectiveTo determine if a nerve stimulation test (NST) could act as a monitoring technique to confirm sacrococcygeal epidural needle placement in cats.Study designProspective experimental trial in a clinical setting.AnimalsTwenty-four adult cats, scheduled for a therapeutic procedure where epidural anesthesia was indicated.MethodsUnder general anesthesia, an insulated needle was inserted through the S₃-Cd₁ intervertebral space guided by the application of a fixed electrical current (0.7 mA) until a motor response was obtained. The NST was considered positive when the epidural nerve stimulation produced a motor response of the muscles of the tail, whereas it was considered negative when no motor response was evoked. In the NST positive cases, 0.3 mL kg⁻¹ of 0.5% bupivacaine was administrated before needle withdrawal. Ten minutes after injection, epidural blockade was confirmed by the loss of perineal (anal), and pelvic limbs reflexes (patellar and withdrawal).ResultsThe use of a fixed electrical stimulation current of 0.7 mA resulted in correct prediction of sacrococcygeal epidural injection, corroborated by post bupivacaine loss of perineal and pelvic limb reflexes, in 95.8% of the cases.Conclusion and clinical relevanceThis study demonstrates the feasibility of using, in a clinical setting, an electrical stimulation test as an objective and in real-time method to confirm sacrococcygeal epidural needle placement in cats.     

Chemonucleolysis with Collagenase A Radiographic and Pathologic Study in Dogs

Collagenase, a proteolytic enzyme, was injected intradiscally in nine clinically normal, middle-aged beagles. Calcium chloride diluent solution (control), 100 ABC units of collagenase, and 250 ABC units of collagenase, were injected in randomly selected intervertebral discs (T13-L1 to L5-L6). On day 11, the discs injected with collagenase were narrowed radiographically, but there was no significant change in myelograms. Grossly and histologically, there was dissolution of the intervertebral discs, mainly nucleus pulposus, and protrusion of nucleus material in the vertebral body through bony end-plates in discs injected with collagenase. Collagenase chemonucleolysis may be an alternative to spinal surgery for intervertebral disc protrusion in dogs.