Foramen magnum decompression for treatment of caudal occipital malformation syndrome in dogs

A method for foramen magnum decompression (FMD) in dogs with caudal occipital malformation syndrome (COMS) and results for 16 dogs are described. In brief, a dorsal approach to the caudal portion of the occiput and arch of the atlas was made, and a high-speed drill was used to remove a portion of the occiput in the region of the foramen magnum and the dorsal aspect of C1. The meninges that were exposed were removed or marsupialized to surrounding tissues. Foramen magnum decompression was performed in 16 dogs. No intraoperative complications occurred, and postoperative complications occurred in only 2 dogs after initial surgery and in 1 of these dogs after follow-up surgery. In both dogs, postoperative complications after the initial surgery resolved without additional treatment. One dog was nonambulatory tetraparetic after follow-up surgery and died of a suspected ruptured viscus 9 days after surgery. Four dogs developed evidence of scar formation at the surgery site and required additional surgery. Overall, 14 dogs survived, 1 died, and 1 was euthanatized. Clinical signs resolved in 7 of the 14 dogs that survived, improved in 6, and did not change in 1. Results suggest that FMD may be an effective treatment for dogs with COMS, especially if performed early in the course of the disease.     

Intraoperative use of ultrasonography during continuous dorsal laminectomy in two dogs with caudal cervical vertebral instability and malformation ("Wobbler syndrome")

OBJECTIVE: To describe an intraoperative ultrasound imaging technique during dorsal laminectomy in 2 dogs with caudal cervical vertebral instability and malformation (CCVIM, "Wobbler syndrome"). STUDY DESIGN: Clinical case report. SAMPLE POPULATION: Two dogs with CCVIM. RESULTS: On neurologic examination there was tetraparesis with upper motor neuron signs in the thoracic limbs and lower motor neuron signs in the pelvic limbs in dog 1, and hyperreflexia of the rear limbs, normoreflexia of the right front limb, and hyporeflexia of the left front limb of dog 2. Both dogs had signs of marked cervical pain and radiographic signs of cervical spinal cord compression. Intraoperative ultrasonography of the spinal cord revealed protruding intervertebral disc at C5-6 (dog 1) and C6-7 (dog 2), and the parallel borders of the spinal cord and central canal after decompression. Continuous dorsal laminectomy (CDL) resulted in improvement over 16 months (dog 1) and 20 months (dog 2). CONCLUSIONS: Intraoperative ultrasonographic imaging of the cervical spinal cord after CDL was helpful in determining adequate decompression (postlaminectomy) of the spinal cord in relation to the ventral and lateral compressive component(s) and to image the protruding intervertebral disc. CLINICAL RELEVANCE: Intraoperative ultrasonography can be used to provide valuable information on the spinal cord and surrounding soft tissues for the neurosurgeon.     

A nervous syndrome in dogs responding to treatment with thiamine

Abstract

Extract

Sir,—Following letters of Mayhew and Stewart 1969) Mayhew, I. G. and Stewart, J. M. 1969. Nervous syndrome in dogs possibly associated with a thiamine deficiency. N.Z. vet. J., 17: 91–92. [Taylor &; Francis Online] , [Google Scholar]and Stirling (1969) Stirling, T. 1969. Possible thiamine deficiency in dogs. N.Z. vet. J., 11: 160–160.  [Google Scholar], I feel that the following case report may be of interest.     

Functional outcome in dogs after surgical treatment of caudal lumbar intervertebral disk herniation.

Caudal lumbar disk herniations (i.e., third lumbar [L3] to seventh lumbar [L7] intervertebral spaces) represent approximately 15% of surgically treated thoracolumbar disk herniations in dogs. A retrospective case-control study was conducted to determine the postoperative outcome of this subset of dogs in the authors' neurosurgical practice. Medical records (1985 through 1996) were reviewed for dogs with caudal lumbar disk herniation confirmed at surgery. Thirty-six cases were identified. For each case, two dogs that underwent surgical treatment for upper motor neuron thoracolumbar disk herniation (tenth thoracic [T10] to L3 intervertebral spaces) were selected as controls. Probabilities of functional recovery for cases and controls were 81% and 85%, respectively (p value of 0.49). In dogs with caudal lumbar disk herniation, complete sensorimotor loss was the only significant predictor of functional recovery (p value of 0.005). Disk herniations that occur at the thoracolumbar junction and those that occur in the caudal lumbar region should not be considered to be different in terms of surgical treatment and postoperative outcome. The lower motor neuron signs that often accompany caudal lumbar disk herniation reflect the site of spinal cord injury and do not necessarily predict a poor prognosis.     

Force plate analysis before and after dorsal decompression for treatment of degenerative lumbosacral stenosis in dogs

OBJECTIVE: Using force plate analysis (FPA), determine ground reaction forces in dogs with degenerative lumbosacral stenosis (DLS) and evaluate the effects of lumbosacral decompressive surgery. STUDY DESIGN: Prospective clinical study. ANIMALS: Twelve dogs with DLS. METHODS: DLS was diagnosed by clinical signs, radiography, computed tomography, and/or magnetic resonance imaging. FPA was performed before surgery, and 3 days, 6 weeks, and 6 months after surgery. The mean peak braking (Fy+), peak propulsive (Fy-), and peak vertical (Fz+) forces of 8 consecutive strides were determined. The ratio between the total Fy- of the pelvic limbs and the total Fy- of the thoracic limbs (P/TFy-), reflecting the distribution of Fy-, was analyzed to evaluate any changes in locomotion pattern postoperatively. Ground reaction force data for DLS dogs were compared with data derived from 24 healthy dogs (control). RESULTS: In dogs with DLS, the propulsive forces (Fy-) of the pelvic limbs were significantly smaller than those of controls. P/TFy- was significantly smaller in dogs with DLS than in control dogs, and increased during the follow-up period, reaching normal values 6 months after surgery. CONCLUSIONS: Cauda equina compression in dogs with DLS decreases the propulsive force of the pelvic limbs and surgical treatment restores the propulsive force of the pelvic limbs in a 6-month period. CLINICAL RELEVANCE: In dogs with DLS, FPA is an effective method in evaluating the response to surgical treatment. Normal propulsive force in the pelvic limbs was restored during 6 months after decompressive surgery.     

A study of the radiographic anatomy of the foramen magnum in dogs

The shape and size of the foramen magnum were investigated in a number of breeds. It was found that dorsal extension occurred in toy breeds, both with and without neurological symptoms. An increase in the size of the foramen magnum was not necessarily associated with a pathological process.     

Euthyroid sick syndrome in dogs with idiopathic epilepsy before treatment with anticonvulsant drugs

Euthyroid sick syndrome is a common finding in dogs and is attributable to nonthyroidal illness or treatment with any of a variety of drugs such as phenobarbital. In dogs with epilepsy, treatment with anticonvulsant drugs can lead to subnormal plasma thyroid hormone concentrations despite normal thyroid function. One-hundred thirteen dogs with seizure activity were retrospectively evaluated to determine the influence of idiopathic epilepsy (IE) on thyroid hormone concentrations. Blood samples were taken from 60 dogs with IE before initiation of anticonvulsant therapy. Control groups consisted of 34 dogs with IE and receiving anticonvulsants and 19 dogs with secondary epilepsy. Thyroid concentrations consistent with euthyroid sick syndrome were diagnosed in 38% of dogs with untreated IE without clinical signs of hypothyroidism or concomitant diseases. There was a significant correlation (r = 0.363, P = .01) between seizure frequency and plasma thyroid hormone concentrations: the longer the interval between 2 seizure events, the higher the serum total thyroxine concentration. There was no correlation between the degree of alteration of thyroid hormone concentrations and the time span between the most recent seizure event and blood collection, the type of the most recent seizure event, the duration of the complete seizure history, or the predominant seizure type. These results suggest that IE can be a reason for euthyroid sick syndrome in dogs. The effect of phenobarbital on plasma thyroid hormone concentrations must be investigated in future studies, as it might be less pronounced than expected.     

Modified lateral spinal decompression in 61 dogs with thoracolurnbar disc protrusion

A modified lateral spinal decompression technique was performed in 61 dogs with thoracolumbar disc protrusion. Myelography combined with plain radiography and neurological examination determined the side of greatest compression in 93 per cent of the dogs. Disc material was retrieved in 98 per cent of the cases. Of the 35 non-ambulatory dogs, 95 per cent regained the ability to walk. The recovery time was three weeks.     

Sub-occipital craniectomy in a lion (Panthera leo) with occipital bone malformation and hypovitaminosis A

Neurologic dysfunction accompanied by malformation of both the skull and the cervical vertebrae has been previously described in lions kept in captivity worldwide, and this dysfunction and malformation were most often related to vitamin A deficiency. Diagnosis of the bone malformation and its effects on the neural tissue was until recently limited to postmortem examination, with characteristic thickening of the bones of the cranial vault, cerebellar herniation, compression of the foramen magnum, and enlargement of the lateral ventricles. For some mildly affected lion cubs with neurologic signs, improvement was reported with excessive vitamin A supplementation. However, definitive diagnosis was only available for those that eventually died or were euthanized. This case documents the antemortem diagnosis of the disease using computed tomographic imaging and liver biopsy. While conservative treatment failed, suboccipital craniectomy removed the thickened occipital bone and was demonstrated to be a successful surgical intervention that can be used to treat more severely affected lions.     

Dorsal notch of foramen magnum due to incomplete ossification of supraoccipital bone in dogs

The shape of the foramen magnum and the variation in the ossification pattern of the supra-occipital bone were studied in 48 skulls, including 12 from neonatal and 33 from immature and mature beagles of known age. The shape varied markedly, and a dorsal notch, dorsomedial to the nuchal tubercles and present in over half of the beagles, developed as a result of incomplete ossification of the ventromedial part of the supra-occipital bone. In a pomeranian and a chihuahua a membrane of dure mater and connective tissue, which covered the prominent dorsal notch, prevented prolapse of the brain. The spinal cord passed through a smaller oval opening in the ventral half of the foramen magnum. As there was no apparent impairment of function or anomalies associated with the dorsal notch and since a prominent dorsal notch was common in small breeds with brachycephalic skulls, it was concluded that the dorsal notch is a variation in the normal morphological pattern.     

The assessment of ventral cervical decompression in the treatment of prolapse of the nucleus pulposus in dogs

The aim of the study is the assessment of treatment effectiveness of disc extrusion with the method of ventral cervical decompression (ventral slot). Surgical procedure was performed on 15 dogs--10 chondrodystrophoid and 5 achondrodystrophoid. Clinical signs and localization of lesions were similar to those reported earlier. All of the dogs, but one which died during the operation, were cured. Percentage of dogs which recovered within 7 days since the surgery is slightly higher than in the previous reports. Atypical mass of nucleus pulposus displaced to the vertebral canal is described and the observation of atypical course of worsening after fenestration is presented.     

Treatment of wobbler syndrome in dogs with electroacupuncture

Based on favorable experiences with acupuncture for the treatment of hind limbs paralysis, lumbo-sacral alterations, and other spinal cord problems; a clinical trial, involving 40 dogs affected with wobbler syndrome was carried out. Patients were graded in three categories according to the severity of each case and then randomly divided in two groups. Both groups contained all three grades. Group 1 (20 dogs) was treated using orthodox medical and surgical interventions, while Group 2 (20 dogs) were treated mainly with electroacupuncture, and in few cases with surgical intervention as well. The study was carried out in a three-year period. Acupuncture treatments were given every other day delivering 150 to 300 mVolts at 125 Hz, equivalents to approximately 20 microAmps, in ten acupuncture points per treatment. Deep needle insertion was used. Overall per cent success in Group I was only 20%, while in group II the corresponding value was 85%. The number of acupuncture treatments required to achieve full recovery in Group II was dependent upon the severity of the case, as follows: Grade I: 18.5 +/- 2.5; Grade II: 25 +/- 5.4; and Grade III: 34 +/- 6.7 (r = 0.962). No adverse effects were observed with acupuncture. The use of this technique is proposed for large-scale clinical trials.     

Intramedullary cavernous malformation of the spinal cord in two dogs

Intramedullary cavernous malformations (CVMs) of the spinal cord were diagnosed in 2 adult dogs that presented for paraparesis. An intramedullary spinal cord lesion was identified on a myelogram in the first dog, and expansion of the vertebral canal was evident on radiographs in the second. Extensive intraparenchymal hemorrhage was found on gross postmortem examination in both dogs, and a distinct lobulated intramedullary mass was evident in the second dog. Microscopically, both lesions were composed of dilated, thin-walled vascular channels with little-to-no intervening neural parenchyma. Both dogs had evidence of channel thrombosis along with perilesional hemorrhage and hemosiderin accumulation. The second dog had additional degenerative changes, including thickened fibrous channel walls with hyalinization, foci of mineralization, and occasional tongues of entrapped gliotic neuropil. CVMs appear to be an uncommon cause of both acute and chronic spinal cord disease in the dog.     

Dorsal laminectomy for caudal cervical spondylomyelopathy: postoperative recovery and long-term follow-up in 20 dogs

OBJECTIVE: To evaluate the postoperative morbidity and long-term outcome of dogs after dorsal laminectomy for caudal cervical spondylomyelopathy (CCSM). STUDY DESIGN: Retrospective study. SAMPLE POPULATION: Twenty dogs with CCSM. METHODS: Medical records of dogs treated by dorsal laminectomy for CCSM at North Carolina State University and Colorado State University between 1989 and 1999 were reviewed. Information on signalment, onset, progression and duration of clinical signs, diagnostic testing, sites of dorsal laminectomy, postoperative complications, length of hospitalization, and the ambulatory status on discharge was recorded. A minimum follow-up of 7 months was required for inclusion in the study. Neurologic status was graded (0 to 5) preoperatively, 2 days after surgery, and at the time of the study (final score). Improvement or worsening of the neurologic status was assessed by comparison of different scores for each dog. Additional follow-up information was obtained by means of a detailed telephone questionnaire directed at both the owner and referring veterinarian. RESULTS: Mean duration of clinical signs before surgery was 4.9 months. At admission, 15 dogs were ambulatory and 5 were nonambulatory. Neurologic status worsened in 70% of dogs 2 days after surgery but improved in all but 1 dog over the long term. Mean time to optimal recovery was 3.6 months. Long-term follow-up ranged from 7 months to 9 years (mean +/- SD, 3.2 +/- 2.4 years). Four dogs had confirmed recurrence; 2 other dogs may have had recurrence. CONCLUSIONS: Dorsal cervical laminectomy is an effective treatment for CCSM in those dogs with dorsal compression or multiple sites of involvement. CLINICAL RELEVANCE: Although most dogs' neurologic status transiently worsened after surgery, long-term outcome and recurrence rates were comparable to those seen with other surgical techniques for CCSM.     

Limb-sparing treatment for osteosarcoma in dogs

Twenty dogs with spontaneously developing osteosarcoma of the extremities were treated with 1 of 3 multimodality limb-sparing procedures. Excision of the tumor was preceded by intra-arterial (IA) administration of cisplatin (cis-diamminedichloroplatinum) alone directed to the affected extremity, irradiation plus IA administration of cisplatin, or irradiation plus IV administration of cisplatin. All dogs were free of apparent metastatic disease at the time of initial treatment. After diagnosis, dogs administered cisplatin IA had selective angiography performed on arteries supplying the tumor, and 70 mg of cisplatin/m2 of body surface was administered over 2 hours. This protocol was repeated 3 weeks later. Dogs that were irradiated received 25 or 40 Gy in 10 fractions over a 22-day period. The first and last radiation doses were immediately preceded by IA administration of cisplatin. Dogs given IV treatment received 10 mg of cisplatin/m2 2 hours before each radiation fraction was administered. Three weeks after the last treatment, tumors were excised and the limb underwent orthopedic reconstruction, generally using cortical allografting and bone plating. Limb function, allograft healing, local tumor control, and metastatic dissemination were monitored. Limb function was good to excellent in 69% (11/16) of dogs evaluated. Forelimb-sparing procedures were generally associated with better function than were limb-sparing procedures performed on hind limbs. Local tumor control was obtained in 79% (11/14) of dogs thoroughly evaluated, with local recurrences in 3 dogs at 3, 4, and 7 months after treatment. Fifteen dogs developed metastatic disease at a median time of 8 months from the time of diagnosis. Mean and median survival times for all dogs, regardless of cause of death, were 11.7 and 8 months, respectively. Tumor necrosis greater than 80% was statistically associated with lack of recurrence. Of 16 dogs, 5 (31%) developed infections at the surgical site. Multimodality limb-sparing treatment is believed to be a viable alternative for appropriately selected dogs with osteosarcoma. The optimal method of treatment prior to or after tumor excision has not yet been established.     

A method for intervertebral space distraction before stabilization combined with complete ventral slot for treatment of disc-associated wobbler syndrome in dogs

Objective— To evaluate the use of a modified K-wire spacer for maintaining intervertebral distraction after ventral decompression and during stabilization as a treatment for disc-associated wobbler syndrome in large breed dogs.
Study Design— A retrospective study.
Animals— Dogs (n=7) with disc-associated wobbler syndrome.
Methods— Medical records (2003–2006) of dogs treated by a modified surgical method were evaluated. Data retrieved were signalment, onset and duration of clinical signs, neurologic abnormalities, diagnostic methods, surgical procedure, immediate, and long-term (≥1 year) postoperative clinical and radiographic outcome.
Results— Mean duration of clinical signs was 4.8 months. Neurologic signs included ataxia (2), ambulatory tetraparesis (2), and non-ambulatory tetraparesis (3). Three dogs had disc protrusion in 2 sites, 2 dogs had the procedure in 1 location and stabilization of both affected sites. All dogs improved dramatically and remained for 1–3 years. One dog had recurrence of cervical discomfort 13 months later.
Conclusions— Despite the limited number of dogs, overall initial successful outcome with only 1 dog having mild recurrence 13 months later supports further use and evaluation of this technique.
Clinical Relevance— Distraction using a K-wire spacer after ventral decompression followed by stabilization should be considered in dogs with disc-associated wobbler syndrome to prevent collapse of the intervertebral space.