CT measures of lumbosacral paraspinal muscle size are not correlated with CT measures of lumbosacral stability in military working Labrador Retrievers

Management of degenerative lumbosacral stenosis in military working dogs more frequently utilizes core conditioning exercise programs. Future research on the effectiveness of these programs may benefit from an improved understanding of relationships between paraspinal muscle size and lumbosacral stability. The aim of this retrospective, secondary analysis, cross‐sectional study was to test the following hypotheses related to CT measures: (a) transverse paraspinal muscle area ratios differ between hip flexion and extension, (b) lumbosacral angle and lumbosacral range of motion differ by lumbosacral angle measurement technique, and (c) transverse paraspinal muscle area ratios are correlated with CT measures of lumbosacral stability (parasagittal and parasagittal oblique foraminal area changes) regardless of hip position and with lumbosacral range of motion within each hip position. Lumbosacral CT scans in hip flexion and extension were retrieved from a previous prospective study of military working Labrador Retrievers. A single observer performed triplicate measurements of transverse paraspinal muscle area ratios, parasagittal foraminal area, and parasagittal oblique foraminal area for each hip position and another observer independently performed triplicate measurements of lumbosacral angle and lumbosacral range of motion at L7‐S1 using two published techniques. Thirty‐nine dogs were analyzed and significant differences were identified between hip flexion and extension for all mean transverse paraspinal muscle area ratio values (P ≤ .05). Mean lumbosacral angles also significantly differed between the published techniques in both hip flexion and extension. When comparing mean lumbosacral range of motion values, one of the published techniques produced significantly smaller values. No significant correlation was found between transverse paraspinal muscle area ratios and parasagittal foraminal area changes, parasagittal oblique foraminal area changes, or lumbosacral range of motion. These results should be considered when designing studies using these CT measures in military working dogs.     

Agreement between computed tomography, magnetic resonance imaging, and surgical findings in dogs with degenerative lumbosacral stenosis

OBJECTIVE: To assess the extent of agreement between computed tomography (CT), magnetic resonance imaging (MRI), and surgical findings in dogs with degenerative lumbosacral stenosis. DESIGN: Observational study. ANIMALS: 35 dogs with degenerative lumbosacral stenosis. PROCEDURES: Results of preoperative CT and MRI were compared with surgical findings with respect to degree and location of disk protrusion, position of the dural sac, amount of epidural fat, and swelling of spinal nerve roots. RESULTS: A lumbosacral step was seen on radiographic images from 22 of 32 (69%) dogs, on CT images from 23 of 35 (66%) dogs, and on MR images from 21 of 35 (60%) dogs. Most dogs had slight or moderate disk protrusion that was centrally located. There was substantial or near perfect agreement between CT and MRI findings in regard to degree of disk protrusion (kappa, 0.88), location of disk protrusion (0.63), position of the dural sac (0.89), amount of epidural fat (0.72), and swelling of spinal nerve roots (0.60). The degree of agreement between CT and surgical findings and between MRI and surgical findings was moderate in regard to degree and location of disk protrusion (kappa, 0.44 to 0.56) and swelling of spinal nerve roots (0.40 and 0.50). CONCLUSIONS AND CLINICAL RELEVANCE: Results indicate that there is a high degree of agreement between CT and MRI findings in dogs with degenerative lumbosacral stenosis but that the degree of agreement between diagnostic imaging findings and surgical findings is lower.     

Endoscopic-assisted lumbosacral foraminotomy in the dog

OBJECTIVE: To determine if endoscopic-assisted foraminotomy significantly increased the area of the L7-S1 intervertebral foramen and if, over 12 weeks, stenosis would occur. STUDY DESIGN: Prospective, experimental study. ANIMAL POPULATION: Six clinically normal, 22-29 kg, adult dogs. METHODS: Using endoscopic assistance, unilateral L7-S1 foraminotomy was performed. Computed tomography of L7-S1 was performed preoperatively, immediately postoperatively, and at 12 weeks. Parasagittal foramen area (PFA) measurements were obtained at the entry, middle, and exit zones of the treated and control foramen for each period. Objective and subjective data were compared among dogs by time period and treatment status. RESULTS: Endoscopic-assisted foraminotomy resulted in a significant increase in the mean PFA of the entry and middle zones immediately postoperatively. The exit zone was not significantly larger at any time. The foramen remained significantly larger at 12 weeks only in the middle zone; however, some decrease in the surgically created foramen enlargement occurred at all 3 levels. The procedure was well tolerated but dogs did have transient, mild delay of functional return postoperatively. CONCLUSIONS: Endoscopic-assisted foraminotomy in dogs can be performed for certain foraminal regions, allowing enhanced visibility of the spinal canal. The foramen can be surgically enlarged at the entry and middle zones using this technique; however, some reduction of the foraminal enlargement occurs by 12 weeks. The clinical implications of this reduction cannot be determined from this study. CLINICAL RELEVANCE: Endoscopic-assisted foraminotomy could be used to improve intraoperative visualization in dogs with foraminal stenosis as a component of degenerative lumbosacral stenosis.     

MAGNETIC RESONANCE IMAGING OF ARTICULAR PROCESS JOINT GEOMETRY AND INTERVERTEBRAL DISK DEGENERATION IN THE CAUDAL LUMBAR SPINE (L5–S1) OF DOGS WITH CLINICAL SIGNS OF CAUDA EQUINA COMPRESSION

The geometry of the lumbosacral region has been suspected to play a role in the development of degenerative lumbosacral stenosis in the dog. In this study, 50 dogs (21 German Shepherd dogs and 29 dogs of other breeds) with clinical signs of cauda equina compression were studied by magnetic resonance (MR) imaging. The orientation of the articular process joints in the L5-S1 region and the angle difference between two adjacent motion segments were calculated. Intervertebral disc degeneration of the same region was identified and classified in four stages. A positive association between MR-imaging stage and articular process joint angle difference in the transverse plane was found in the two groups of animals. German Shepherd dogs and dogs of other breeds had different geometry of the lumbosacral region with different articular process joint angles in the transverse plane and statistically different stages of disc degeneration.     

SUBCLINICAL CT ABNORMALITIES IN THE LUMBOSACRAL SPINE OF OLDER LARGE-BREED DOGS

Computed tomography (CT) of the L5-S3 vertebral levels was performed in six, large-breed dogs presented for problems unrelated to the lumbosacral spine. All dogs were asymptomatic for lumbosacral stenosis on neurologic examination. Breeds included German Shepherd, Golden Retriever, Boxermix and Belgian Malinois. Ages ranged from 5-12 years. Five out of six dogs exhibited CT abnormalities. Among the 18 disc levels examined, the most common findings were idiopathic stenosis, loss of vertebral canal epidural fat, and nerve tissue displacement. Less common abnormalities were vertebral canal or foraminal bone proliferation, loss of intervertebral foramen fat, vertebral canal disc bulging, degenerative articular process joint disease, transitional vertebra, dural ossification, foraminal disc bulging, Schmorl's nodes, calcified extruded disc fragment, and sacroiliac joint osteophytes. Vertebral subluxation was absent in all dogs. Findings indicate that some lumbosacral CT abnormalities may be clinically insignificant, especially in older dogs.     

COMPARABILITY OF LEFT VENTRICULAR M-MODE ECHOCARDIOGRAPHY IN DOGS PERFORMED IN LONG-AXIS AND SHORT-AXIS

The purpose of this prospective study was to determine comparability of left ventricular (LV) M-mode echocardiographic indices derived from right parasternal long-axis and short-axis imaging planes. In 104 dogs (37 healthy dogs and 67 dogs with heart disease), LV M-mode echocardiograms were recorded from both long-axis and short-axis views and interventricular septum thickness (IVS), left ventricular internal dimensions (LVD), left ventricular posterior wall thickness (LVPW), and LV shortening fraction (FS) were measured. Statistical analysis included paired t-test and graphical analysis to assess agreement between the two methods of data acquisition. Mean LVD in systole and diastole and mean IVS in systole were significantly (P<0.001) larger when measured from short-axis recordings compared to long-axis measurements. An increased magnitude of measurement resulted in increased differences between the methods for LV dimensions and fractional shortening. Differences between the two methods were small and within clinically acceptable limits in normal dogs. However, in 23 (34%) of the dogs with cardiac abnormality, one or more LV M-mode derived dimension obtained from one imaging plane did not agree sufficiently closely with the same measure from the other plane. Only for measurement of FS was there good agreement between methods in dogs with cardiac disease. Therefore, with the exception of FS, data gained from LV short-axis and long-axis M-mode recordings should not be used interchangeably in dogs with cardiac disease.     

Surgical treatment of lumbosacral foraminal stenosis using a lateral approach in twenty dogs with degenerative lumbosacral stenosis

Objectives— To describe clinical signs, magnetic resonance imaging (MRI) and surgical findings using a lateral approach to the lumbosacral intervertebral foramen and to evaluate clinical outcomes in dogs with or without concurrent dorsal decompression and annulectomy.
Study Design— Retrospective study.
Animals— Dogs (n=20) with degenerative lumbosacral stenosis (DLSS).
Methods— Medical records (2002–2006) of dogs that had lumbosacral lateral foraminotomy alone or in combination with dorsal decompression were reviewed. Degree of dysfunction was assessed separately for each pelvic limb; dogs with unilateral signs were included in group A, those with bilateral signs in group B. Retrieved data were: signalment, history, neurologic status on admission, 3 days, 6 weeks, and 6 months postoperatively, duration of clinical signs, results of MRI, surgical site(s), intraoperative findings, and outcome.
Results— Based on the clinical and MRI findings unilateral foraminotomy was performed in 8 dogs, bilateral foraminotomy in 1 dog, unilateral foraminotomy with concurrent dorsal decompression in 7 dogs, and bilateral foraminotomy with concomitant dorsal decompression in 4 dogs. Surgery confirmed the presence of foraminal stenosis in all dogs, with osteophyte formation and soft tissue proliferations being the most common lesions. Outcome was good to excellent in 19 dogs and poor in 1 dog. Mean follow-up was 15.2 months (range, 6–42 months).
Conclusion— Lateral foraminotomy addresses compressive lesions within exit and middle zones of the lumbosacral foramen.
Clinical Relevance— Successful surgical management of DLSS is dependent on recognition and correction of each of the compressive lesions within the lumbosacral junction.     

QUANTITATIVE SURVEY RADIOGRAPHIC EVALUATION OF THE LUMBOSACRAL SPINE OF NORMAL DOGS AND DOGS WITH DEGENERATIVE LUMBOSACRAL STENOSIS

Survey radiographic studies of the lumbosacral region for 93 normal dogs and for 26 dogs with confirmed degenerative lumbosacral stenosis were reviewed. Normal dogs were divided into 9 groups based on age and body weight. For normal dogs, increasing age and body weight were associated with a decreased ability to extend the lumbosacral joint and with increased incidence and severity of spondylosis. Transitional lumbosacral vertebrae and evidence of lumbosacral disc space collapse were very infrequent findings, and the pivot point for lumbosacral motion was consistently centered over the lumbosacral disc space. Relative to an age/weight matched sub-population of normal dogs, dogs with degenerative lumbosacral stenosis had similar mean normalized lumbosacral vertebral canal height, larger mean neutral lumbosacral angle, decreased extension of the lumbosacral joint, increased flexion of the lumbosacral joint, reduced lumbosacral range of motion, increased lumbosacral dynamic malalignment, higher incidence and severity of spondylosis, higher incidence of transitional vertebrae, and higher incidence of lumbosacral disc space collapse. A logistic model based strictly on radiographic parameters was able to discriminate normal from affected dogs with an overall accuracy rate of 86%.     

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.     

MAGNETIC RESONANCE IMAGING OF THE CAUDAL LUMBAR AND LUMBOSACRAL SPINE IN 13 DOGS (1990–1993)

The caudal lumbar and lumbosacral spine of 13 dogs with pain or neurologic deficits were evaluated using magnetic resonance imaging (MRI). Spin echo T1, proton density, and T2 weighted and gradient echo T2* imaging sequences were utilized. MRI permitted direct, multiplanar, tomographic visualization of the spine facilitating evaluation of all components of degenerative caudal lumbar and lumbosacral stenosis. Abnormalities detected included intervertebral disc degeneration, intervertebral disc protrusion involving both the vertebral canal and intervertebral foramina, articular process osteophytosis, articular process fracture, nerve root impingement by spondylosis deformans, and the presence of low signal material within the vertebral canal of 2 dogs with recurrent pain following previous spinal surgery. In all 7 dogs treated surgically, MRI findings were consistent with surgical findings.     

Direct and reconstructed multiplanar computed tomography of the orbits of healthy dogs

OBJECTIVE: To describe anatomy of the orbits as revealed by computed tomography (CT) in different scan planes, determine the most useful scan plane for imaging the eye, optic nerve, and extraocular muscles, and compare image quality of direct CT images with reconstructed images obtained from 2-mm-thick and 5-mm-thick transverse images. ANIMALS: 9 dogs with no ocular abnormalities. PROCEDURE: In 3 dogs, CT was combined with cisternography to facilitate imaging of the optic nerve and determine the scan plane that allowed optimum imaging of the optic nerve in a single image. In 6 dogs, CT images were made in transverse, dorsal oblique, and sagittal oblique scan directions. Dorsal and sagittal reconstructions were made from transverse images. RESULTS: In all dogs, scanning in different planes enabled identification of ocular structures, optic nerves, and orbital adnexa, as well as identification of the confines of the orbit. Imaging of optic nerve and extraocular muscles was optimal on dorsal oblique scans at an angle of 43 to 45 degrees to the skull base and on sagittal oblique images at an angle of 59 to 61 degrees to the midline of the skull. CONCLUSIONS AND CLINICAL RELEVANCE: All scan directions provided detailed images of orbital structures. Transverse images were convenient for survey examination, and dorsal oblique and sagittal oblique images were superior for imaging optic nerves and extraocular muscles. Image quality of reconstructed images obtained from the 2-mm-thick transverse images was superior to that obtained from the 5-mm-thick images. Optimum quality was achieved with direct multiplanar imaging.     

A sacro‐caudal spinal cord choroid plexus papilloma in a shar‐pei dog

A seven‐year‐old shar‐pei dog was referred because of severe lumbosacral pain and faecal incontinence of 20 days’ duration. Neurological examination was characterised by plegic tail, absence of perineal reflex, dilated anus, perineum and tail analgesia, and severe lumbosacral pain. The neurological clinical signs were suggestive of a selective lesion involving sacral and caudal spinal cord segments and/or related nerve roots. A magnetic resonance imaging of lumbosacral spine was performed and was suggestive of an intradural lesion. Primary or secondary neoplasia was considered as the most probable differential diagnosis. The dog was euthanased upon the owner's request. Histopathological examination confirmed the presence of an intradural‐extramedullary neoplastic tissue enveloping intradural tract of spinal nerve roots. On the basis of histological and immunohistochemical findings, a diagnosis of well‐differentiated choroid plexus papilloma was made. To the authors's knowledge, this is the first case of primary or metastatic spinal choroid plexus papilloma in dogs.     

Dynamic MRI is reliable for evaluation of the lumbosacral spine in healthy dogs

Magnetic resonance imaging (MRI) is commonly used to diagnose degenerative lumbosacral stenosis; however, studies show limited correlation between imaging and clinical signs. The purpose of this prospective observer agreement study was to use dynamic MRI of the lumbosacral (LS) spine of healthy dogs to determine reliable reference ranges. Twenty‐two healthy large breed dogs were prospectively enrolled. MRI of the LS spine was performed in T2‐weighted, T1‐weighted, and T2‐weighted SPACE sequences in neutral, flexed, and extended positions. Four observers performed image analyses. Measurements included LS angle, vertebral canal height and area, and LS foraminal areas. Ordinal categorical assessment of loss of fat signal in the foramina, LS compression, intervertebral disc (IVD) degeneration, spondylosis, and IVD protrusion was also performed. The majority of values were significantly larger in flexion versus neutral position, and significantly smaller in extension versus neutral position (P < .05). Subclinical compression and IVD protrusion was noted in a neutral position in 45% and 55% of dogs and in an extended position in 85% and 73% of dogs, respectively. Interobserver agreement was strong (intracluster correlation coefficient [ICC] > .5) except for the L7:LS vertebral canal area ratio (ICC ≤ .03). Intraobserver agreement was high (rho > .5) for all measurements except for the mid‐L6:LS vertebral canal height ratio (rho = .38). There was poor interobserver agreement for loss of fat signal in the foramina and evidence of compression. This study provides the groundwork for future studies using dynamic MRI to evaluate dogs with signs of clinical LS disease.     

MR-imaging of lumbosacral intervertebral disc degeneration in clinically sound German shepherd dogs compared to other breeds

German shepherd dogs are overrepresented in the group of dogs with cauda equina compression syndrome due to degenerative lumbosacral stenosis. A congenital predisposition for early degeneration of the lumbosacral intervertebral disc has been suspected. Our aims were to assess the morphologic appearance of the lumbosacral intervertebral disc and the lumbosacral junction in healthy German shepherd dogs compared to other breeds and to evaluate for an early onset of degenerative changes. The lumbosacral spine of 110 clinically sound German shepherd dogs and 47 healthy dogs of other large breeds was examined using magnetic resonance (MR) imaging. The degeneration of every intervertebral disc was graded using an established classification system. Signal intensity of the entire lumbosacral disc and the nucleus pulposus was determined independently. Lumbosacral malalignment was assessed according to a previously described method. The findings for the German shepherd dogs were compared to those of the other breeds. Although most dogs were younger than 18 months at the date of examination, significantly higher grades of degeneration were detected for the lumbosacral intervertebral disc of German shepherd dogs (P < 0.003). Degeneration of the lumbosacral intervertebral disc was independent from findings in the other lumbar discs. We conclude that the German shepherd dog has a predisposition for degenerative changes in the lumbosacral intervertebral disc.     

FLEXION-EXTENSION MYELOGRAPHY OF THE CANINE CAUDA EQUINA

The radiographic appearance of the canine dural end-sac and its behavior during flexion and extension of the spine is described in a myelographic study in 22 normal dogs and 26 dogs with cauda equina compression syndrome. In more than 80% of the dogs, the dural sac ended at the level of the sacrum. There were relatively large individual differences in shape and size of the dural end-sac. In contrast, shape, length, position, and diameter of the dural end-sac at the level of the lumbosacral articulation is extremely constant during flexion and extension in normal individuals. In the 26 dogs with lesions affecting the cauda equina and nerve roots between L6 and the first caudal vertebra, myelography was diagnostic in 21 dogs. Myelographic diagnosis of cauda equina compression was possible in seven dogs with spine in flexion. In 14 dogs, overextension of the spine and imaging in lateral and dorsal recumbency was necessary to establish a diagnosis. The five dogs with nondiagnostic myelograms had either a dural end-sac ending cranially to the lesion (two dogs), diseases not associated with compression (two dogs), or only slight indentations of the contrast medium column (one dog).     

Association between postoperative outcome and results of magnetic resonance imaging and computed tomography in working dogs with degenerative lumbosacral stenosis

OBJECTIVE: To determine whether results of magnetic resonance imaging (MRI) and computed tomography (CT) are associated with postoperative outcome in working dogs with degenerative lumbosacral stenosis. DESIGN: Prospective cohort study. ANIMALS: 12 dogs treated surgically for degenerative lumbosacral stenosis. PROCEDURE: The lumbosacral vertebral column was examined before surgery by use of MRI and CT and after surgery by use of CT. Outcome, based on performance in standardized training exercises, was assessed 6 months after decompressive surgery. Associations between imaging results and postoperative outcome were determined by use of a Fisher exact test and logistic regression. RESULTS: None of the dogs were able to perform their duties before surgery. By 6 months after surgery, 8 of 12 dogs had been returned to full active duty. Nerve tissue compression was effectively localized by use of CT and MRI. Significant associations between results of imaging studies and postoperative outcome were not identified. CONCLUSIONS AND CLINICAL RELEVANCE: Surgical intervention is justified in high-performance working dogs with degenerative lumbosacral stenosis. However, results of imaging studies may be less important than clinical or surgical factors for predicting outcome in affected dogs.     

FEASIBILITY OF ULTRASOUND‐GUIDED EPIDURAL ACCESS AT THE LUMBO‐SACRAL SPACE IN DOGS

Epidural injections are commonly performed blindly in veterinary medicine. The aims of this study were to describe the lumbosacral ultrasonographic anatomy and to assess the feasibility of an ultrasound‐guided epidural injection technique in dogs. A cross sectional anatomic atlas of the lumbosacral region and ex vivo ultrasound images were obtained in two cadavers to describe the ultrasound anatomy and to identify the landmarks. Sixteen normal weight canine cadavers were used to establish two variations of the technique for direct ultrasound‐guided injection, using spinal needles or epidural catheters. The technique was finally performed in two normal weight cadavers, in two overweight cadavers and in five live dogs with radiographic abnormalities resulting of the lumbosacral spine. Contrast medium was injected and CT was used to assess the success of the injection. The anatomic landmarks to carry out the procedure were the seventh lumbar vertebra, the iliac wings, and the first sacral vertebra. The target for directing the needle was the trapezoid‐shaped echogenic zone between the contiguous articular facets of the lumbosacral vertebral canal visualized in a parasagittal plane. The spinal needle or epidural catheter was inserted in a 45° craniodorsal–caudoventral direction through the subcutaneous tissue and the interarcuate ligament until reaching the epidural space. CT examination confirmed the presence of contrast medium in the epidural space in 25/25 dogs, although a variable contamination of the subarachnoid space was also noted. Findings indicated that this ultrasound‐guided epidural injection technique is feasible for normal weight and overweight dogs, with and without radiographic abnormalities of the spine.     

Magnetic Resonance Imaging in the Diagnosis of Degenerative Lumbosacral Stenosis in Four Dogs

Magnetic resonance imaging was used to diagnose degenerative lumbosacral stenosis in four dogs that had physical and neurologic signs consistent with a cauda equina lesion. Nerve root displacement by protruding disc material and loss of epidural fat were identified. In all dogs, the diagnosis was confirmed by dorsal laminectomy of the lumbosacral area.