METRIZAMIDE MYELOGRAPHY OF THE EQUINE CERVICAL SPINE

Case histories of 14 horses with pelvic limb ataxia requiring myelography were reviewed. Because differential diagnosis requires radiography, comparisons of lesion location, radiographic techniques, and lesion patterns were studied. Survey radiography and myelography were performed under general anesthesia, with recumbent-lateral and flexed-lateral views of the carnial and caudal cervical spine. Metrizamide was the myelographic contrast medium. Assessment of radiography as a diagnostic aid for cervical vertebral instability and cervical stenotic myelopathy was made through the comparison of survey radiographs and myleograms, in nonflexed and flexed positions, using these criteria: width of dorsal and ventral columns of contrast medium, compression of intervertebral disc spaces, presence or absence of bone proliferation at articular facets, remodeling secondary to vertebral instability. Radiography was an adequate diagnostic aid for cervical vertebral instability and cervical stenotic myelopathy. Distribution of lesions showed C_3–4 most common, with C_2–3 and C_4–5 following.     

Contrast-enhanced computed tomography and myelography in six horses with cervical stenotic myelopathy.

The cervical spines of 6 horses with cervical stenotic myelopathy (CSM) were examined using myelography and contrast-enhanced computed tomography (CECT). Histopathology of the spinal cord of these horses identified 10 neurologically significant compressive lesions. Myelography and CECT were both able to demonstrate all 10 spinal cord compressive lesions, but myelography falsely identified 2 sites and CECT falsely identified 1 site as compressive lesions of the spinal cord which were not supported by histopathology. Additional qualitative information was obtained by CECT regarding the source, severity and location of spinal cord compression. Computed tomography identified stenosis of the vertebral canal with circumferential loss of contrast agent and documented lateral compressive lesions of the spinal cord due to malformed articular facets. Compression of the peripheral nerve roots by malformed articular facets encroaching on the intervertebral foramen was easily identified by CECT in the axial plane. No compressive lesions were identified in 3 unaffected horses by either method. Minimum sagittal diameter (MSD) values obtained from CECT images were strongly correlated with necropsy measurements, validating CECT as an accurate method of obtaining MSD values. The MSD values in the CSM-affected horses were significantly narrowed (P less than 0.05) from C3C6 regardless of the site of spinal cord compression, when compared with the unaffected controls. This finding supports previous reports suggesting that generalised stenosis of the vertebral canal is an important feature in the pathogenesis of cervical stenotic myelopathy.     

Vascular malformation (cavernous angioma) of the spinal cord in a dog

Cavernous angioma was found in the C₅-C₆ spinal cord segments of a 4–month-old female Siberian Husky. The malformation appeared as vessels packed together and lined by simple endothelial cells surrounded by a thin layer of collagenous connective tissue. These vessels were not separated by neural tissue. Clinically, the dog was presented with progressive tetraparesis over a 1-month period.     

Evaluation of decision criteria for detection of spinal cord compression based on cervical myelography in horses: 38 cases (1981-2001)

REASONS FOR PERFORMING STUDY: Different criteria have been described based on height reduction of the total myelographic contrast column and components of it as tests for compression of the spinal cord due to cervical stenotic myelopathy (CSM). Fifty percent height reduction of the dorsal myelographic column (DMC), <2 mm empiric height of the DMC and a 40% reduction of the ratio of stenosis calculated based on the height reduction of the entire dural diameter (DD) have been described as decision criteria for considering the test result positive. The reasons for selecting these decision criteria or their accuracies have rarely been reported. OBJECTIVES: To evaluate the accuracy of diagnostic criteria based on reduced height of the total myelographic column and components of it for diagnosing extradural spinal cord compression using different decision criteria, and make recommendations for consistent myelographic interpretation in horses suspected of having CSM. METHODS: Four measurements were obtained by 2 readers in a retrospective sample population of 38 horses in which both cervical myelography and histopathological examination of the cervical spinal cord were performed. The prevalence of CSM in the sample was 50%. At intervertebral sites, the minimum heights of the DD and DMC were measured. At intravertebral sites, the maximum heights of the entire DD and DMC were obtained. Percent height reductions of the DMC and DD were determined as the ratio of minimum intervertebral height to maximum intravertebral height within the next cranial vertebra. Histological examination was used as the gold standard for determining the actual site of spinal cord compression. Sensitivity and specificity for the diagnostic criteria were estimated at each site in neutral and flexed neck positions using several different decision criteria. CONCLUSIONS: At C6-C7, in neutral or flexed neck position and using 20% reduction of DD, the test was highly sensitive and specific for CSM. At other sites, reduced height of the myelographic column generally was not accurate for diagnosing extradural spinal cord compression. Using 20% reduction of DD in neutral position at the mid-cervical sites, the test had only low sensitivity and high specificity. Flexion of the neck appeared to increase detection of spinal cord compression in the mid-cervical region, but also substantially increased the frequency of false-positive diagnoses. POTENTIAL RELEVANCE: By using the reported sensitivity and specificity estimates, readers may decide on a decision criterion for diagnosis of extradural spinal cord compression due to CSM. However, in planning a surgical correction, it is difficult to define a decision criterion that combines acceptable sensitivity and specificity, especially at the mid-cervical sites.     

Management of cervical spondylopathy-associated intervertebral, disc protrusions using metal washers in 78 dogs

Intervertebral 7.5 mm (n = 75) and 6.0 mm (n = 22) metal washers were used to distract intervertebral spaces in 78 consecutive cases of canine cervical spondylopathy-associated disc protrusions, where myelography had demonstrated traction-responsive spinal cord compression. Nineteen dogs had compressive lesions at two sites. Fifty lesions were evaluated myelographically on immediate postoperative radiographs; of these, 32 compressions had been eliminated and 18 had been reduced. Euthanasia was performed in nine dogs within six months of surgery and 15 dogs had varying degrees of neck pain during this period. Long-term follow-up information was available on 65 dogs nine to 70 months following surgery (median 32 months). Sixty-three of these dogs improved postoperatively. Neurological function subsequently deteriorated in 17 dogs 10 to 59 months following surgery (median 34 months). Eight of these 17 cases had further myelographic investigations and all had additional disc protrusions with no evidence of cord compression at the previous sites of surgery. The remaining nine cases had a deterioration in hindlimb function but were not investigated further.     

TRAUMATIC DURAL LACERATION IN A RACING GREYHOUND

Acute pelvic limb paralysis occurred in a racing Greyhound after a traumatic incident. During myelography, a dorsal laceration of the dura mater was detected at T_12–13. Immediate hemilaminectomy was performed at T_12–13, but neurologic status did not improve. At necropsy there was epidural and subdural hemorrhage at the T_12–13 interspace, and malacia and swelling of the spinal cord at that level. Intramedullary hemorrhage, malacia, and free fibrocartilaginous material characterized histopathology of the lesion. Possible mechanisms of the traumatic disk extrusion are discussed.     

Suspected Spinal Epidural Empyema and Associated Vertebral Osteomyelitis (Physitis)in a Dog

A 1 year old female Aurstralian Heeler dog was presented for fever and paraplegia of recent onset. Radiography and myelography revealed osteolysis of the first lumber (L₁) vertebra and extensive epidural spinal cord compression from the level of the thirteenth thoracic (T₁₃) to the fourth lumbar (L4) vertebra. A decompressive hemilaminectomy was performed; purulent-appearing fluid and inflamed epidural fat were present in the vertebral canal. The neurologic recovery of the dog was satisfactory 6 months following surgery.     

Epidural Idiopathic Sterile Pyogranulomatous Inflammation Causing Spinal Cord Compressive Injury in Five Miniature Dachshunds

Objective— To characterize the clinical signs, diagnostic and surgical findings, and outcome of dogs with idiopathic sterile pyogranulomatous inflammation (ISP) of epidural fat causing spinal cord compression.
Study Design— Retrospective study.
Animals— Dogs (n=5).
Methods— Dogs with epidural ISP (2002–2006) were identified retrospectively. Inclusion criteria were neurologic examination, myelography, and definitive diagnosis of ISP confirmed by surgery and histopathologic examination of epidural spinal cord compressive tissue.
Results— The most common clinical sign was paraparesis/paraplegia. No abnormalities were detected by laboratory testing or survey spine radiographs. On myelography, extradural spinal cord compressions were focal (dogs 1, 3, and 5) or multifocal (dogs 2 and 4). Surgical decompression of the spinal cord was completed by hemilaminectomy. Epidural fat collected surgically had pyogranulomatous inflammation of unknown cause and was histologically similar to subcutaneous ISP. All dogs had good long-term neurologic outcome (10–45 months follow-up). Some dogs had episodes of ISP at other sites before or after surgical treatment of epidural ISP, suggesting there may be a systemic form of ISP.
Conclusion— Epidural ISP may cause a spinal cord compressive lesion in Miniature Dachshunds, which can be treated by surgical decompression of the spinal cord with or without administration of adjunctive steroids.
Clinical Relevance— Epidural ISP should be considered as a possible cause of thoracolumbar myelopathy for Miniature Dachshunds.     

Confirmed and presumptive cervical vertebral compressive myelopathy in older horses: a retrospective study (1992-2004)

BACKGROUND: Cervical vertebral compressive myelopathy (CVCM) is a common cause of myelopathy in horses aged 6 months to 4 years. Little information is available regarding the types of lesions, treatment, and outcomes in horses with CVCM that are > or =4 years old. ANIMALS: Twenty-two affected horses (10 with a confirmed diagnosis of CVCM and 12 presumptive cases) and 210 contemporaneous control horses. METHODS: Horses > or =4 years old that were diagnosed with CVCM between January 1992 and January 2004 were identified from medical records at Texas A&M University and the University of Florida. Data analyzed included history, signalment, neurologic examination findings, lesion location, treatment, and outcome. Signalment was also recorded in a population of contemporaneous controls. RESULTS: Horses identified had a median age of 8.4 years, and there was a greater percentage of male horses among the cases than among the controls. The most common breeds represented were warmblood (n=6) and quarter horse (n=5) types; warmbloods were significantly (P < .05) overrepresented relative to control horses. The caudal cervical vertebral column was the most common site of CVCM lesions, and the C5-C6 (4/9) and C6-C7 (3/9) articulations were most often identified as abnormal via myelography. The most common lesions seen with radiography and myelography were articular process osteophytes. Of the 22 affected horses, 8 were euthanized and a diagnosis of CVCM was confirmed by necropsy for all; 5 of 8 of these horses had spinal cord compression caused, entirely or in part, by articular process osteophytes. Medical management was the therapy chosen in all horses, and administration of corticosteroids and nonsteroidal anti-inflammatory drugs resulted in improvement in the greatest number of horses. CONCLUSIONS AND CLINICAL IMPORTANCE: CVCM should be a differential diagnosis in older horses with cervical myelopathy. Articular process osteophytes are the most frequently identified cause of spinal cord compression in this group. Male horses and horses of warmblood or Tennessee Walking Horse breeds may be predisposed to this condition.     

EVALUATION OF DIFFERENT COMPUTED TOMOGRAPHY TECHNIQUES AND MYELOGRAPHY FOR THE DIAGNOSIS OF ACUTE CANINE MYELOPATHY

Forty‐six dogs with either cervical (C1–C5 or C6–T2) or thoracolumbar (T3–L3) acute myelopathy underwent prospective conventional computed tomography (CT), angiographic CT, myelography, and CT myelography. Findings were confirmed at either surgery or necropsy. Seventy‐eight percent of lesions were extradural, 11% were extradural with an intramedullary abnormality, 7% were intramedullary, 2% were intradural–extramedullary, and 2% had nerve root compression without spinal cord compression. Intervertebral disc herniation was the most frequent abnormality regardless of signalment or neurolocalization. Twenty‐one of 23 Hansen type I disc extrusions but none of the Hansen type II disc protrusions were mineralized. Two chondrodystrophic dogs had acute myelopathy attributable to extradural hemorrhage and subarachnoid cyst. CT myelography had the highest interobserver agreement, was the most sensitive technique for identification of compression, demonstrating lesions in 8% of dogs interpreted as normal from myelography and enabling localization and lateralization in 8% of lesions incompletely localized on myelography due to concurrent spinal cord swelling. None of the imaging techniques evaluated permitted definitive diagnosis of spinal cord infarction or meningomyelitis but myelography and CT myelography did rule out a surgical lesion in those cases. While conventional CT was adequate for the diagnosis and localization of mineralized Hansen type I disc extrusions in chondrodystrophic breeds, if no lesion was identified, plegia was present due to concurrent extradural compression and spinal cord swelling, or the dog was nonchondrodystrophic, CT myelography was often necessary for correct diagnosis.     

Usefulness of myelography with multiple views in diagnosis of circumferential location of disc material in dogs with thoracolumber intervertebral disc herniation

The usefulness of myelography with multiple views (lateral, ventrodorsal, left and right oblique view) in the diagnosis of the exact circumferential location of herniated disc material around the spinal cord in 80 dogs diagnosed with thoracolumbar intervertebral disc herniation at surgery was assessed by comparison of clinical and surgical findings. The circumferential location of the compressing mass was diagnosed in 94% of dogs on myelography. The oblique view was of more benefit than the ventrodorsal view in diagnosing the circumferential distribution of the compressing mass. Only the oblique view contributed to a diagnosis of lateralization of the compressing mass in 45% of dogs. Fourteen percent of dogs had clinical lateralization contralateral to myelographic lateralization. The myelographic localization agreed with the surgical localization in 97% of dogs with regard to the exact location of herniated disc material. The presence of clinical lateralization contralateral to myelographic lateralization and a high proportion of agreement of myelographic and surgical localization documents that myelography with multiple views is useful and essential to accurately determine the circumferential location of disc material around the spinal cord.     

Biomechanical Analysis of the Three-Dimensional Motion Pattern of the Canine Cervical Spine Segment C4–C5

Objective— To study the kinematics of cervical spine segment C₄–C₅ and its association with disc dimensions and the coupled motion (CM) in relation to primary motion (PM).
Study Design— Cadaveric biomechanical study.
Animals— Cadavers of large breed dogs (>20 kg; n=11).
Methods— Spines were freed from muscles. Radiographs were taken orthogonal to the C₄–C₅ disc space and disc thickness, endplate width, and height were measured. Spines were mounted on a simulator for 3-dimensional motion analysis. Data were recorded with an optoelectronic motion analysis system. Range of motion (ROM) and neutral zone (NZ) were determined in the direction of flexion/extension, left/right lateral bending, and left/right axial rotation, as well as the ROM of CM.
Results— ROM in flexion and extension was similar; there was no CM in flexion/extension. Left/right axial rotation and left/right lateral bending were coupled to the same side. CM was 1.72 and 3.56 times the ROM of the PM in lateral bending and axial rotation, respectively. Disc dimensions were positively correlated with body weight. Flexion/extension magnitude was significantly reduced for larger endplates, but axial rotation was not influenced. Lateral bending had no correlation with weight or disc dimensions.
Conclusion— Left/right lateral bending and left/right axial rotation are coupled differently in the C₄–C₅ segment in dogs compared with humans.
Clinical Relevance— The canine C₄–C₅ spinal segment has unique motion coupling patterns that should be considered for dynamic implant designs.     

Pharmacokinetics of chloramphenicol in the neonatal horse

Chloramphenicol sodium succinate was administered as an intravenous bolus (50 mg/kg) to eight foals which weighed 49–57 kg (mean ± 1 standard deviation = 53.19 ± 2.66) each, and were 1–9 days (4.5 ± 2.56) of age. The drug was rapidly distributed and followed first-order elimination. Mean pharmacokinetic values were: zero-time serum concentration (C₀) = 36.14 μg/ml (±14.80); apparent specific volume of distribution ( V_d ) = 1.614 1/kg (±0.669); and elimination rate constant ( K ) = 0.7295 h^-1 (±0.3066) which corresponds to a biological half-life ( t _1/2) = 0.95 h. These values do not differ greatly from those reported for adult horses and ponies.
A suspension of chloramphenicol was administered by nasogastric tube (50 mg/kg) to a second group of seven foals which weighed 49 to 57 kg (51.34 ± 2.82) each and were 1 to 7 days (4.43 ± 1.90) of age. A mean peak serum chloramphenicol concentration of 23.97 μg/ml (±7.06) was achieved 1.14h (±0.63) after administration. The bioavailability of this preparation was 83.27 percent.     

Computed tomographic myelography of a foal with discospondylitis and extradural spinal cord compression due to a vertebral abscess

A one‐month‐old Quarter Horse colt presented with progressive gait abnormalities and weakness. The foal was ataxic at presentation. Radiography identified focal endplate irregularities and lysis at C6–7. Radiographic diagnosis was discospondylitis. Computed tomographic myelography was performed immediately following euthanasia and identified an extradural compressive spinal cord lesion corresponding to the site of discospondylitis. Post mortem examination findings included abscess formation at the C6–7 intervertebral space with osteomyelitis extending into the adjacent physes and subchondral bone of caudal C6 and cranial C7. The vertebral abscess extended into the ventral spinal canal at C6–7 and was identified as the cause of extradural spinal cord compression. Salmonella sp. was cultured and isolated from purulent exudate at the intervertebral space. Computed tomographic myelography has not been previously reported for assessment of discospondylitis in horses and was successful at accurately characterising spinal cord compression in addition to osteolytic changes associated with discospondylitis.     

Characteristic computed tomographic myelography findings in 23 Thoroughbred horses

The purpose of this observational study was to determine the characteristic computed tomographic (CT) myelography findings of cervical vertebral stenotic myelopathy (CVSM) lesions in Thoroughbred horses. A total of 23 Thoroughbred horses (age range, 155–717 days on CT examination; mean, 410.9 days) were analyzed. All 23 Thoroughbred horses underwent unenhanced radiography, radiographic myelography, and CT myelography. Unenhanced radiographs were observed the presence of cervical vertebral malalignment and osseous lesions. Radiographic myelograms were observed for signs of cervical spinal cord compression; additionally, CT myelograms were used to detect cervical vertebral osseous lesions. Ventral compressions were frequently observed in the cranial cervical vertebrae (C2–C4), whereas dorsal compressions were frequently observed in the caudal cervical vertebrae (C5–C7). Furthermore, osseous lesions of the caudal articular process developed more frequently than those of the cranial articular process. CT myelography in Thoroughbred horses is a useful method for detecting CVSM changes.     

Thoraco-Lumbar Myelography with Water-Soluble Contrast Medium in Dogs I. Technique of Myelography; Side-effects and Complications

Abstract— A technique previously devised by the author for filling the greater part of the spinal subarachnoid space with water-soluble contrast medium (Kontrast U^R) has been tested for myelographic localization, of thoracic and lumbar compression of the spinal cord in the dog. The principle for the myelographic examination has been to inject the medium in the lumbar region in a sufficient dose for it to be forced beyond the compressed part of the subarachnoid space, to permit demonstration of both the posterior and anterior limit of the compression. A single injection of 20 per cent Kontrast U into the subarachnoid space in the dose generally used (0·3 ml/kg of body weight) does not seem to have any detrimental effect on the spinal cord. On the other hand, morphologic lesions of the spinal cord, presumably to be ascribed to the preparation in question, have been observed after repeated injections of contrast medium at the same examination.     

Vertebral stabilization using positively threaded profile pins and polymethylmethacrylate, with or without laminectomy, for spinal canal stenosis and vertebral instability caused by congenital thoracic vertebral anomalies

Objective— To describe diagnostic findings, surgical technique, and outcome in dogs with thoracic spinal canal stenosis and vertebral instability secondary to congenital vertebral anomalies.
Study Design— Retrospective clinical study.
Animals— Dogs (n=9) with thoracic spinal canal stenosis.
Methods— Medical records (1995–1996; 2000–2006) of 9 dogs with a myelographic diagnosis of spinal canal stenosis and/or vertebral instability secondary to congenital vertebral anomaly that were surgically managed by vertebral stabilization with or without laminectomy were reviewed. Data on pre- and postoperative neurologic status, diagnostic findings, surgical techniques, and outcomes were retrieved. Follow-up evaluations were performed at 1, 2, and 6 months. Long-term outcome was assessed by means of clinical examination or owner telephone interviews.
Results— Spinal cord compression was confirmed by myelography, and in 2 dogs, dynamic compression by stress myelography. Eight dogs regained the ability to ambulate postoperatively. One dog with a partial recovery regained voluntary movement but did not become ambulatory.
Conclusions— Spinal cord injury secondary to congenital vertebral anomaly may have a good outcome when treated by vertebral stabilization with or without laminectomy. Adequate stabilization of the vertebrae and improved neurologic outcome were achieved in most dogs.
Clinical Relevance— Vertebral stabilization using positively threaded profile pins and polymethylmethacrylate with or without laminectomy is an effective treatment for spinal canal stenosis and vertebral instability secondary to congenital thoracic vertebral anomalies.     

Congenital kyphosis secondary to lumbar vertebral hypoplasia causing paraparesis in a Friesian foal

A 5‐day‐old Friesian colt was presented with a history of severe bilateral pelvic limb weakness since birth. Clinical examination revealed a painful dorsal deviation of the spinous processes of the lumbar vertebrae, pelvic limb paraparesis and grade 4/5 ataxia. Radiographic examination revealed kyphosis due to hypoplasia and malformation of the 5 lumbar vertebrae present. At myelography performed immediately after euthanasia, dorsal deviation of the myelographic contrast column was demonstrated at the level of T18–L4 with suspected spinal cord compression noticeable at L1. There was no lateral deviation of the spinal cord or scoliosis of the vertebrae visible.     

Pathology of the vertebral column of horses with cervical static stenosis

Specimens of ligamentum flavum, joint capsule, and dorsal lamina were collected at surgery or necropsy from 25 horses with cervical static stenosis. All horses had myelographic evidence of dorsal compression of the spinal cord caused by soft tissue and/or bone in the caudal cervical area, primarily at C6-7. Most horses also had radiographic evidence of degenerative joint disease of articular facets. Histologically 19 horses had osteosclerosis and cartilage retention in the dorsal lamina, and 24 horses had increased fibrocartilage at the ligamentum flavum attachment to dorsal lamina. The ligamentum flavum and joint capsule had fibrovascular tissue in 20 horses. Fibrocartilaginous tissue, old hemorrhage, and fat necrosis were not unusual. One horse each had a synovial cyst, eosinophilic granulomas in the joint capsule, and osteochondrosis of articular facets. These findings indicate that abnormal biomechanical forces or instability of articulations result in stretching and tearing of the ligamentum flavum and joint capsule with subsequent fibrovascular and fibrocartilaginous proliferation, osteosclerosis of the dorsal lamina, and osteophyte formation on the articular facets.