Prevalence of Urinary Tract Infection in Dogs after Surgery for Thoracolumbar Intervertebral Disc Extrusion

Background: Urinary tract infection (UTI) is a common complication in people with spinal cord injury (SCI). Dogs with acute intervertebral disc extrusion (IVDE) have similar risk factors for UTI when compared with human SCI patients and have a high perioperative prevalence of UTI. Objectives: Determine the prevalence of UTI in dogs for 3 months after surgery for thoracolumbar IVDE and identify risk factors for development of UTI. Animals: Twenty‐five dogs treated surgically for 26 acute disc extrusions. Methods: Prospective study. Urinalysis and urine culture were performed perioperatively. At home, owners monitored urine with dipsticks every 48 hours for 1 month then once a week until 3 months. Dogs returned for assessment of motor function, urinalysis, and urine culture at 1 and 3 months after surgery. Presence of UTI over the 3‐month period was correlated to potential risk factors. Results: Ten dogs (38%) developed 12 UTIs over the 3‐month period, with the majority occurring between weeks 1 and 6; 60% of the UTIs were occult. Hematuria in the absence of pyuria or UTI was a common finding in the perioperative period. Sex, breed, and ambulatory status influenced the risk of developing a UTI. Conclusions and Clinical Importance: There is a high prevalence of UTIs, many of which are occult, in the 3 months after surgery for thoracolumbar IVDE. These dogs should be routinely monitored for UTI with urine culture regardless of urinalysis results.     

Clinical Characteristics of Dogs with Progressive Myelomalacia Following Acute Intervertebral Disc Extrusion

Background

Progressive myelomalacia (PMM) is a catastrophic disease associated with acute intervertebral disc extrusion (IVDE). Published data on the clinical characteristics of this disease are limited.

Objective

To describe the onset and progression of clinical signs of PMM in a large case cohort.

Animals

Fifty‐one dogs, 18 with histopathologically confirmed PMM, 33 presumptively diagnosed based on clinical signs and diagnostic imaging.

Methods

Retrospective study. Dogs with confirmed IVDE and either a histopathologic diagnosis of PMM or a high clinical suspicion were identified by medical record search. Data on nature and progression of signs were extracted.

Results

Twenty‐four of 51 dogs were Dachshunds. T12–T13 was the most common site of disc extrusion (12 of 56), and 18 of 55 of mid‐to‐caudal lumbar discs (between L3 and L6) were affected. Onset of PMM signs ranged from present at first evaluation (17/51) to 5 days after presentation, with 25 of 51 cases developing signs within 48 hours. Progression of signs from onset of PMM to euthanasia or death, excluding 7 cases euthanized at presentation, ranged from 1 to 13 days with 23 being euthanized within 3 days. Nonspecific systemic signs were documented in 30 of 51 dogs.

Conclusion and Clinical Importance

The majority of dogs developed PMM within 2 days of presentation and was euthanized within another 3 days. However, onset can be delayed up to 5 days after presentation with progression to euthanasia taking as long as 2 weeks. Mid‐to‐caudal lumbar discs might be associated with an increased risk of PMM.     

Surgical Decompression in Dogs with Thoracolumbar Intervertebral Disc Disease and Loss of Deep Pain Perception: A Retrospective Study of 46 Cases

The case details and outcome after surgical decompression of 46 dogs with thoracolumbar intervertebral disc disease with loss of deep pain perception prior to surgery were reviewed. Nineteen dogs (41.3%) recovered with a median follow-up period of 12.5 months. Recovery was defined as an ambulatory paraparesis, or better, with urinary and fecal continence. There was a better outcome in dogs with loss of deep pain for less than 24 hours prior to surgery (19/41; 46.3% recovered) than in dogs without deep pain perception for more than 24 hours (0/5; 0% recovered). Dogs with deep pain perception present at two weeks postoperatively had significantly higher success rate (8/12; 66.7% recovered) than dogs without deep pain perception at this time period (1/10; 10.0% recovered). The return of deep pain perception by two weeks postoperatively can be a useful positive prognostic indicator.     

A Comparison of Manual and Power-Assisted Thoracolumbar Disc Fenestration in Dogs

Thoracolumbar disc fenestration was performed in eight canine cadavers. A hole was cut in the anulus fibrosus with a scalpel in four dogs, and with a high speed drill and burr in four dogs. A curette was used to remove as much of the nucleus pulposus as possible. Sixty-five percent of the nucleus pulposus was removed with the power-assisted technique and 41% was removed by manual fenestration. Manual and power-assisted disc fenestration were performed on alternate intervertebral discs from T11-12 to L5-6 in four dogs. Six months after surgery, results of high-detail radiographic and histologic evaluation of the vertebral bodies and discs showed minimal difference in the sequelae of the two techniques. A retrospective medical records analysis and follow-up of 60 clinical cases treated with prophylactic, power-assisted disc fenestration failed to identify any cases with postoperative recurrence of neurologic deficits. Ten percent of the dogs had periodic back pain of unknown etiology, without other signs of intervertebral disc disease. The findings of this study indicate that power-assisted disc fenestration permits more complete evacuation of the nucleus than manual fenestration, causes no more postoperative complications, and results in a low recurrence rate of neurologic deficits.     

Urinary Tract Infection in Dogs with Thoracolumbar Intervertebral Disc Herniation and Urinary Bladder Dysfunction Managed by Manual Expression,Indwelling Catheterization or Intermittent Catheterization

Objective— To evaluate risk factors for lower urinary tract infection (UTI) in dogs with intervertebral disc disease (IVDD) that had manual expression (ME), indwelling catheterization (IDC) or intermittent catheterization (ITC) for urinary bladder management. Study Design— Randomized‐clinical trial. Animals— Dogs (n=62) treated with urinary bladder dysfunction requiring surgery for IVDD and control dogs (n=30) that had surgery for reasons other than IVDD. Methods— Treated dogs were randomly assigned to ME, IDC, or ITC. Urine was collected for culture and antimicrobial susceptibility testing before and after treatment. Incidence and risk factors for UTI were evaluated. Bacterial isolates and antimicrobial resistance patterns were described. Results— Mean (±SD) time to urination was significantly longer for IDC dogs (7.4±2.75 days) than ME dogs (4.2±2.63) and ITC dogs (4.9±3.12). Thirteen treated dogs (21%) and no control dogs developed UTI: 4/25 (16%) ME, 8/25 (32%) IDC, and 1/12 (8%) ITC. Enterobacter sp. was most frequently isolated (4/13; 31%). Duration of treatment was the only risk factor for UTI and each additional day of treatment increased the risk of UTI 1.5 times. Conclusion— For dogs with acute IVDD, the duration of required urinary bladder management establishes the risk of UTI, not the urinary bladder management technique. Clinical Relevance— Duration of treatment for urinary bladder dysfunction is a risk factor for UTI in dogs recovering from acute IVDD. Treatment for urinary bladder management should be limited where possible and no method of treatment is preferred. For dogs managed by IDC, voluntary urination might occur before clinically suspected.     

Incidence of Spinal Compressive Lesions in Chondrodystrophic Dogs with Abnormal Recovery after Hemilaminectomy for Treatment of Thoracolumbar Disc Disease: A Prospective Magnetic Resonance Imaging Study

Objective— To investigate causes of the lack of clinical improvement after thoracolumbar disc surgery. Study Design— Case–control magnetic resonance imaging (MRI) study. Animals— Chondrodystrophic dogs with acute thoracolumbar disc disease treated by hemilaminectomy: 10 that had no short‐term clinical improvement and 12 with “normal” clinical improvement. Methods— Dogs that had surgery for treatment of intervertebral disc extrusion (2003–2008) where thoracolumbar disc disease was confirmed by MRI were evaluated to identify dogs that had lack of clinical improvement after surgery. Ten dogs with delayed recovery or clinical deterioration were reexamined with MRI and compared with 12 dogs with normal recovery and MRI reexamination after 6 weeks (control group). Results— Of 173 dogs, 10 (5.8%) had clinical deterioration within 1–10 days after surgery. In 8 dogs, residual spinal cord compression was identified on MRI. Bleeding was present in 1 dog. In 3 dogs, the cause was an incorrect approach and insufficient disc material removal. In 3 dogs, recurrence occurred at the surgical site. In 1 dog, the centrally located extruded material was shifted to the contralateral side during surgery. These 8 dogs had repeat surgery and recovery was uneventful. In 2 dogs, deterioration could not be associated with a compressive disc lesion. Hemorrhagic myelomalacia was confirmed by pathologic examination in 1 dog. The other dog recovered after 6 months of conservative management. Conclusion— Delayed postsurgical recovery or deterioration is commonly associated with newly developed and/or remaining compressive disc lesion. Clinical Relevance— We recommend early MRI reexamination to assess the postsurgical spinal canal and cord, and to plan further therapeutic measures in chondrodystrophic dogs with delayed recovery after decompressive hemilaminectomy for thoracolumbar disc disease.     

Dorsal Decompressive Laminectomy for Treatment of Thoracolumbar Disc Disease in Dogs: A Retrospective Study of 98 Cases

This study reviews the records of all dogs that underwent dorsal decompressive laminectomy for thoracolumbar disc disease at the Angell Memorial Animal Hospital during a 2-year period. Findings as to age, breed, sex, and site of disc protrusion did not differ from those published by others. All dogs were operated on within 36 hours of the onset of inability to walk. The overall recovery rate was 80.6%. The recovery rate of dogs that had preoperative sensory perception was 89.5%, but was only 50.0% for those without sensory perception. The most important factor determining recovery rate was the presence or absence of preoperative sensory perception.     

针灸治疗犬椎间盘突出症90例(2000-2002)

对90例犬椎间盘突出症病例进行了总结性回顾，经针灸治疗有81例取得了很好的疗效，有效率为90％，但对于临床分级为四级的病例的疗效较低，仅为45．5％，但是针灸疗法对于提高患犬的食欲、精神状态和降低疼痛方面具有很好的作用。总之，采取中医针灸的治疗方法是一种有效的、经济的治疗方法。该种疗法是值得推广和发扬的中国中兽医的传统治疗方法。     

Correlation of Clinical, Radiographic, and Surgical Localization of Intervertebral Disc Extrusion in Small-Breed Dogs: A Prospective Study of 50 Cases

Objective —To compare prospectively clinical, radiographic, and surgical findings of intervertebral disc extrusion (IDE) localization in small-breed dogs and to determine the best means of lesion localization for the purpose of hemilaminectomy. Study Design —Clinical, radiographic, and surgical findings of small-breed dogs with thoracolumbar IDE were prospectively compared for agreement on lesion localization. Sample Population—50 small-breed dogs with IDE treated at the three participating veterinary hospitals were included in the study if no other confounding diseases were identified and if the owner gave permission for diagnostic tests and surgery. Methods —Clinical and surgical findings were recorded by the surgeon assigned to the case. Radiographic studies were evaluated independently by two radiologists blinded as to the clinical and surgical findings. values and 95% confidence intervals were calculated for agreement on lesion localization by clinical, radiographic, and surgical means and for agreement between radiologists. Results —K values for agreement of lesion localization were as follows: clinical versus surgical, 0.595; radiologist A versus radiologist B, 0.81; radiologist A versus surgical findings, 0.60; radiologist B versus surgical findings, 0.71. Both radiologists' interpretation of IDE localization agreed with surgical localization in 60% of cases. Conclusions —Clinical lateralization of IDE was found to be the least reliable factor of those studied for determining on which side the hemilaminectomy should be performed. Results of this study differ from those of previous studies examining the reliability of myelography to localize the site of IDE accurately. The results of this study further suggest that surgery may not be an absolute standard for determination of the localization of IDE in small-breed dogs. Clinical Relevance —Intervertebral disc extrusion in small-breed dogs frequently results in bilateral distribution of extruded material. Computed tomography or magnetic resonance imaging may be necessary to delineate completely the distribution of extruded disc material in IDE.     

Spinal Cord Swelling as a Myelographic Indicator of Prognosis: A Retrospective Study in Dogs With Intervertebral Disc Disease and Loss of Deep Pain Perception

The association of myelographic spinal cord swelling with neurological outcome was examined in 46 dogs with intervertebral disc disease and absence of deep pain perception (DPP). Spinal cord swelling was measured by calculating a ratio of the length of the loss of the myelographic dye column to the length of the second lumbar vertebra (L2). A positive neurological outcome was defined as return of voluntary motor function. A cut-off value for swelling:L2 of 5.0 was established by the creation of a receiver operator characteristic curve. Using a swelling:L2 ratio of 5.0 as a cutoff for indication of neurological recovery yielded a sensitivity of 74% and a specificity of 61%. Overall neurological recovery rate was 43%. Dogs with spinal cord swelling: L2 ratios less than 5.0 had a recovery rate of 61%, whereas dogs with a ratio greater than or equal to 5.0 had a recovery rate of 26%. Evaluation of these data by chi square analysis confirmed that a ratio less than 5.0 was associated with a positive outcome, and a ratio greater than or equal to 5.0 was associated with a negative outcome, ( P <.05). Although other factors, such as duration of neurological signs, affect neurological outcome in dogs with no DPP, evaluation of myelographic spinal cord swelling can assist in establishing a prognosis.     

Early Biomarkers of Inflammation in Dogs and Cats: The Acute Phase Proteins

Veterinary Research Communications - Paltrinieri, S., 2007. Early biomarkers of inflammation in dogs and cats: the acute phase proteins. Veterinary Research Communications, 31(Suppl. 1), 125–129     

Electrophysiologic Assessment of Acute Polyradiculoneuropathy in Dogs: Comparison with Guillain-Barré Syndrome in People

Electrophysiologic investigations of motor and sensory nerve as well as ventral nerve root function were performed on 12 dogs with suspected acute canine polyradiculoneuropathy (ACP) at different stages and with different severity of disease. The most reliable electrophysiologic indicators of ACP were electromyographic changes (occurring in 100% of affected dogs), significantly decreased compound muscle action potential amplitudes (in 75, 90, and 100% of affected dogs at all sites along the sciatic/tibial, radial, and ulnar nerves, respectively), increased minimum F-wave latencies (67%), increased F ratios (92%), and decreased F-wave amplitudes (67%). These findings suggest that ACP represents a peripheral motor axonopathy, with demyelination and axonal involvement also occurring in ventral nerve roots. Evidence of peripheral demyelination was present in some dogs although it was overshadowed by the prominent axonopathy. ACP more closely resembles the acute axonal or intermediate forms of Guillain-Barré syndrome in people.