Objectives: Report the rate of recurrent clinical signs following successful treatment of cervical intervertebral disc extrusion, and explore the association between treatment method and recurrence.Materials and Methods: Medical records of dogs with MRI‐ or CT‐confirmed cervical intervertebral disc extrusion were reviewed to verify that they recovered. Type of treatment, site of initial extrusion and whether dogs re‐presented with recurrent clinical signs were recorded. Recurrence was considered presumed if based on clinical signs or confirmed if based on repeat cross‐sectional imaging.Results: Complete recovery was documented following medical (36/119, 30.3%) or surgical (83/119, 69.7%) management of initial cervical disc extrusion. There was a recurrence of consistent clinical signs in 40 of 119 (34%) cases, of which 27 of 83 (33%) were initially managed surgically and 13 of 36 (36%) medically. In 24 of 40 (60%) cases, there was imaging confirmation of recurrent extrusion; in medically managed dogs, recurrence mostly occurred at the same site, whereas after surgery, recurrence most commonly involved an adjacent disc. Of the 40 recurrences, 32 (80%) occurred within 2 years of diagnosis. Rate of recurrence was similar between treatment methods in both univariable and multivariable time‐to‐event analyses (hazard ratio 1.03; 95% confidence interval: 0.67 to 1.53; P=0.87).Clinical Significance: Following successful initial medical or surgical treatment, clinical signs consistent with recurrent cervical disc extrusion occurred with similar frequency. Medically treated cases tended to have recurrence at the same site as initial presentation, whereas surgical treatment prevented this. Recurrence usually occurred within 2 years. The retrospective study design, small number of recurrences and lack of imaging confirmation of every recurrence should be considered when interpreting the results.
7 December 2020 in Journal of Veterinary Internal Medicine
Background: Radiographic signs of intervertebral disc mineralization are thought to indicate sites of future recurrence of disc extrusion (Hansen type I) but the relationship between evidence of disc degeneration on magnetic resonance imaging (MRI) and future disc extrusion with recurrence of clinical signs has not been examined. Objectives: To examine the relationship between MRI-assessed degeneration of thoracolumbar intervertebral discs and late recurrence of clinical signs in dogs presented with acute thoracolumbar intervertebral disc extrusion and treated by hemilaminectomy alone. Animals: Ninety-two client-owned dogs presented to 2 referral hospitals between 2009 and 2014. Methods: Retrospective analysis of association between clinical signs consistent with recurrent thoracolumbar intervertebral disc extrusion and MRI evidence of disc degeneration in dogs undergoing hemilaminectomy for acute thoracolumbar intervertebral disc extrusion. Univariable and multivariable Cox regression analyses were used to explore associations between recurrence of clinical signs and several characteristics of T10-L3 discs at initial diagnosis. Results: Ninety-two cases were included, of which 42 (46%) were Dachshunds and median age was 5.3 years. Clinical signs recurred in 33/92 (36%) dogs. Finding a completely degenerate disc in the T10 to L3 region (in addition to the operated site) at the time of surgery was associated with a hazard ratio of 2.92 (95% confidence interval: 1.37-6.20) for recurrence of clinical signs. Conclusions and clinical importance: Our results suggest that in cases of thoracolumbar intervertebral disc extrusion in dogs, recurrence of signs is likely if at least 1 completely degenerate disc in addition to the currently symptomatic disc is visible on MRI.
21 November 2022 in Journal of Feline Medicine and Surgery
Objectives: The aim of this study was to evaluate the association between meningeal enhancement (MgE) and cerebrospinal fluid (CSF) analysis results, their individual association with bacteriology results from affected ear samples and whether these test results influenced clinicians’ therapeutic choice in cats with otitis media and interna (OMI). Methods: This was a multicentre retrospective study carried out over an 8-year period. Cats diagnosed with OMI, with or without a nasopharyngeal polyp, leading to peripheral vestibular signs were included. Only cats for which MRI with postcontrast T1-weighted sequences and CSF analyses available were included. Cats with intra-axial MRI lesions or empyema were excluded. Results: Fifty-eight cats met the inclusion criteria. MgE was reported in 26/58 cases, of which nine had an abnormal CSF result (increased total nucleated cell count [TNCC] or total protein); 32/58 cases had no MgE, of which 10 showed abnormal CSF results. There was no association between bacteriology results (external ear canal or bulla) and MgE or abnormal CSF results. CSF abnormalities were statistically significantly more common in acute cases (n = 16/37) than in chronic cases (n = 3/21; Fischer’s test P = 0.04). Prednisolone was prescribed in 10/16 cases with increased TNCC. Among the 42 cases with normal TNCC, 15 received prednisolone and 13 received non-steroidal anti-inflammatory drugs. Various antimicrobial drugs were prescribed in 53/58 cats. Duration of antimicrobial treatment was similar, regardless of positive bacterial culture (5.58 vs 4.22 weeks), abnormal CSF (5.83 vs 4.76 weeks) or MgE (5.33 vs 4.90 weeks). Conclusions and relevance: No association was found between the CSF and MgE results. Furthermore, no association was found between MgE, CSF or bacteriology findings. In addition, abnormal CSF results might lead the clinician to treat with corticosteroids, but they did not have any impact on duration of antimicrobial treatment. CSF abnormalities were seen significantly less frequently in chronic cases. The outcome tended to be poorer when MgE was detected on MRI.
17 November 2021 in Journal of Small Animal Practice
Objectives: A previous single‐country pilot study indicated serum anti‐GM2 and anti‐GA1 anti‐glycolipid antibodies as potential biomarkers for acute canine polyradiculoneuritis. This study aims to validate these findings in a large geographically heterogenous cohort.Materials and Methods: Sera from 175 dogs clinically diagnosed with acute canine polyradiculoneuritis, 112 dogs with other peripheral nerve, cranial nerve or neuromuscular disorders and 226 neurologically normal dogs were screened for anti‐glycolipid antibodies against 11 common glycolipid targets to determine the immunoglobulin G anti‐glycolipid antibodies with the highest combined sensitivity and specificity for acute canine polyradiculoneuritis.Results: Anti‐GM2 anti‐glycolipid antibodies reached the highest combined sensitivity and specificity (sensitivity: 65.1%, 95% confidence interval 57.6 to 72.2%; specificity: 90.2%, 95% confidence interval 83.1 to 95.0%), followed by anti‐GalNAc‐GD1a anti‐glycolipid antibodies (sensitivity: 61.7%, 95% confidence interval 54.1 to 68.9%; specificity: 89.3%, 95% confidence interval 82.0 to 94.3%) and these anti‐glycolipid antibodies were frequently present concomitantly. Anti‐GA1 anti‐glycolipid antibodies were detected in both acute canine polyradiculoneuritis and control animals. Both for anti‐GM2 and anti‐GalNAc‐GD1a anti‐glycolipid antibodies, sex was found a significantly associated factor with a female to male odds ratio of 2.55 (1.27 to 5.31) and 3.00 (1.22 to 7.89), respectively. Anti‐GalNAc‐GD1a anti‐glycolipid antibodies were more commonly observed in dogs unable to walk (OR 4.56, 1.56 to 14.87).Clinical Significance: Anti‐GM2 and anti‐GalNAc‐GD1a immunoglobulin G anti‐glycolipid antibodies represent serum biomarkers for acute canine polyradiculoneuritis.
3 August 2021 in Veterinary and Comparative Orthopaedics and Traumatology
Objective Intervertebral disc fenestration has been shown to reduce the risk of extrusion in the thoracolumbar region in dogs, but use of the technique varies between individual neurologists and surgeons. Our aim was to investigate opinions and practices regarding disc fenestration amongst those involved in neurosurgery in dogs. Study Design A web-based survey containing questions relating to the use of fenestration during treatment of intervertebral disc extrusion in dogs was distributed to board-certified neurologists and surgeons. Results were analysed using Microsoft Excel. Results There were 323 responses from 190 neurologists and 133 surgeons. Seventy-one per cent of respondents routinely used concurrent disc fenestration when performing decompressive surgery in the thoracolumbar region, although the rate was lower amongst surgeons (55%) than neurologists (82%). Only 25% of respondents performed concurrent fenestration in the cervical spine. Forty-five per cent of respondents reported having experienced complications, with haemorrhage being the most common. Conclusion Fenestration is widely used in the management of thoracolumbar intervertebral disc extrusion, but a universally accepted approach does not exist, and differences are seen between neurologists and surgeons.