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Togawa G, Lewis MJ, Devathasan D. Outcome in paraplegic dogs with or without pain perception due to thoracolumbar fibrocartilaginous embolic myelopathy or acute non-compressive nucleus pulposus extrusion. Front Vet Sci 2024; 11:1406843. [PMID: 38784658 PMCID: PMC11111901 DOI: 10.3389/fvets.2024.1406843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 04/23/2024] [Indexed: 05/25/2024] Open
Abstract
Background Fibrocartilaginous embolic myelopathy (FCEM) and acute non-compressive nucleus pulposus extrusion (ANNPE) are common causes of acute spinal cord injury in dogs. Outcome among paraplegic deep pain positive (DPP) and deep pain negative (DPN) dogs with either condition and factors influencing recovery have not been clearly established. Methods Dogs with thoracolumbar FCEM or ANNPE resulting in paraplegia presenting to university hospitals between 2012 and 2022 were retrospectively included. Diagnosis of FCEM or ANNPE was based on clinical and magnetic resonance imaging findings. Outcome was defined as successful (recovery of independent ambulation) or unsuccessful (non-ambulatory ≥3 months following diagnosis or at the time of death/euthanasia). Logistic regression analysis was performed to investigate associations between clinical or imaging variables and outcome. Results Thirty-one dogs were included. In total, 14 dogs were initially paraplegic DPP (8 FCEM, 6 ANNPE) and 17 dogs were paraplegic DPN (11 FCEM, 6 ANNPE). Outcome was available for 26 dogs (14 DPP, 12 DPN) with a median follow-up time of 182 days (range 0-2,311) including 2 dogs euthanized at the time of diagnosis; 1 of 12 DPN dogs (8.3%) regained independent ambulation, whereas 9 of 14 DPP dogs (64.3%) regained independent ambulation. DPN dogs had a significantly higher risk of not regaining independent ambulation compared with DPP dogs (OR: 47.40, 95% CI: 2.09-1073.99). No other variables were associated with outcome. Conclusion While recovery of ambulation was possible, these results confirm that the absence of pain perception is a useful negative prognostic indicator in dogs with severe thoracolumbar FCEM or ANNPE.
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Affiliation(s)
- Go Togawa
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN, United States
| | - Melissa J. Lewis
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN, United States
| | - Dillon Devathasan
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL, United States
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Jeffery ND, Rossmeisl JH, Harcourt-Brown TR, Granger N, Ito D, Foss K, Chase D. Randomized Controlled Trial of Durotomy as an Adjunct to Routine Decompressive Surgery for Dogs With Severe Acute Spinal Cord Injury. Neurotrauma Rep 2024; 5:128-138. [PMID: 38414780 PMCID: PMC10898236 DOI: 10.1089/neur.2023.0129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024] Open
Abstract
Although many interventions for acute spinal cord injury (SCI) appear promising in experimental models, translation directly from experimental animals to human patients is a large step that can be problematic. Acute SCI occurs frequently in companion dogs and may provide a model to ease translation. Recently, incision of the dura has been highlighted in both research animals and human patients as a means of reducing intraspinal pressure, with a view to improving perfusion of the injured tissue and enhancing functional recovery. Observational clinical data in humans and dogs support the notion that it may also improve functional outcome. Here, we report the results of a multi-center randomized controlled trial of durotomy as an adjunct to traditional decompressive surgery for treatment of severe thoracolumbar SCI caused by acute intervertebral disc herniation in dogs. Sample-size calculation was based on the proportion of dogs recovering ambulation improving from an expected 55% in the traditional surgery group to 70% in the durotomy group. Over a 3.5-year period, we enrolled 140 dogs, of which 128 had appropriate duration of follow-up. Overall, 65 (51%) dogs recovered ambulation. Recovery in the traditional decompression group was 35 of 62 (56%) dogs, and in the durotomy group 30 of 66 (45%) dogs, associated with an odds ratio of 0.643 (95% confidence interval: 0.320-1.292) and z-score of -1.24. This z-score indicates trial futility to reach the target 15% improvement over traditional surgery, and the trial was terminated at this stage. We conclude that durotomy is ineffective in improving functional outcome for severe acute thoracolumbar SCI in dogs. In the future, these data can be compared with similar data from clinical trials on duraplasty in human patients and will aid in determining the predictive validity of the "companion dog model" of acute SCI.
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Affiliation(s)
- Nick D. Jeffery
- Department of Small Animal Clinical Sciences, Texas A&M University, College Station, Texas, USA
| | - John H. Rossmeisl
- Department of Small Animal Clinical Sciences, VA-MD College of Veterinary Medicine, Blacksburg, Virginia, USA
| | | | | | - Daisuke Ito
- Nihon University College of Bioresource Sciences Department of Veterinary Medicine, Fujisawa, Japan
| | - Kari Foss
- Department of Veterinary Clinical Medicine, University of Illinois Urbana–Champaign, Champaign, Illinois, USA
| | - Damian Chase
- Veterinary Specialists Aotearora, Auckland, New Zealand
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Gouveia D, Carvalho C, Vong N, Pereira A, Cardoso A, Moisés M, Rijo I, Almeida A, Gamboa Ó, Ferreira A, Martins Â. Spinal shock in severe SCI dogs and early implementation of intensive neurorehabilitation programs. Res Vet Sci 2023; 164:105018. [PMID: 37722219 DOI: 10.1016/j.rvsc.2023.105018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 09/07/2023] [Indexed: 09/20/2023]
Abstract
Spinal shock is complex, paradoxical with sudden presentation, possibly leading to a guarded prognosis. Thus, it is suggested the need for early implementation of intensive neurorehabilitation. This prospective controlled blinded cohort study aims to understand the implication of spinal shock in neurorehabilitation of severe SCI dogs and the importance of its evaluation thought a spinal shock scale (SSS). 371 dogs were randomized by stratification according the presence of spinal shock in the SG (n = 245) or CG (n = 126). The SSS, a punctuation scale (0-7), was evaluated at admission and each 6 h for 3 days, each day for 15 days, each week for 6 weeks, each month until 3 months, followed by 3 monthly follow-ups. All dogs had similar land and underwater treadmill training with functional electrical stimulation. Observational dataset allowed an approximate level of power (1-β) of 0.90 and an α (Type I error) of 0.01, with a total of 11,088 SSS observations between two blinded observers and 18% of disagreement. 75% of the dogs were admitted in 24-48 h after injury, allowing early detection of spinal shock, and dogs admitted at 72 h with SSS ≥ 4 were not able to achieve ambulation. Regarding ambulation rate, there was a significant difference between groups, with 66.9% of ambulation in the SG and 97.6% in the CG. Also, there was a difference in regard to time until ambulation, with a mean of 31.57 days for the SG and 23.02 for the CG. The SSS estimated marginal means had an exponential decrease within the first 6 h, followed by a slower decrease, but always faster in spinal shock dogs diagnosed with non-compressive myelopathies. Thus, early intensive neurorehabilitation in dogs after severe SCI may benefit from SSS classifications at admission and during treatment to establish different therapeutic protocols according to each patient's needs, especially in deep pain negative dogs.
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Affiliation(s)
- Débora Gouveia
- Arrábida Veterinary Hospital - Arrábida Animal Rehabilitation Center, Setubal 2925-538, Portugal; Superior School of Health, Protection and Animal Welfare, Polytechnic Institute of Lusophony, Campo Grande, Lisboa 1950-396, Portugal; Faculty of Veterinary Medicine, Lusófona University, Campo Grande, Lisboa 1749-024, Portugal
| | - Carla Carvalho
- Arrábida Veterinary Hospital - Arrábida Animal Rehabilitation Center, Setubal 2925-538, Portugal
| | - Natalina Vong
- Faculty of Veterinary Medicine, Évora University, Évora 94, 7002-554, Portugal
| | - Ana Pereira
- Arrábida Veterinary Hospital - Arrábida Animal Rehabilitation Center, Setubal 2925-538, Portugal
| | - Ana Cardoso
- Arrábida Veterinary Hospital - Arrábida Animal Rehabilitation Center, Setubal 2925-538, Portugal
| | - Marina Moisés
- Arrábida Veterinary Hospital - Arrábida Animal Rehabilitation Center, Setubal 2925-538, Portugal
| | - Inês Rijo
- Arrábida Veterinary Hospital - Arrábida Animal Rehabilitation Center, Setubal 2925-538, Portugal
| | - António Almeida
- Faculty of Veterinary Medicine, University of Lisbon, Lisboa 1300-477, Portugal
| | - Óscar Gamboa
- Faculty of Veterinary Medicine, University of Lisbon, Lisboa 1300-477, Portugal
| | - António Ferreira
- Faculty of Veterinary Medicine, University of Lisbon, Lisboa 1300-477, Portugal; CIISA - Centro Interdisciplinar-Investigação em Saúde Animal, Faculdade de Medicina Veterinária, Av. Universidade Técnica de Lisboa, Lisboa 1300-477, Portugal
| | - Ângela Martins
- Arrábida Veterinary Hospital - Arrábida Animal Rehabilitation Center, Setubal 2925-538, Portugal; Superior School of Health, Protection and Animal Welfare, Polytechnic Institute of Lusophony, Campo Grande, Lisboa 1950-396, Portugal; Faculty of Veterinary Medicine, Lusófona University, Campo Grande, Lisboa 1749-024, Portugal.
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Santifort KM, Carrera I, Platt S. Case report: Traumatic hemorrhagic cervical myelopathy in a dog. Front Vet Sci 2023; 10:1260719. [PMID: 37869493 PMCID: PMC10585029 DOI: 10.3389/fvets.2023.1260719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/21/2023] [Indexed: 10/24/2023] Open
Abstract
A 1.5-year-old female entire French bulldog was referred for neurological evaluation, further diagnostic tests, and treatment 24 h after a road traffic accident. Initial emergency treatment, diagnostic tests, and stabilization had been performed by the referring veterinarian. Neurological examination revealed severe spastic non-ambulatory tetraparesis and was consistent with a C1-5 myelopathy. A magnetic resonance imaging (MRI) study revealed an irregular to elongated ovoid intramedullary lesion centered over the body of C2. The lesion showed marked signal heterogeneity with a central T2W and T2* hyperintense region, surrounded by a hypointense rim on both sequences. The lesion appeared heterogeneously T1W hypointense. The lesion was asymmetric (right-sided), affecting both white and gray matter. The C2-3 intervertebral disk appeared moderately degenerate with a Pfirrmann grade of 3. No evidence of vertebral fracture or luxation was found on radiographs or MRI of the vertebral column. Additional soft tissue abnormalities in the area of the right brachial plexus were suggestive of brachial plexus and muscle injury. A diagnosis of traumatic hemorrhagic myelopathy at the level of C2 and concurrent brachial plexus injury was formed. Conservative treatment was elected and consisted of physiotherapy, bladder care with an indwelling urinary catheter, repeated IV methadone based on pain scoring (0.2 mg/kg), oral meloxicam 0.1 mg/kg q24h, and oral gabapentin 10 mg/kg q8h. The dog was discharged after 4 days, with an indwelling urinary catheter and oral medication as described. The catheter was replaced two times by the referring veterinarian and finally removed after 10 days. Thereafter, voluntary urination was seen. During the 2 months after the road traffic accident, slow recovery of motor function was seen. The right thoracic limb recovery progressed more slowly than the left limb, also showing some lower motor neuron signs during follow-up. This was judged to be consistent with a right-sided brachial plexus injury. The dog was reported ambulatory with mild residual ataxia and residual monoparesis of the right thoracic limb at the last follow-up 3 months post-injury. This case report highlights the MRI-based diagnosis of traumatic hemorrhagic myelopathy in a dog. A fair short-term outcome was achieved with conservative treatment in this case.
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Affiliation(s)
- Koen M. Santifort
- IVC Evidensia Small Animal Referral Hospital Arnhem, Neurology, Arnhem, Netherlands
- IVC Evidensia Small Animal Referral Hospital Hart van Brabant, Neurology, Waalwijk, Netherlands
| | - Ines Carrera
- Vet Oracle Teleradiology, Norfolk, United Kingdom
| | - Simon Platt
- Vet Oracle Teleradiology, Norfolk, United Kingdom
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Hu X, Xu W, Ren Y, Wang Z, He X, Huang R, Ma B, Zhao J, Zhu R, Cheng L. Spinal cord injury: molecular mechanisms and therapeutic interventions. Signal Transduct Target Ther 2023; 8:245. [PMID: 37357239 DOI: 10.1038/s41392-023-01477-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 03/22/2023] [Accepted: 05/07/2023] [Indexed: 06/27/2023] Open
Abstract
Spinal cord injury (SCI) remains a severe condition with an extremely high disability rate. The challenges of SCI repair include its complex pathological mechanisms and the difficulties of neural regeneration in the central nervous system. In the past few decades, researchers have attempted to completely elucidate the pathological mechanism of SCI and identify effective strategies to promote axon regeneration and neural circuit remodeling, but the results have not been ideal. Recently, new pathological mechanisms of SCI, especially the interactions between immune and neural cell responses, have been revealed by single-cell sequencing and spatial transcriptome analysis. With the development of bioactive materials and stem cells, more attention has been focused on forming intermediate neural networks to promote neural regeneration and neural circuit reconstruction than on promoting axonal regeneration in the corticospinal tract. Furthermore, technologies to control physical parameters such as electricity, magnetism and ultrasound have been constantly innovated and applied in neural cell fate regulation. Among these advanced novel strategies and technologies, stem cell therapy, biomaterial transplantation, and electromagnetic stimulation have entered into the stage of clinical trials, and some of them have already been applied in clinical treatment. In this review, we outline the overall epidemiology and pathophysiology of SCI, expound on the latest research progress related to neural regeneration and circuit reconstruction in detail, and propose future directions for SCI repair and clinical applications.
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Affiliation(s)
- Xiao Hu
- Division of Spine, Department of Orthopaedics, Tongji Hospital, Tongji University School of Medicine, 200065, Shanghai, China
- Key Laboratory of Spine and Spinal cord Injury Repair and Regeneration (Tongji University), Ministry of Education, 200065, Shanghai, China
- Clinical Center For Brain And Spinal Cord Research, Tongji University, 200065, Shanghai, China
| | - Wei Xu
- Division of Spine, Department of Orthopaedics, Tongji Hospital, Tongji University School of Medicine, 200065, Shanghai, China
- Key Laboratory of Spine and Spinal cord Injury Repair and Regeneration (Tongji University), Ministry of Education, 200065, Shanghai, China
- Clinical Center For Brain And Spinal Cord Research, Tongji University, 200065, Shanghai, China
| | - Yilong Ren
- Division of Spine, Department of Orthopaedics, Tongji Hospital, Tongji University School of Medicine, 200065, Shanghai, China
- Key Laboratory of Spine and Spinal cord Injury Repair and Regeneration (Tongji University), Ministry of Education, 200065, Shanghai, China
- Clinical Center For Brain And Spinal Cord Research, Tongji University, 200065, Shanghai, China
| | - Zhaojie Wang
- Division of Spine, Department of Orthopaedics, Tongji Hospital, Tongji University School of Medicine, 200065, Shanghai, China
- Key Laboratory of Spine and Spinal cord Injury Repair and Regeneration (Tongji University), Ministry of Education, 200065, Shanghai, China
- Clinical Center For Brain And Spinal Cord Research, Tongji University, 200065, Shanghai, China
| | - Xiaolie He
- Division of Spine, Department of Orthopaedics, Tongji Hospital, Tongji University School of Medicine, 200065, Shanghai, China
- Key Laboratory of Spine and Spinal cord Injury Repair and Regeneration (Tongji University), Ministry of Education, 200065, Shanghai, China
- Clinical Center For Brain And Spinal Cord Research, Tongji University, 200065, Shanghai, China
| | - Runzhi Huang
- Division of Spine, Department of Orthopaedics, Tongji Hospital, Tongji University School of Medicine, 200065, Shanghai, China
- Key Laboratory of Spine and Spinal cord Injury Repair and Regeneration (Tongji University), Ministry of Education, 200065, Shanghai, China
- Clinical Center For Brain And Spinal Cord Research, Tongji University, 200065, Shanghai, China
| | - Bei Ma
- Division of Spine, Department of Orthopaedics, Tongji Hospital, Tongji University School of Medicine, 200065, Shanghai, China
- Key Laboratory of Spine and Spinal cord Injury Repair and Regeneration (Tongji University), Ministry of Education, 200065, Shanghai, China
- Clinical Center For Brain And Spinal Cord Research, Tongji University, 200065, Shanghai, China
| | - Jingwei Zhao
- Division of Spine, Department of Orthopaedics, Tongji Hospital, Tongji University School of Medicine, 200065, Shanghai, China
- Key Laboratory of Spine and Spinal cord Injury Repair and Regeneration (Tongji University), Ministry of Education, 200065, Shanghai, China
- Clinical Center For Brain And Spinal Cord Research, Tongji University, 200065, Shanghai, China
| | - Rongrong Zhu
- Division of Spine, Department of Orthopaedics, Tongji Hospital, Tongji University School of Medicine, 200065, Shanghai, China.
- Key Laboratory of Spine and Spinal cord Injury Repair and Regeneration (Tongji University), Ministry of Education, 200065, Shanghai, China.
- Clinical Center For Brain And Spinal Cord Research, Tongji University, 200065, Shanghai, China.
| | - Liming Cheng
- Division of Spine, Department of Orthopaedics, Tongji Hospital, Tongji University School of Medicine, 200065, Shanghai, China.
- Key Laboratory of Spine and Spinal cord Injury Repair and Regeneration (Tongji University), Ministry of Education, 200065, Shanghai, China.
- Clinical Center For Brain And Spinal Cord Research, Tongji University, 200065, Shanghai, China.
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Cordle KJ, Seiler GS, Barnes D, Olby NJ. MRI features can help to confirm a diagnosis of progressive myelomalacia, but may not be accurate in dogs lacking characteristic clinical signs at the time of imaging. Vet Radiol Ultrasound 2023; 64:283-293. [PMID: 36660871 DOI: 10.1111/vru.13178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 08/16/2022] [Accepted: 08/20/2022] [Indexed: 01/21/2023] Open
Abstract
Progressive myelomalacia (PMM) is a fatal sequela of acute thoracolumbar intervertebral disc extrusion in dogs, with unpredictable onset in the days after the inciting injury. No single reliable diagnostic test is currently available. Magnetic resonance imaging (MRI) features such as T2-weighted spinal cord hyperintensity and loss of subarachnoid signal in a half-Fourier single-shot turbo spin echo (HASTE) sequence have been associated with PMM, but are sometimes present in other dogs with severe deficits. Magnetic resonance imaging findings in 22 dogs with a clinical or histopathologic diagnosis of PMM and 38 deep pain-negative paraplegic dogs were compared in a retrospective case-control study. Length of T2-weighted hyperintense spinal cord change and HASTE signal loss were significantly associated with clinically evident PMM (P = .0019 and P = .0085), however, there were no significant differences between groups when analysis was restricted to dogs not yet showing clinical signs of PMM. The PMM group also had significantly shorter compressive lesions than the control group (P = 0.026), suggesting a possible role of more severe focal pressure at the extrusion site. A segment of total loss of contrast enhancement in the venous sinuses and meninges, a feature not previously described, was more common in the PMM group and the difference approached significance (P = 0.054). Findings show that MRI features can support the diagnosis in dogs with clinical evidence of PMM, and absence of these features supports absence of PMM at time of imaging. However, their absence does not reliably differentiate dogs with imminent progressive myelomalacia from other dogs with severe deficits following intervertebral disc extrusion.
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Affiliation(s)
- Katelyn J Cordle
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Gabriela S Seiler
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Danielle Barnes
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Natasha J Olby
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
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Freeman P, Jeffery N. Is decompression in acute thoracolumbar intervertebral disc herniation overvalued? Front Vet Sci 2022; 9:1049366. [DOI: 10.3389/fvets.2022.1049366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 10/13/2022] [Indexed: 11/10/2022] Open
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Jeffery ND, Budke CM, Chanoit GP. What is the value of statistical testing of observational data? Vet Surg 2022; 51:1043-1051. [PMID: 35810406 PMCID: PMC9795996 DOI: 10.1111/vsu.13845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 05/28/2022] [Accepted: 06/02/2022] [Indexed: 01/07/2023]
Abstract
Statistical analysis of medical data aims to reveal patterns that can aid in decision making for future cases and, hopefully, improve patient outcomes. Large and bias-free datasets, such as those produced in formal randomized clinical trials, are necessary to make such analyses as reliable as possible. For a host of reasons, randomized trials are, unfortunately, relatively uncommon in veterinary medicine and surgery, implying that less ideal datasets (mostly observational data) must form the basis for much of our decision making regarding treatment of individual patients under our care. In this review, we first describe the common shortcomings of many observational veterinary datasets when viewed in comparison with their optimal counterparts and highlight how the deficiencies can lead to unreliable conclusions. We illustrate how many of the interpretative problems associated with observational data, predominantly various forms of bias, are not solved, and may even be exacerbated, by statistical analysis. We emphasize the need to examine summary data and its derivation in detail without being lured into relying upon P values to draw conclusions and advocate for completely omitting statistical analysis of many observational datasets. Finally, we present some suggestions for alternative statistical methods, such as propensity scoring and Bayesian methods, which might help reduce the risk of drawing unwarranted, and overconfident, conclusions from imperfect data.
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Affiliation(s)
- Nick D. Jeffery
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical SciencesTexas A&M UniversityCollege StationTexasUSA
| | - Christine M. Budke
- Department of Veterinary Integrative Biosciences, College of Veterinary Medicine & Biomedical SciencesTexas A&M UniversityCollege StationTexasUSA
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Pontikaki AE, Pavlidou K, Polizopoulou Z, Savvas I, Kazakos G. Prophylactic Effect of Fenestration on the Recurrence of Thoracolumbar Intervertebral Disc Disease in Dogs. Animals (Basel) 2022; 12:ani12192601. [PMID: 36230341 PMCID: PMC9559642 DOI: 10.3390/ani12192601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary The prophylactic effect of fenestration on the recurrence of thoracolumbar (TL) intervertebral disc herniation (IVDH) in dogs that have been surgically decompressed has been a topic of ongoing debate in veterinary medicine. The aim of this study was to systematically review the existing literature and critically evaluate the evidence behind the application of prophylactic fenestration on the recurrence of TL IVDH in dogs. PubMed, Web of Science and Scopus electronic databases were searched to collect relevant articles. Twenty-nine articles met the inclusion criteria and were assessed for scientific quality, treatment plan, and recurrence incidence. Five articles were selected for a meta-analysis to test if the recurrence differs in animals treated with or without prophylactic fenestration. In the light of the low scientific quality and the amount of published literature on the topic, further research is needed to robustly support the prophylactic effect of fenestration on the recurrence of TL IVDH in dogs. Abstract This systematic review aimed to assess the effect of prophylactic fenestration (PF) on the recurrence of thoracolumbar (TL) intervertebral disc (IVD) disease in dogs. Three online databases were searched (Web of Science, MEDLINE via PubMed, SCOPUS), 115 relevant studies were thoroughly examined by the authors, 29 of which met the pre-defined inclusion criteria for this systematic review. Data about the initial treatment, the performance of PF, the incidence of recurrence, and the site of recurrence were extracted. Most of the studies were deemed to have serious to moderate risk of bias. Out of 5457 dogs, 1264 underwent prophylactic fenestration. A total of 504 cases of suspected or confirmed recurrence were recorded, in which 164 (32.54% of total recurrences and 11.02% of PF cases) were in dogs treated with PF. In order to perform quantitative analysis for the recurrence odds, we conducted a meta-analysis. Five studies were included that met the inclusion criteria. Despite a large number of relevant publications, the quality of the evidence they provide is low. This prevented us from reaching a definitive conclusion on the prophylactic effect of fenestration on recurrence in dogs surgically treated for TL IVDH.
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10
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Moore SA, Olby NJ, Brisson B, Fenn J, Flegel T, Kortz G, Lewis M, Tipold A. ACVIM consensus statement on diagnosis and management of acute canine thoracolumbar intervertebral disc extrusion. J Vet Intern Med 2022; 36:1570-1596. [PMID: 35880267 PMCID: PMC9511077 DOI: 10.1111/jvim.16480] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 06/12/2022] [Indexed: 12/16/2022] Open
Abstract
Background Thoracolumbar intervertebral disc extrusion (TL‐IVDE) is the most common cause of acute paraparesis and paraplegia in dogs; however, guidelines on management of the condition are lacking. Objectives To summarize the current literature as it relates to diagnosis and management of acute TL‐IVDE in dogs, and to formulate clinically relevant evidence‐based recommendations. Animals None. Methods A panel of 8 experts was convened to assess and summarize evidence from the peer‐reviewed literature in order to develop consensus clinical recommendations. Level of evidence available to support each recommendation was assessed and reported. Results The majority of available literature described observational studies. Most recommendations made by the panel were supported by a low or moderate level of evidence, and several areas of high need for further study were identified. These include better understanding of the ideal timing for surgical decompression, expected surgical vs medical outcomes for more mildly affected dogs, impact of durotomy on locomotor outcome and development of progressive myelomalacia, and refining of postoperative care, and genetic and preventative care studies. Conclusions and Clinical Importance Future efforts should build on current recommendations by conducting prospective studies and randomized controlled trials, where possible, to address identified gaps in knowledge and to develop cost effectiveness and number needed to treat studies supporting various aspects of diagnosis and treatment of TL‐IVDE.
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Affiliation(s)
- Sarah A Moore
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Natasha J Olby
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | | | - Brigitte Brisson
- Department of Clinical Studies, Ontario Veterinary College, Ontario Veterinary College, Guelph, Ontario, Canada
| | - Joe Fenn
- Department of Clinical Science and Services, Royal Veterinary College, London, United Kingdom
| | - Thomas Flegel
- Department for Small Animals, Leipzig University, Leipzig, Germany
| | - Gregg Kortz
- VCA Sacramento Veterinary Referral Center, Sacramento, California, USA.,VCA Sacramento Veterinary Referral Center, UC Davis, California, USA
| | - Melissa Lewis
- Department of Veterinary Clinical Sciences, Purdue University, West Lafayette, Indiana, USA
| | - Andrea Tipold
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hanover, Hanover, Germany
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Sekiguchi N, Ito D, Ishikawa C, Tanaka N, Kitagawa M. Heavily T2-weighted imaging findings of spinal cord swelling in dogs with intervertebral disc extrusion. J S Afr Vet Assoc 2022. [DOI: 10.36303/jsava.2022.93.1.500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Affiliation(s)
- N Sekiguchi
- Laboratory of Veterinary Neurology, School of Veterinary Medicine, Nihon University,
Japan
| | - D Ito
- Laboratory of Veterinary Neurology, School of Veterinary Medicine, Nihon University,
Japan
| | - C Ishikawa
- Laboratory of Veterinary Neurology, School of Veterinary Medicine, Nihon University,
Japan
| | - N Tanaka
- Laboratory of Veterinary Neurology, School of Veterinary Medicine, Nihon University,
Japan
| | - M Kitagawa
- Laboratory of Veterinary Neurology, School of Veterinary Medicine, Nihon University,
Japan
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12
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Van Sandt RL, Welsh CJ, Jeffery ND, Young CR, McCreedy DA, Wright GA, Boudreau CE, Levine GJ, Levine JM. Circulating neutrophil activation in dogs with naturally occurring spinal cord injury secondary to intervertebral disk herniation. Am J Vet Res 2022; 83:324-330. [DOI: 10.2460/ajvr.21.05.0073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
OBJECTIVE
To investigate the time course of circulating neutrophil priming and activity in dogs with spinal cord injury secondary to intervertebral disk herniation that undergo decompressive surgery.
ANIMALS
9 dogs with spinal cord injury and 9 healthy dogs (controls).
PROCEDURES
For dogs with spinal cord injury, blood samples were collected on the day of hospital admission and 3, 7, 30, and 90 days after injury and decompressive surgery. A single blood sample was collected from the control dogs. Flow cytometry analysis was performed on isolated neutrophils incubated with antibody against CD11b and nonfluorescent dihydrorhodamine 123, which was converted to fluorescent rhodamine 123 to measure oxidative burst activity.
RESULTS
Expression of CD11b was increased in dogs with spinal cord injury 3 days after injury and decompressive surgery, relative to day 7 expression. Neutrophils expressed high oxidative burst activity both 3 and 7 days after injury and decompressive surgery, compared with activity in healthy dogs.
CLINICAL RELEVANCE
For dogs with spinal cord injury, high CD11b expression 3 days after injury and decompressive surgery was consistent with findings for rodents with experimentally induced spinal cord injury. However, the high oxidative burst activity 3 and 7 days after injury and decompressive surgery was not consistent with data from other species, and additional studies on inflammatory events in dogs with naturally occurring spinal cord injury are needed.
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Affiliation(s)
- Rae L. Van Sandt
- 1Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX
- 2Department of Veterinary Integrative Biosciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX
| | - C. Jane Welsh
- 2Department of Veterinary Integrative Biosciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX
| | - Nick D. Jeffery
- 1Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX
| | - Colin R. Young
- 2Department of Veterinary Integrative Biosciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX
| | - Dylan A. McCreedy
- 3Department of Biology, College of Science, Texas A&M University, College Station, TX
| | - Gus A. Wright
- 4Department of Veterinary Pathobiology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX
- 5Flow Cytometry Facility, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX
| | - C. Elizabeth Boudreau
- 1Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX
| | - Gwendolyn J. Levine
- 4Department of Veterinary Pathobiology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX
| | - Jonathan M. Levine
- 1Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX
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13
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Santifort K, Mandigers P, Bergknut N, Van Soens I, Carrera I. Dysphonia in a dog with cervical spinal cord injury and suspected progressive myelomalacia caused by a C4‐C5 hydrated nucleus pulposus extrusion. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Koen Santifort
- Department of Neurology and Neurosurgery Evidensia Small Animal Hospital Arnhem The Netherlands
- Department of Neurology and Neurosurgery Evidensia Small Animal Hospital ‘Hart van Brabant’ Waalwijk The Netherlands
| | - Paul Mandigers
- Department of Neurology and Neurosurgery Evidensia Small Animal Hospital Arnhem The Netherlands
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine University of Utrecht Utrecht The Netherlands
| | - Niklas Bergknut
- Department of Neurology and Neurosurgery Evidensia Small Animal Hospital ‘Hart van Brabant’ Waalwijk The Netherlands
| | - Iris Van Soens
- Department of Neurology and Neurosurgery Evidensia Small Animal Hospital ‘Hart van Brabant’ Waalwijk The Netherlands
| | - Ines Carrera
- Department of Diagnostic Imaging Willows Referral Centre Solihull UK
- Vet Oracle Teleneurology Diss UK
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14
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Martins Â, Gouveia D, Cardoso A, Carvalho C, Coelho T, Silva C, Viegas I, Gamboa Ó, Ferreira A. A Controlled Clinical Study of Intensive Neurorehabilitation in Post-Surgical Dogs with Severe Acute Intervertebral Disc Extrusion. Animals (Basel) 2021; 11:ani11113034. [PMID: 34827767 PMCID: PMC8614363 DOI: 10.3390/ani11113034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 10/16/2021] [Accepted: 10/20/2021] [Indexed: 12/15/2022] Open
Abstract
Simple Summary This study explores the potential intensive neurorehabilitation plasticity effects in post-surgical paraplegic dogs with severe acute intervertebral disc extrusion aiming to achieve ambulatory status. The intensive neurorehabilitation protocol translated in 99.4% (167/168) of recovery in deep pain perception-positive dogs and 58.5% (55/94) in deep pain perception-negative dogs. There was 37.3% (22/59) spinal reflex locomotion, obtained within a maximum period of 3 months. Thus, intensive neurorehabilitation may be a useful approach for this population of dogs, avoiding future euthanasia and promoting an estimated time window of 3 months to recover. Abstract This retrospective controlled clinical study aimed to verify if intensive neurorehabilitation (INR) could improve ambulation faster than spontaneous recovery or conventional physiotherapy and provide a possible therapeutic approach in post-surgical paraplegic deep pain perception-positive (DPP+) (with absent/decreased flexor reflex) and DPP-negative (DDP−) dogs, with acute intervertebral disc extrusion. A large cohort of T10-L3 Spinal Cord Injury (SCI) dogs (n = 367) were divided into a study group (SG) (n = 262) and a control group (CG) (n = 105). The SG was based on prospective clinical cases, and the CG was created by retrospective medical records. All SG dogs performed an INR protocol by the hospitalization regime based on locomotor training, electrical stimulation, and, for DPP−, a combination with pharmacological management. All were monitored throughout the process, and measuring the outcome for DPP+ was performed by OFS and, for the DPP−, by the new Functional Neurorehabilitation Scale (FNRS-DPP−). In the SG, DPP+ dogs had an ambulation rate of 99.4% (n = 167) and, in DPP−, of 58.5% (n = 55). Moreover, in DPP+, there was a strong statistically significant difference between groups regarding ambulation (p < 0.001). The same significant difference was verified in the DPP– dogs (p = 0.007). Furthermore, a tendency toward a significant statistical difference (p = 0.058) regarding DPP recovery was demonstrated between groups. Of the 59 dogs that did not recover DPP, 22 dogs achieved spinal reflex locomotion (SRL), 37.2% within a maximum of 3 months. The progressive myelomalacia cases were 14.9% (14/94). Therefore, although it is difficult to assess the contribution of INR for recovery, the results suggested that ambulation success may be improved, mainly regarding time.
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Affiliation(s)
- Ângela Martins
- Faculty of Veterinary Medicine, Lusófona University, Campo Grande, 1300-477 Lisboa, Portugal
- Animal Rehabilitation Center, Arrábida Veterinary Hospital, Azeitão, 2925-583 Setúbal, Portugal; (D.G.); (A.C.); (C.C.); (T.C.); (C.S.); (I.V.)
- CIISA—Centro Interdisciplinar-Investigação em Saúde Animal, Faculdade de Medicina Veterinária, Av. Universidade Técnica de Lisboa, 1300-477 Lisboa, Portugal;
- Superior School of Health, Protection and Animal Welfare, Polytechnic Institute of Lusophony, Campo Grande, 1300-477 Lisboa, Portugal
- Correspondence:
| | - Débora Gouveia
- Animal Rehabilitation Center, Arrábida Veterinary Hospital, Azeitão, 2925-583 Setúbal, Portugal; (D.G.); (A.C.); (C.C.); (T.C.); (C.S.); (I.V.)
- Superior School of Health, Protection and Animal Welfare, Polytechnic Institute of Lusophony, Campo Grande, 1300-477 Lisboa, Portugal
| | - Ana Cardoso
- Animal Rehabilitation Center, Arrábida Veterinary Hospital, Azeitão, 2925-583 Setúbal, Portugal; (D.G.); (A.C.); (C.C.); (T.C.); (C.S.); (I.V.)
| | - Carla Carvalho
- Animal Rehabilitation Center, Arrábida Veterinary Hospital, Azeitão, 2925-583 Setúbal, Portugal; (D.G.); (A.C.); (C.C.); (T.C.); (C.S.); (I.V.)
| | - Tiago Coelho
- Animal Rehabilitation Center, Arrábida Veterinary Hospital, Azeitão, 2925-583 Setúbal, Portugal; (D.G.); (A.C.); (C.C.); (T.C.); (C.S.); (I.V.)
| | - Cátia Silva
- Animal Rehabilitation Center, Arrábida Veterinary Hospital, Azeitão, 2925-583 Setúbal, Portugal; (D.G.); (A.C.); (C.C.); (T.C.); (C.S.); (I.V.)
| | - Inês Viegas
- Animal Rehabilitation Center, Arrábida Veterinary Hospital, Azeitão, 2925-583 Setúbal, Portugal; (D.G.); (A.C.); (C.C.); (T.C.); (C.S.); (I.V.)
| | - Óscar Gamboa
- Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisboa, Portugal;
| | - António Ferreira
- CIISA—Centro Interdisciplinar-Investigação em Saúde Animal, Faculdade de Medicina Veterinária, Av. Universidade Técnica de Lisboa, 1300-477 Lisboa, Portugal;
- Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisboa, Portugal;
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15
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Saadoun S, Papadopoulos MC. Acute, Severe Traumatic Spinal Cord Injury: Monitoring from the Injury Site and Expansion Duraplasty. Neurosurg Clin N Am 2021; 32:365-376. [PMID: 34053724 DOI: 10.1016/j.nec.2021.03.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
We discuss 2 evolving management options for acute spinal cord injury that hold promise to further improve outcome: pressure monitoring from the injured cord and expansion duraplasty. Probes surgically implanted at the injury site can transduce intraspinal pressure, spinal cord perfusion pressure, and cord metabolism. Intraspinal pressure is not adequately reduced by bony decompression alone because the swollen, injured cord is compressed against the dura. Expansion duraplasty may be necessary to effectively decompress the injured cord. A randomized controlled trial called DISCUS is investigating expansion duraplasty as a novel treatment for acute, severe traumatic cervical spinal cord injury.
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Affiliation(s)
- Samira Saadoun
- Academic Neurosurgery Unit, St. George's, University of London, Cranmer Terrace, London SW17 0RE, UK.
| | - Marios C Papadopoulos
- Department of Neurosurgery, Atkinson Morley Wing, St. George's Hospital NHS Foundation Trust, Blackshaw Road, London SW17 0QT, UK
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16
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Zhao C, Xing Z, Zhang C, Fan Y, Liu H. Nanopharmaceutical-based regenerative medicine: a promising therapeutic strategy for spinal cord injury. J Mater Chem B 2021; 9:2367-2383. [PMID: 33662083 DOI: 10.1039/d0tb02740e] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Spinal cord injury (SCI) is a neurological disorder that can lead to loss of perceptive and athletic function due to the severe nerve damage. To date, pieces of evidence detailing the precise pathological mechanisms in SCI are still unclear. Therefore, drug therapy cannot effectively alleviate the SCI symptoms and faces the limitations of systemic administration with large side effects. Thus, the development of SCI treatment strategies is urgent and valuable. Due to the application of nanotechnology in pharmaceutical research, nanopharmaceutical-based regenerative medicine will bring colossal development space for clinical medicine. These nanopharmaceuticals (i.e. nanocrystalline drugs and nanocarrier drugs) are designed using different types of materials or bioactive molecules, so as to improve the therapeutic effects, reduce side effects, and subtly deliver drugs, etc. Currently, an increasing number of nanopharmaceutical products have been approved by drug regulatory agencies, which has also prompted more researchers to focus on the potential treatment strategies of SCI. Therefore, the purpose of this review is to summarize and elaborate the research progress as well as the challenges and future of nanopharmaceuticals in the treatment of SCI, aiming to promote further research of nanopharmaceuticals in SCI.
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Affiliation(s)
- Chen Zhao
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, P. R. China. and School of Pharmaceutical Sciences, Tsinghua University, Beijing, 100084, P. R. China
| | - Zheng Xing
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, P. R. China.
| | - Chunchen Zhang
- Key Laboratory for Biomedical Engineering of Education Ministry of China, Zhejiang University, Hangzhou, 310027, P. R. China and Zhejiang Provincial Key Laboratory of Cardio-Cerebral Vascular Detection Technology and Medicinal Effectiveness Appraisal, Zhejiang University, Hangzhou, 310027, P. R. China
| | - Yubo Fan
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, P. R. China.
| | - Haifeng Liu
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, P. R. China.
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17
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Saadoun S, Jeffery ND. Acute Traumatic Spinal Cord Injury in Humans, Dogs, and Other Mammals: The Under-appreciated Role of the Dura. Front Neurol 2021; 12:629445. [PMID: 33613434 PMCID: PMC7887286 DOI: 10.3389/fneur.2021.629445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 01/04/2021] [Indexed: 01/16/2023] Open
Abstract
We review human and animal studies to determine whether, after severe spinal cord injury (SCI), the cord swells against the inelastic dura. Evidence from rodent models suggests that the cord swells because of edema and intraparenchymal hemorrhage and because the pia becomes damaged and does not restrict cord expansion. Human cohort studies based on serial MRIs and measurements of elevated intraspinal pressure at the injury site also suggest that the swollen cord is compressed against dura. In dogs, SCI commonly results from intervertebral disc herniation with evidence that durotomy provides additional functional benefit to conventional (extradural) decompressive surgery. Investigations utilizing rodent and pig models of SCI report that the cord swells after injury and that durotomy is beneficial by reducing cord pressure, cord inflammation, and syrinx formation. A human MRI study concluded that, after extensive bony decompression, cord compression against the dura may only occur in a small number of patients. We conclude that the benefit of routinely opening the dura after SCI is only supported by animal and level III human studies. Two randomized, controlled trials, one in humans and one in dogs, are being set up to provide Level I evidence.
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Affiliation(s)
- Samira Saadoun
- Academic Neurosurgery Unit, St. George's, University of London, London, United Kingdom
| | - Nicolas D Jeffery
- Department of Small Animal Clinical Sciences, Texas A&M University, College Station, TX, United States
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18
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Hirano R, Asahina R, Hirano T, Hyakkoku A, Miura R, Kunihiro T, Nakamoto Y. Outcomes of extensive hemilaminectomy with durotomy on dogs with presumptive progressive myelomalacia: a retrospective study on 34 cases. BMC Vet Res 2020; 16:476. [PMID: 33287802 PMCID: PMC7720392 DOI: 10.1186/s12917-020-02690-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 11/23/2020] [Indexed: 11/21/2022] Open
Abstract
Background Progressive myelomalacia (PMM) is a fatal complication of progressive ascending and descending necrosis of the spinal cord after acute spinal cord injury. A recent study suggested that extensive hemilaminectomy with durotomy (EHLD) at the intramedullary T2-hyperintense region which performed immediately after magnetic resonance imaging (MRI) improved the survival rate in dogs with presumptive PMM. The objective of this retrospective study was to evaluate the effects of EHLD on halting the progression of PMM in dogs presumptively diagnosed with PMM which had the interval between MRI and surgery. Results Thirty-four dogs with presumptive PMM which had undergone EHLD with the delay following MRI examination (range, 0 to 3 days) were included. The cranial side of EHLD was set depending on the delay time after MRI, MRI findings, neurological examination and intraoperative macroscopic appearance. Two weeks after surgery, the perioperative survival rate was 97% (33/34). During follow-up with a median time period of 82.5 weeks (range, 0-290 weeks), the postoperative survival rate was 91% (31/34). At the end of the follow-up period, 31 out of 34 dogs were alive without severe postoperative complications while the remaining 2 dogs died from causes not directly attributable to the surgery. There was no improvement in the pelvic limb function of all dogs. Conclusions EHLD appears to be effective in halting the progression of presumptive PMM and preventing morbidity even in dogs which had the interval between MRI and EHLD. Our algorithm of determining the range of EHLD may enable to set the appropriate ranges of EHLD in the cases which develop signs consistent with PMM after MRI examination.
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Affiliation(s)
- Ryuji Hirano
- Ukyo Animal Hospital, 12-2 Uzumasa-Kyonomichicho, Ukyo-ku, Kyoto, Japan. .,Kyoto Animal Medical Center, 550-4 Bishamoncho, Nakagyo-ku, Kyoto, Japan.
| | - Ryota Asahina
- Kyoto Animal Medical Center, 550-4 Bishamoncho, Nakagyo-ku, Kyoto, Japan.,Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto, Japan
| | - Taiyo Hirano
- Ukyo Animal Hospital, 12-2 Uzumasa-Kyonomichicho, Ukyo-ku, Kyoto, Japan
| | - Ayuko Hyakkoku
- Ukyo Animal Hospital, 12-2 Uzumasa-Kyonomichicho, Ukyo-ku, Kyoto, Japan
| | - Rino Miura
- Ukyo Animal Hospital, 12-2 Uzumasa-Kyonomichicho, Ukyo-ku, Kyoto, Japan
| | - Takuya Kunihiro
- Ukyo Animal Hospital, 12-2 Uzumasa-Kyonomichicho, Ukyo-ku, Kyoto, Japan
| | - Yuya Nakamoto
- Neuro Vets Animal Neurology Clinic, 550-4 Bishamoncho, Nakagyo-ku, Kyoto, Japan
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19
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Boudreau E, Otamendi A, Levine J, Griffin JF, Gilmour L, Jeffery N. Relationship between Machine-Learning Image Classification of T 2-Weighted Intramedullary Hypointensity on 3 Tesla Magnetic Resonance Imaging and Clinical Outcome in Dogs with Severe Spinal Cord Injury. J Neurotrauma 2020; 38:725-733. [PMID: 33054592 DOI: 10.1089/neu.2020.7188] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Early prognostic information in cases of severe spinal cord injury can aid treatment planning and stratification for clinical trials. Analysis of intraparenchymal signal change on magnetic resonance imaging has been suggested to inform outcome prediction in traumatic spinal cord injury. We hypothesized that intraparenchymal T2-weighted hypointensity would be associated with a lower potential for functional recovery and a higher risk of progressive neurological deterioration in dogs with acute, severe, naturally occurring spinal cord injury. Our objectives were to: 1) demonstrate capacity for machine-learning criteria to identify clinically relevant regions of hypointensity and 2) compare clinical outcomes for cases with and without such regions. A total of 95 dogs with complete spinal cord injury were evaluated. An image classification system, based on Speeded-Up Robust Features (SURF), was trained to recognize individual axial T2-weighted slices that contained hypointensity. The presence of such slices in a given transverse series was correlated with a lower chance of functional recovery (odds ratio [OR], 0.08; confidence interval [CI], 0.02-0.38; p < 10-3) and with a higher risk of neurological deterioration (OR, 0.14; 95% CI, 0.05-0.42; p < 10-3). Identification of intraparenchymal T2-weighted hypointensity in severe, naturally occurring spinal cord injury may be assisted by an image classification tool and is correlated with functional recovery.
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Affiliation(s)
- Elizabeth Boudreau
- Texas A&M University College of Veterinary Medicine and Biomedical Sciences, College Station, Texas, USA
| | - Arturo Otamendi
- VCA San Francisco Veterinary Specialists, San Francisco, California, USA
| | - Jonathan Levine
- Texas A&M University College of Veterinary Medicine and Biomedical Sciences, College Station, Texas, USA
| | - John F Griffin
- Texas A&M University College of Veterinary Medicine and Biomedical Sciences, College Station, Texas, USA
| | - Lindsey Gilmour
- Texas A&M University College of Veterinary Medicine and Biomedical Sciences, College Station, Texas, USA
| | - Nicholas Jeffery
- Texas A&M University College of Veterinary Medicine and Biomedical Sciences, College Station, Texas, USA
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20
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Lewis MJ, Granger N, Jeffery ND. Emerging and Adjunctive Therapies for Spinal Cord Injury Following Acute Canine Intervertebral Disc Herniation. Front Vet Sci 2020; 7:579933. [PMID: 33195591 PMCID: PMC7593405 DOI: 10.3389/fvets.2020.579933] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/04/2020] [Indexed: 11/13/2022] Open
Abstract
Some dogs do not make a full recovery following medical or surgical management of acute canine intervertebral disc herniation (IVDH), highlighting the limits of currently available treatment options. The multitude of difficulties in treating severe spinal cord injury are well-recognized, and they have spurred intense laboratory research, resulting in a broad range of strategies that might have value in treating spinal cord-injured dogs. These include interventions that aim to directly repair the spinal cord lesion, promote axonal sparing or regeneration, mitigate secondary injury through neuroprotective mechanisms, or facilitate functional compensation. Despite initial promise in experimental models, many of these techniques have failed or shown mild efficacy in clinical trials in humans and dogs, although high quality evidence is lacking for many of these interventions. However, the continued introduction of new options to the veterinary clinic remains important for expanding our understanding of the mechanisms of injury and repair and for development of novel and combined strategies for severely affected dogs. This review outlines adjunctive or emerging therapies that have been proposed as treatment options for dogs with acute IVDH, including discussion of local or lesion-based approaches as well as systemically applied treatments in both acute and subacute-to-chronic settings. These interventions include low-level laser therapy, electromagnetic fields or oscillating electrical fields, adjunctive surgical techniques (myelotomy or durotomy), systemically or locally-applied hypothermia, neuroprotective chemicals, physical rehabilitation, hyperbaric oxygen therapy, electroacupuncture, electrical stimulation of the spinal cord or specific peripheral nerves, nerve grafting strategies, 4-aminopyridine, chondroitinase ABC, and cell transplantation.
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Affiliation(s)
- Melissa J Lewis
- Department of Veterinary Clinical Sciences, Purdue University College of Veterinary Medicine, West Lafayette, IN, United States
| | - Nicolas Granger
- The Royal Veterinary College, University of London, Hertfordshire, United Kingdom.,CVS Referrals, Bristol Veterinary Specialists at Highcroft, Bristol, United Kingdom
| | - Nick D Jeffery
- Department of Small Animal Clinical Sciences, Texas A & M College of Veterinary Medicine and Biomedical Sciences, College Station, TX, United States
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21
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Fenn J, Olby NJ. Classification of Intervertebral Disc Disease. Front Vet Sci 2020; 7:579025. [PMID: 33134360 PMCID: PMC7572860 DOI: 10.3389/fvets.2020.579025] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/24/2020] [Indexed: 12/24/2022] Open
Abstract
Intervertebral disc disease (IVDD) has been recognized in dogs since the 1800s, when the first descriptions of extruded disc material within the vertebral canal were published. In the intervening time our understanding of intervertebral disc pathology in dogs and cats has increased dramatically, with many variations of IVDD described. Whilst the volume of literature and collective understanding of IVDD has expanded, there has also been scope for confusion as the definition of intervertebral disc disease, with its myriad different manifestations, becomes more complicated. A large volume of literature has aimed to combine the use of histopathology, diagnostic imaging and clinical findings to better understand the various ways in which IVDD can be classified. Much of this research has focused on the classification of mechanisms of intervertebral disc degeneration, centering around the differences between, and overlaps in, IVDD in chondrodystrophic and non-chondrodystrophic dog breeds. However, with the increasing availability of advanced imaging modalities allowing more accurate antemortem diagnosis, the concept of IVDD has expanded to include other clinical presentations that may not fit into traditional models of classification of IVDD. This review aims to provide an up to date overview of both historical and current systems of IVDD classification, highlighting the important findings and controversies underpinning them.
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Affiliation(s)
- Joe Fenn
- Department of Clinical Science and Services, Royal Veterinary College, London, United Kingdom
| | - Natasha J Olby
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
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22
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Jeffery ND, Olby NJ, Moore SA. Clinical Trial Design-A Review-With Emphasis on Acute Intervertebral Disc Herniation. Front Vet Sci 2020; 7:583. [PMID: 33134333 PMCID: PMC7512142 DOI: 10.3389/fvets.2020.00583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/20/2020] [Indexed: 11/13/2022] Open
Abstract
There is a clear need for new methods of treatment of acute disc herniation in dogs, most obviously to address the permanent loss of function that can arise because of the associated spinal cord injury. Clinical trials form the optimal method to introduce new therapies into everyday clinical practice because they are a reliable source of unbiased evidence of effectiveness. Although many designs are available, parallel cohort trials are most widely applicable to acute disc herniation in dogs. In this review another key trial design decision—that between pragmatic and explanatory approaches—is highlighted and used as a theme to illustrate the close relationship between trial objective and design. Acute disc herniation, and acute spinal cord injury, is common in dogs and there is a multitude of candidate interventions that could be trialed. Most current obstacles to large-scale clinical trials in dogs can be overcome by collaboration and cooperation amongst interested veterinarians.
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Affiliation(s)
- Nick D Jeffery
- Department of Small Animal Clinical Sciences, Texas A&M University, College Station, TX, United States
| | - Natasha J Olby
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
| | - Sarah A Moore
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, United States
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