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

Accuracy of low-field magnetic resonance imaging for differentiating intervertebral disc extrusions and protrusions at the lumbosacral disc space in dogs

Introduction/Purpose

MRI features differentiating extrusion from protrusion in thoracolumbar discs have been published, however little specifically evaluates the lumbosacral disc. The high prevalence of degenerative changes in apparently normal animals complicates assessment of this region and features relevant elsewhere in the spine may not apply. The aims of this study were to determine the accuracy of MRI in differentiating IVDE and IVDP at the lumbosacral disc space in dogs and determine which MRI characteristics discriminate between IVDE and IVDP.

Method

MRI examinations from dogs with surgically confirmed IVDE or IVDP at the lumbosacral disc space were collected retrospectively (2011-2019). Two radiologists independently recorded a diagnosis of IVDE or IVDP, gave a confidence rating, and evaluated specific MRI features. Univariable statistical analysis was performed to identify which MRI characteristics might help distinguish IVDE from IVDP.

Results

117 dogs with lumbosacral IVDE (n = 16) or IVDP (n = 101) were included. Features associated with IVDE were in concordance with previous studies and included interruption of the dorsal annulus, suspected epidural hemorrhage, dispersed (rather than confined) intervertebral disc herniation on T2W sagittal images, lateralized intervertebral disc herniation and displacement of the cauda equina. Overall diagnostic accuracy was 68.8% and interobserver agreement was fair (κ = 0.37), which is lower than has been reported in thoracolumbar disc herniation, but accuracy increased to 85.3% with substantially improved agreement (κ = 0.87) in "confident" diagnoses.

Discussion/Conclusion

MRI characteristics used in differentiating thoracolumbar IVDE and IVDP can be extrapolated to the lumbosacral intervertebral disc space, but diagnostic accuracy in low-field MRI is lower than previously reported in herniations involving the thoracolumbar spine.

Canine models of spine disorders

Neck and low back pain are common among the adult human population and impose large social and economic burdens on health care and quality of life. Spine-related disorders are also significant health concerns for canine companions with etiopathogeneses, clinical presentations, and diagnostic and therapeutic options that are very similar to their human counterparts. Historically, induced and spontaneous pathology in laboratory rodents, dogs, sheep, goats, pigs, and nonhuman primates have been used for study of human spine disorders. While each of these can serve as useful preclinical models, they all have inherent limitations. Spontaneously occurring spine disorders in dogs provide highly translatable data that overcome many of the limitations of other models and have the added benefit of contributing to veterinary healthcare as well. For this scoping review, peer-reviewed manuscripts were selected from PubMed and Google Scholar searches using keywords: "intervertebral disc," "intervertebral disc degeneration," "biomarkers," "histopathology," "canine," and "mechanism." Additional keywords such as "injury," "induced model," and "nucleus degeneration" were used to further narrow inclusion. The objectives of this review were to (a) outline similarities in key features of spine disorders between dogs and humans; (b) describe relevant canine models; and (c) highlight the applicability of these models for advancing translational research and clinical application for mechanisms of disease, diagnosis, prognosis, prevention, and treatment, with a focus on intervertebral disc degeneration. Best current evidence suggests that dogs share important anatomical, physiological, histological, and molecular components of spinal disorders in humans, such that induced and spontaneous canine models can be very effective for translational research. Taken together, the peer-reviewed literature supports numerous advantages for use of canine models for study of disorders of the spine when the potential limitations and challenges are addressed.

Qualitative and quantitative computed tomographic characteristics of the lumbosacral spine in German Shepherd military working dogs with versus without lumbosacral pain

Lumbosacral (LS) stenosis is a cause of lower back pain, loss of mission readiness, and early retirement in military working dogs (MWDs). Aims of the present two-part study were to evaluate a sample of German Shepherd MWDs using standard clinical criteria for LS pain, standard qualitative computed tomographic (CT) criteria for LS stenosis, novel quantitative CT criteria for LS stenosis, and novel behavioral classification criteria for LS pain. Data were retrieved from archives of a tertiary referral MWD hospital. Study 1 was a retrospective, observational, two-group design with a hypothesis that there would be a significant difference in the percentage of affected German Shepherd MWDs with multilevel stenosis (affecting ≥ 3 vertebrae) between LS pain groups, based on standard clinical and qualitative CT criteria. Study 2 was a retrospective, observational, cross-sectional, two- and three-group study design with a hypothesis that quantitative CT measurements would significantly differ between LS pain groups, assigned based on 3 classification systems. The 1st classification system used standard clinical criteria, while the 2nd and 3rd novel classifications included behavioral signs of LS pain. The following quantitative CT measures were recorded without knowledge of behavioral classification: vertebral foramen area, vertebral foramen volume, vertebral foramen fat area; and ratios of vertebral foramen area/vertebral body area (foramen area ratio), cranial vertebral foramen area/caudal vertebral foramen area (cranial:caudal foramen area ratio), and vertebral fat area/vertebral body area (fat area ratio). Study 1 findings did not support the hypothesis in that there was no significant difference in the percentage of dogs affected with multilevel stenosis between LS pain groups (P = 0.6567). Findings for study 2 supported the hypothesis in that dogs with LS pain were significantly more affected by multilevel stenosis (P = 0.0273). Significant differences occurred between LS pain groups in select vertebral locations for all measurements (P ≤ 0.05) except vertebral foramen area and vertebral foramen volume (P > 0.05). Comparisons using novel quantitative CT measures and behavioral classification criteria identified significant differences between LS pain groups that were not detected using standard qualitative criteria. These novel quantitative and behavioral classification criteria may be helpful in future research on causes for early retirement in German Shepherd MWDs.

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

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

Computed Tomographic Measures of Funnel-Shaped Lumbar Vertebral Canal and Articular Process Dysplasia Malformations Differ Between German Shepherd and Belgian Malinois Military Working Dogs

Researchers who study the selection and breeding program criteria for military working dogs aim to help maximize the years of active duty service. Computed tomographic (CT) quantitative phenotyping has been previously described as a method for supporting these research studies. Funnel-shaped lumbar vertebral foramen malformations have been previously described in Labrador retriever military working dogs and proposed to be risk factors for impaired arterial perfusion of nerve tissues during exercise. Articular process dysplasia malformations have been previously described in varying dog breeds and proposed to be risk factors for articular process degenerative joint disease and vertebral foramen stenosis. Aims of this retrospective, cross-sectional study were to describe quantitative CT phenotyping methods for characterizing funnel-shaped lumbar vertebral foramina and articular process dysplasia malformations and to apply these methods in a comparison between groups of German shepherd and Belgian Malinois military working dogs. A military working dog hospital's database was searched for German shepherd and Belgian Malinois dogs aged <6 years that had CT scans of the lumbosacral region during the period of 2008–2016. Observers unaware of CT findings recorded available clinical data for each of the dogs. An observer unaware of clinical data recorded CT measures of funnel-shaped lumbar vertebral foramina and articular process dysplasia malformations for each of dogs and each of the lumbar vertebrae that were available in the scans. A total of 59 dogs were sampled: 41 German shepherd and 18 Belgian Malinois. Articular process dysplasia and funnel-shaped vertebral foramen phenotypic traits were present in both breeds in this sample, with the frequency and quantitative measure of these traits being greater in German shepherd dogs and heavier dogs. Lower weight dogs had a lesser degree of a funnel-shaped foramen at all sampled vertebral locations. A consistent relationship between articular process dysplasia measures and body weight was not seen. Computed tomography measures of funnel shaped vertebral foramina were greater in German shepherd vs. Belgian Malinois dogs at the L7 vertebra (P < 0.01). The CT measures of cranial articular process dysplasia were greater in German shepherd vs. Belgian Malinois dogs at the L4 (P < 0.01) and L5 (P < 0.05) vertebrae.

Single dose epidural methylprednisolone as a treatment and predictor of outcome following subsequent decompressive surgery in degenerative lumbosacral stenosis with foraminal stenosis

Alternative treatments to surgery in canine degenerative lumbosacral stenosis (DLSS) remain limited and reliable predictors of outcome are lacking. The aims of this clinical trial were threefold: to assess the usefulness of single epidural steroid injection (ESI) in DLSS, to compare the outcomes of ESI and decompressive surgery, and evaluate ESI as a predictor of outcome following decompressive surgery. Dogs diagnosed with DLSS were prospectively recruited and administered an ESI. If clinical signs persisted or relapsed, decompressive surgery was recommended. Follow-up was obtained. Thirty-two dogs underwent ESI with 17 having subsequent surgery. Improvement after ESI was seen in 27/32 dogs (84.4%), with 17/22 (77.2%) relapsing within 6 months (n = 15/17 relapsing within 2 months). Five dogs failed to respond to ESI and another five (15.6%) presented a persistent post-ESI favourable response (mean follow-up time, 9.4 months). Post-surgical improvement occurred in all dogs. Outcome appeared more favourable following surgical decompression, with a trend towards reduced pain, increased mobility, and greater quality of life score. This study was unable to demonstrate that ESI could predict surgical outcome. ESI was confirmed as an effective treatment in most but not all cases, leading to transient alleviation of clinical signs for longer than previously reported. ESI provided a complete and apparently long-term sustained resolution of clinical signs in a subset of dogs. Despite this, there was indication that surgical decompression can lead to a more favourable outcome. Epidural steroid injection has a role in the management of DLSS dogs, particularly when surgery is not an option.

Canine Degenerative Lumbosacral Stenosis: Prevalence, Impact And Management Strategies

Canine degenerative lumbosacral stenosis (DLSS) is a syndrome of low back pain with or without neurologic dysfunction associated with compression of the cauda equina. Most commonly occurring in medium- to large-breed dogs of middle to older age, German shepherd and working dogs are predisposed. Diagnosis is based on a combination of clinical signs, advanced imaging and ruling out other differential diagnoses. The volume of the intervertebral foramina at the lumbosacral junction is naturally reduced on extension but degenerative changes lead to a more marked reduction that can impinge the L7 nerve roots. Evidence is lacking on which to base decision-making for treatment of dogs with DLSS. However, surgical intervention may be indicated in dogs that do not respond to conservative management, or for dogs in which there is a requirement to work that prevents lifestyle adjustments. Improvements in electrodiagnosis and novel intra-discal treatments may improve the management of DLSS in the future.

Long-term outcome following lateral foraminotomy as treatment for canine degenerative lumbosacral stenosis

Lateral foraminotomy has been described as an effective surgical treatment for foraminal stenosis in the treatment of degenerative lumbosacral stenosis (DLSS) in dogs. Clinical records were reviewed from 45 dogs which had undergone lateral foraminotomy at the lumbosacral junction either alone or in combination with decompressive midline dorsal laminectomy. Short-term outcome at six weeks was assessed by the surgeon to be good (11.1 per cent) or excellent (88.9 per cent) in all 45 cases. Long-term outcome beyond six months for lumbosacral syndrome was assessed by the owner as excellent in all 34 cases for which follow-up was available despite recurrence in five cases. Recurrence of clinical signs was not related to re-establishment of foraminal compression at the surgical site when assessed on repeat MRI and was managed by either contralateral foraminotomy in one case or conservative management with excellent response. This study confirms lateral foraminotomy as an effective procedure in the management of DLSS-affected dogs suffering from foraminal stenosis and demonstrates that initial good short-term results are maintained long term despite some treatable recurrences. Lateral foraminotomy is an effective procedure when used appropriately in DLSS with foraminal stenosis either alone or in combination with midline dorsal laminectomy.

Lumbosacral stenosis in Labrador retriever military working dogs - an exomic exploratory study

Background

Canine lumbosacral stenosis is defined as narrowing of the caudal lumbar and/or sacral vertebral canal. A risk factor for neurologic problems in many large sized breeds, lumbosacral stenosis can also cause early retirement in Labrador retriever military working dogs. Though vital for conservative management of the condition, early detection is complicated by the ambiguous nature of clinical signs of lumbosacral stenosis in stoic and high-drive Labrador retriever military working dogs. Though clinical diagnoses of lumbosacral stenosis using CT imaging are standard, they are usually not performed unless dogs present with clinical symptoms. Understanding the underlying genomic mechanisms would be beneficial in developing early detection methods for lumbosacral stenosis, which could prevent premature retirement in working dogs. The exomes of 8 young Labrador retriever military working dogs (4 affected and 4 unaffected by lumbosacral stenosis, phenotypically selected by CT image analyses from 40 dogs with no reported clinical signs of the condition) were sequenced to identify and annotate exonic variants between dogs negative and positive for lumbosacral stenosis.

Results

Two-hundred and fifty-two variants were detected to be homozygous for the wild allele and either homozygous or heterozygous for the variant allele. Seventeen non-disruptive variants were detected that could affect protein effectiveness in 7 annotated (SCN1B, RGS9BP, ASXL3, TTR, LRRC16B, PTPRO, ZBBX) and 3 predicted genes (EEF1A1, DNAJA1, ZFX). No exonic variants were detected in any of the canine orthologues for human lumbar spinal stenosis candidate genes.

Conclusions

TTR (transthyretin) gene could be a possible candidate for lumbosacral stenosis in Labrador retrievers based on previous human studies that have reported an association between human lumbar spinal stenosis and transthyretin protein amyloidosis. Other genes identified with exonic variants in this study but with no known published association with lumbosacral stenosis and/or lumbar spinal stenosis could also be candidate genes for future canine lumbosacral stenosis studies but their roles remain currently unknown. Human lumbar spinal stenosis candidate genes also cannot be ruled out as lumbosacral stenosis candidate genes. More definitive genetic investigations of this condition are needed before any genetic test for lumbosacral stenosis in Labrador retriever can be developed.

Electronic supplementary material

The online version of this article (10.1186/s40575-017-0052-6) contains supplementary material, which is available to authorized users.

Postoperative computed tomography and low-field magnetic resonance imaging findings in dogs with degenerative lumbosacral stenosis treated by dorsal laminectomy

OBJECTIVES

To describe postoperative computed tomography (CT) and magnetic resonance imaging (MRI) findings in dogs with degenerative lumbosacral stenosis (DLSS) treated by dorsal laminectomy and partial discectomy.

METHODS

Prospective clinical case study of dogs diagnosed with and treated for DLSS. Surgical and clinical findings were described. Computed tomography and low field MRI findings pre- and postoperatively were described and graded. Clinical, CT and MRI examinations were performed four to 18 months after surgery.

RESULTS

Eleven of 13 dogs were clinically improved and two dogs had unchanged clinical status postoperatively despite imaging signs of neural compression. Vacuum phenomenon, spondylosis, sclerosis of the seventh lumbar (L7) and first sacral (S1) vertebrae endplates and lumbosacral intervertebral joint osteoarthritis became more frequent in postoperative CT images. Postoperative MRI showed mild disc extrusions in five cases, and in all cases contrast enhancing non-discal tissue was present. All cases showed contrast enhancement of the L7 spinal nerves both pre- and postoperatively and seven had contrast enhancement of the lumbosacral intervertebral joints and paraspinal tissue postoperatively. Articular process fractures or fissures were noted in four dogs.

CLINICAL SIGNIFICANCE

The study indicates that imaging signs of neural compression are common after DLSS surgery, even in dogs that have clinical improvement. Contrast enhancement of spinal nerves and soft tissues around the region of disc herniation is common both pre- and postoperatively and thus are unreliable criteria for identifying complications of the DLSS surgery.

Feasibility for Measuring Transverse Area Ratios and Asymmetry of Lumbosacral Region Paraspinal Muscles in Working Dogs Using Computed Tomography

OBJECTIVES

Describe computed tomographic (CT) anatomy of canine lumbosacral (LS) paraspinal muscles, a method for measuring paraspinal muscle transverse area ratios and asymmetry using CT, and application of this method in a small sample of working dogs with versus without LS pain.

METHODS

Published anatomy references and atlases were reviewed and discrepancies were resolved by examination of anatomic specimens and multiplanar reformatted images to describe transverse CT anatomy of LS region paraspinal muscles. Sixteen Belgian malinois military working dogs were retrospectively recruited and assigned to LS pain positive versus negative groups based on medical record entries. A single observer unaware of dog group measured CT transverse areas of paraspinal muscles and adjacent vertebral bodies, in triplicate, for L5-S1 vertebral locations. A statistician compared muscle transverse area ratios and asymmetry at each vertebral location between groups.

RESULTS

The relative coefficient of variation for triplicate CT area measurements averaged 2.15% (N = 16). Multifidus lumborum (L6-7), psoas/iliopsoas (L5-6, L6-7), and sacrocaudalis dorsalis lateralis (L6-7, L7-S1) transverse area ratios were significantly smaller in dogs with LS pain (n = 11) versus without LS pain (n = 5) (p ≤ 0.05). Muscle asymmetry values were not significantly greater in dogs with versus without LS pain.

CLINICAL RELEVANCE

Computed tomographic morphometry of LS region paraspinal muscles is a feasible objective method for use in future evidence-based research studies in working dogs. Potential future research applications include determining whether decreased paraspinal muscle area ratios and/or increased paraspinal muscle asymmetry could be used as markers for preclinical LS pain in stoic dogs or risk factors for other injuries in high performance canine athletes, or determining whether core muscle strengthening exercise prescriptions for dogs with LS pain have an effect on paraspinal muscle area ratios and asymmetry.

Transarticular facet screw stabilization and dorsal laminectomy in 26 dogs with degenerative lumbosacral stenosis with instability

OBJECTIVE

To describe outcome after transarticular facet screw stabilization and dorsal laminectomy for treatment of dynamic degenerative lumbosacral stenosis (DLS) in 26 dogs.

STUDY DESIGN

Retrospective case series.

ANIMALS

Dogs (n = 26) with dynamic DLS.

METHODS

Medical records (2004-2009) of dogs treated with transarticular facet screw stabilization and dorsal laminectomy were reviewed. Dogs (n = 26) were available for immediate postoperative follow-up, 21 dogs at 6 weeks, and 15 at greater than 6 months. Dogs were evaluated by radiographic assessment and owner questionnaire. Lumbosacral (LS) intervertebral disc (IVD) spaces were measured on pre and postoperative 6-week and 6-month radiographs.

RESULTS

In 23 dogs, improvement in clinical signs occurred within 7 days of surgery. Overall postsurgical complication rate directly related to the surgical procedure was 15.4%. LS IVD space measurements taken immediately postoperatively, at 6 weeks, and ≥ 6 months were all significantly increased compared with preoperative measurements. All working dogs (4) returned to full work within 14 months. Most owners (85%) reported their dog was ambulating normally at 6 months with no perceptible lameness during normal activity. All owners perceived their dog's ability to walk, run, and jump after surgery to be improved.

CONCLUSIONS

Transarticular facet screw stabilization and dorsal laminectomy maintains distraction of the LS IVD space for medium-to-large breed dogs with dynamic DLS with a high degree of owner satisfaction, and is comparable to other reported surgical techniques for DLS.

Residual herniated disc material following hemilaminectomy in chondrodystrophic dogs with thoracolumbar intervertebral disc disease

OBJECTIVE

To evaluate the presence of residual disc material within the vertebral canal following hemilaminectomy in chondrodystrophic dogs with thoracolumbar intervertebral disc disease.

METHODS

Forty dogs were treated by hemilaminectomy. Computed tomography was performed preoperatively and immediately postoperatively. The vertebral canal height, width, area, and herniated disc material area were measured. Maximum filling percentage (MFP), residual disc percentage (RDP), maximum residual filling percentage (MRFP), and residual filling percentage (RFP) were calculated. Clinical outcome was determined by telephone interviews.

RESULTS

Residual disc material was present in 100% of the dogs. Mean MFP = 55.4% (range 25.9-82.3%; median 56.9%). Mean RDP = 50.3% (range 2.6-155.8%; median 47.9%). Mean MRFP = 30.8% (range 4.9-60%; median 30.1%). Mean RFP = 19.8% (range 4.8-45%; median 19.0%). All dogs were ambulatory with voluntary urination at the long-term follow-up (range: 88-735 days).

CLINICAL SIGNIFICANCE

Residual disc was present in all dogs following hemilaminectomy for intervertebral disc disease. Residual disc was not associated with failure to achieve functional recovery in these cases.

Effects of body position, imaging plane, and observer on computed tomographic measurements of the lumbosacral intervertebral foraminal area in dogs

OBJECTIVE

To evaluate effects of imaging plane, flexion and extension, patient weight, and observer on computed tomographic (CT) image measurements of the area of the lumbosacral (L7-S1) intervertebral foramen (LSIF) in dogs.

SAMPLE

12 dog cadavers (2 were excluded because of foraminal stenosis).

PROCEDURES

In each cadaver, sagittal, sagittal oblique, transverse oblique, and double oblique CT images were obtained at 3 zones (entrance, middle, and exit zones) of the region of the lateral lumbar spinal canal that comprises the LSIF while the lumbosacral junction (LSJ) was positioned in flexion or extension. Barium-impregnated polymethylmethacrylate was used to fill the intervertebral foramina to aid boundary detection. Measurements of interest were obtained.

RESULTS

Among the dog cadavers, there was large variability in LSIF cross-sectional areas (range, 0.12 to 0.44 cm2; SD, 0.1 cm2) and in foraminal angles required to obtain a double oblique plane in LSJ extension (SD, 8 ° to 9 °). For LSIF area measurements in standard sagittal CT images, interobserver variability was 23% to 44% and intraobserver variability was 4% to 5%. Sagittal oblique images obtained during LSJ extension yielded smaller mean LSIF areas (0.30 cm2), compared with findings in sagittal images (0.37 to 0.52 cm2). The exit and middle zone areas were smaller than the entrance zone area in sagittal images obtained during LSJ extension.

CONCLUSIONS AND CLINICAL RELEVANCE

Repeated measurements of the LSIF area in images obtained during LSJ extension may be unreliable as a result of interobserver variability and the effects of dog positioning and CT slice orientation.

A musculatura epaxial e a fibrose epidural na compressão medular em cães submetidos à laminectomia dorsal modificada

O objetivo deste experimento foi isolar a musculatura epaxial da medula espinhal de cães submetidos à laminectomia dorsal modificada (LDM) e averiguar se os músculos influenciaram na formação da fibrose epidural, na compressão medular e no aparecimento dos sinais neurológicos. Para isso, dez cães hígidos foram submetidos à LDM entre as vértebras T13 e L1 e distribuídos aleatoriamente em dois grupos denominados controle (I) onde a medula espinhal permaneceu exposta sem a presença de implante, e tratado (II)onde foi colocado um im-plante a base de alumínio entre a musculatura epaxial adjacente e a medula espinhal exposta pela LDM. As avaliações constaram de exames neurológicos diários até 180 dias de pós-operatório (PO); mielografia, decorridos 15, 30 e 60 dias de PO; e avaliação macroscópica mediante a reintervenção cirúrgica. Não houve diferença durante as avaliações neurológicas. Aos 15 dias de PO, foi verificado na mielografia, que o grau de compressão da linha de contraste foi maior no grupo tratado (P<0,05) quando comparado ao grupo controle, não havendo diferença dos demais tempos estudados. Na avaliação macroscópica, pode-se observar que no Grupo II, a musculatura epaxial adjacente à medula espinhal não estava em contato com a fibrose epidural, diferentemente do grupo controle. O implante pôde ser removido facilmente e apresentava discreto grau de deformidade crânio-dorsal. Pode-se concluir que a musculatura epaxial adjacente é isolada da medula espinhal pelo implante à base de alumínio em cães submetidos à LDM, e esta não influencia na formação da fibrose epidural, compressão medular e no aparecimento dos sinais neurológicos.

Surgical Treatment of Lumbosacral Foraminal Stenosis Using a Lateral Approach in Twenty Dogs with Degenerative Lumbosacral Stenosis

OBJECTIVES

To describe clinical signs, magnetic resonance imaging (MRI) and surgical findings using a lateral approach to the lumbosacral intervertebral foramen and to evaluate clinical outcomes in dogs with or without concurrent dorsal decompression and annulectomy.

STUDY DESIGN

Retrospective study.

ANIMALS

Dogs (n=20) with degenerative lumbosacral stenosis (DLSS).

METHODS

Medical records (2002-2006) of dogs that had lumbosacral lateral foraminotomy alone or in combination with dorsal decompression were reviewed. Degree of dysfunction was assessed separately for each pelvic limb; dogs with unilateral signs were included in group A, those with bilateral signs in group B. Retrieved data were: signalment, history, neurologic status on admission, 3 days, 6 weeks, and 6 months postoperatively, duration of clinical signs, results of MRI, surgical site(s), intraoperative findings, and outcome.

RESULTS

Based on the clinical and MRI findings unilateral foraminotomy was performed in 8 dogs, bilateral foraminotomy in 1 dog, unilateral foraminotomy with concurrent dorsal decompression in 7 dogs, and bilateral foraminotomy with concomitant dorsal decompression in 4 dogs. Surgery confirmed the presence of foraminal stenosis in all dogs, with osteophyte formation and soft tissue proliferations being the most common lesions. Outcome was good to excellent in 19 dogs and poor in 1 dog. Mean follow-up was 15.2 months (range, 6-42 months).

CONCLUSION

Lateral foraminotomy addresses compressive lesions within exit and middle zones of the lumbosacral foramen.

CLINICAL RELEVANCE

Successful surgical management of DLSS is dependent on recognition and correction of each of the compressive lesions within the lumbosacral junction.

Assessment of Decompressive Surgery in Dogs with Degenerative Lumbosacral Stenosis Using Force Plate Analysis and Questionnaires

OBJECTIVE

To evaluate the long-term outcome after decompressive surgery in dogs with degenerative lumbosacral stenosis (DLS), using force plate analysis (FPA) and owner questionnaires.

STUDY DESIGN

Prospective clinical study.

ANIMALS

Dogs with DLS (n=31) and 24 clinically normal Labrador Retrievers.

METHODS

FPA was performed before surgery (31 dogs) and at 3 days, 6 weeks, 6 months (each, 31 dogs) and >or=1.5 years (12 dogs) after surgery. Peak vertical forces (Fz(+)), braking (Fy(+)), and propulsive forces (Fy(-)), and the corresponding impulses were determined. Questionnaires were completed by the owners before and at 6 months and >or=1.5 years after surgery.

RESULTS

Fy(-) of the pelvic limbs and the ratio pelvic/thoracic of Fy(-) (P/TFy(-)) were significantly smaller in dogs with DLS than controls. Fy(-) and P/TFy(-) decreased significantly 3 days after surgery, and increased during 6 months follow-up, but with long-term follow-up the values remained the same and were smaller than controls. From questionnaires there was a significant improvement after surgery compared with function before surgery. Most owners were satisfied with outcome after surgery.

CONCLUSIONS

Propulsive forces of the pelvic limbs in dogs with DLS are impaired and are partially restored by decompressive surgery.

CLINICAL RELEVANCE

Owner's questionnaires illustrate that decompressive surgery restores function as perceived by owners whereas FPA continues to show impaired propulsive forces for the pelvic limbs.

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

OBJECTIVE

To assess the extent of agreement between computed tomography (CT), magnetic resonance imaging (MRI), and surgical findings in dogs with degenerative lumbosacral stenosis.

DESIGN

Observational study.

ANIMALS

35 dogs with degenerative lumbosacral stenosis.

PROCEDURES

Results of preoperative CT and MRI were compared with surgical findings with respect to degree and location of disk protrusion, position of the dural sac, amount of epidural fat, and swelling of spinal nerve roots.

RESULTS

A lumbosacral step was seen on radiographic images from 22 of 32 (69%) dogs, on CT images from 23 of 35 (66%) dogs, and on MR images from 21 of 35 (60%) dogs. Most dogs had slight or moderate disk protrusion that was centrally located. There was substantial or near perfect agreement between CT and MRI findings in regard to degree of disk protrusion (kappa, 0.88), location of disk protrusion (0.63), position of the dural sac (0.89), amount of epidural fat (0.72), and swelling of spinal nerve roots (0.60). The degree of agreement between CT and surgical findings and between MRI and surgical findings was moderate in regard to degree and location of disk protrusion (kappa, 0.44 to 0.56) and swelling of spinal nerve roots (0.40 and 0.50).

CONCLUSIONS AND CLINICAL RELEVANCE

Results indicate that there is a high degree of agreement between CT and MRI findings in dogs with degenerative lumbosacral stenosis but that the degree of agreement between diagnostic imaging findings and surgical findings is lower.

Force plate analysis before and after dorsal decompression for treatment of degenerative lumbosacral stenosis in dogs

OBJECTIVE

Using force plate analysis (FPA), determine ground reaction forces in dogs with degenerative lumbosacral stenosis (DLS) and evaluate the effects of lumbosacral decompressive surgery.

STUDY DESIGN

Prospective clinical study.

ANIMALS

Twelve dogs with DLS.

METHODS

DLS was diagnosed by clinical signs, radiography, computed tomography, and/or magnetic resonance imaging. FPA was performed before surgery, and 3 days, 6 weeks, and 6 months after surgery. The mean peak braking (Fy+), peak propulsive (Fy-), and peak vertical (Fz+) forces of 8 consecutive strides were determined. The ratio between the total Fy- of the pelvic limbs and the total Fy- of the thoracic limbs (P/TFy-), reflecting the distribution of Fy-, was analyzed to evaluate any changes in locomotion pattern postoperatively. Ground reaction force data for DLS dogs were compared with data derived from 24 healthy dogs (control).

RESULTS

In dogs with DLS, the propulsive forces (Fy-) of the pelvic limbs were significantly smaller than those of controls. P/TFy- was significantly smaller in dogs with DLS than in control dogs, and increased during the follow-up period, reaching normal values 6 months after surgery.

CONCLUSIONS

Cauda equina compression in dogs with DLS decreases the propulsive force of the pelvic limbs and surgical treatment restores the propulsive force of the pelvic limbs in a 6-month period.

CLINICAL RELEVANCE

In dogs with DLS, FPA is an effective method in evaluating the response to surgical treatment. Normal propulsive force in the pelvic limbs was restored during 6 months after decompressive surgery.

Magnetic resonance imaging in the diagnosis and surgical management of sacral osteochondrosis in a mastiff dog

The clinical, radiographic, magnetic resonance imaging (MRI), surgical and pathological findings related to an osteochondral lesion of the sacrum in a mastiff dog are described. The dog showed chronic signs of pain in its pelvic limbs. Radiography revealed a triangular mineralised opacity at the craniodorsal aspect of the sacrum consistent with sacral osteochondrosis. A T2-weighted spin-echo MRI revealed dorsal and lateral compression of the cauda equina. The osteochondral fragment was removed via a dorsal laminectomy, and the clinical signs resolved. Histological abnormalities in the fragment were consistent with a diagnosis of osteochondrosis.

Endoscopic-Assisted Lumbosacral Foraminotomy in the Dog

OBJECTIVE

To determine if endoscopic-assisted foraminotomy significantly increased the area of the L7-S1 intervertebral foramen and if, over 12 weeks, stenosis would occur.

STUDY DESIGN

Prospective, experimental study.

ANIMAL POPULATION

Six clinically normal, 22-29 kg, adult dogs.

METHODS

Using endoscopic assistance, unilateral L7-S1 foraminotomy was performed. Computed tomography of L7-S1 was performed preoperatively, immediately postoperatively, and at 12 weeks. Parasagittal foramen area (PFA) measurements were obtained at the entry, middle, and exit zones of the treated and control foramen for each period. Objective and subjective data were compared among dogs by time period and treatment status.

RESULTS

Endoscopic-assisted foraminotomy resulted in a significant increase in the mean PFA of the entry and middle zones immediately postoperatively. The exit zone was not significantly larger at any time. The foramen remained significantly larger at 12 weeks only in the middle zone; however, some decrease in the surgically created foramen enlargement occurred at all 3 levels. The procedure was well tolerated but dogs did have transient, mild delay of functional return postoperatively.

CONCLUSIONS

Endoscopic-assisted foraminotomy in dogs can be performed for certain foraminal regions, allowing enhanced visibility of the spinal canal. The foramen can be surgically enlarged at the entry and middle zones using this technique; however, some reduction of the foraminal enlargement occurs by 12 weeks. The clinical implications of this reduction cannot be determined from this study.

CLINICAL RELEVANCE

Endoscopic-assisted foraminotomy could be used to improve intraoperative visualization in dogs with foraminal stenosis as a component of degenerative lumbosacral stenosis.

Computed tomography of the normal lumbosacral intervertebral disc in 22 dogs

Computed tomography of the lumbosacral spine was performed on 22 purpose-bred, medium-sized hound dogs between 1 and 6 years of age. Images were evaluated to determine the degree of disc bulge. All dogs were neurologically normal. Dogs were imaged in dorsal recumbency with the pelvic limbs variably extended. Sagittal reconstructions were made from transverse images. The mean (+/-SD) width of the mid-portion of the L7-S1 intervertebral disc was 0.5 +/- 0.07 cm (range 0.33-0.62 cm). All L7-S1 intervertebral discs were dorsally convex, with the mean bulge measuring 0.25 +/- 0.07 cm (range 0.17-0.50 cm). The height of the vertebral canal at L7-S1 was 0.91 +/- 0.11 cm (range 0.68-1.15 cm). The mean percentage of the vertebral canal occupied by the bulge was 26.89 +/- 5.05% (range 20.74-43.08%). Mild bulging of the L7-S1 intervertebral disc can be present without associated neuropathy in medium-sized dogs.

Lumbosacral stenosis in 29 military working dogs: epidemiologic findings and outcome after surgical intervention (1990-1999)

OBJECTIVE

To study the outcome of military working dogs (MWDs) diagnosed with degenerative lumbosacral stenosis (DLS) after surgical intervention and to determine what prognostic indicators affected outcome.

STUDY DESIGN

Retrospective study.

ANIMALS

Twenty-nine MWDs with DLS.

METHODS

The medical records of dogs diagnosed and surgically treated for DLS at the Department of Defense Military Working Dog Veterinary Service Hospital were reviewed. Retrieved data were signalment, clinical signs, survey radiograph results, and surgical findings.

RESULTS

Breed and sex were not found to have prognostic significance. Increasing age at surgery correlated with a poor surgical outcome. Twelve dogs (41%) returned to normal function, 11 (38%) improved, and 6 (20%) never returned to active duty. The average age at surgery was 74 months, 93 months, and 112 months for normal, improved, and dogs not returning to duty, respectively. Significant clinical findings associated with a poor prognosis were related to increasing neurologic severity. The only significant radiographic finding indicating a poor prognosis was foraminal narrowing. Surgical findings with negative prognostic significance were hypertrophic articular facets and interarcuate ligament. Recurrence rates were 16.7% and 54.5% for normal and improved dogs, respectively.

CONCLUSIONS

MWDs with DLS have a good prognosis with surgical decompression if they are young dogs with mild clinical signs at the time of diagnosis. As age and severity of clinical signs increase, the prognosis for successful outcome decreases. Recurrence may be seen in some dogs.

CLINICAL RELEVANCE

Information provided by this study should help military veterinarians determine the prognosis for working dogs with DLS after surgical treatment.

Association of cauda equina compression on magnetic resonance images and clinical signs in dogs with degenerative lumbosacral stenosis

Magnetic resonance imaging (MRI) was used to examine the lumbosacral spine of 27 dogs with degenerative lumbosacral stenosis. Four normal dogs were also similarly imaged. Compression of the soft-tissue structures within the vertebral canal at the lumbosacral space was assessed in two ways: by measuring dorsoventral diameter on T1-weighted sagittal images and cross-sectional area on transverse images. The severity of the clinical signs was compared to the severity of cauda equina compression. No significant correlation was found. It is concluded that degree of compression as determined by MRI at time of presentation is independent of disease severity.

Use of computed tomographic densitometry to quantify contrast enhancement of compressive soft tissues in the canine lumbosacral vertebral canal

OBJECTIVES

To evaluate computed tomography (CT) densitometry as a technique for quantifying contrast enhancement of compressive soft tissues in the canine lumbosacral vertebral canal and to determine whether the degree of contrast enhancement can be used to help predict tissue type or histopathologic characteristics.

ANIMALS

29 large breed dogs with lumbosacral stenosis.

PROCEDURE

Contrast-enhanced CT of L5-S3 was performed by use of a previously described protocol. At each disk level, CT densities of a water-filled syringe, epaxial muscles, and 4 vertebral canal locations were measured. Mean tissue enhancement was calculated by vertebral canal location, using water-filled syringe enhancement as a correction factor. Corrected CT enhancement was compared with tissue type, degree of tissue inflammation, and degree of tissue activity.

RESULTS

Intravenous contrast administration of contrast medium significantly increased CT densities of water-filled syringes and epaxial muscles. Corrected CT enhancement of vertebral canal soft tissues at stenotic sites was greater than at nonstenotic sites. There was no association between enhancement and tissue type for any vertebral canal location. There was no correlation between enhancement and degree of tissue inflammation. There was a correlation between enhancement and tissue activity in the dorsal vertebral canal only.

CONCLUSIONS AND CLINICAL RELEVANCE

A water-filled syringe is a useful calibration tool for CT density measurements. The degree of tissue contrast enhancement, measured by CT densitometry, can be helpful for predicting the location of compressive soft tissues in dogs with lumbosacral stenosis. However, it is of limited value for predicting compressive soft-tissue types or histopathologic characteristics.