Outcomes of surgically and conservatively managed thoracolumbar and lumbosacral intervertebral disc herniations in cats

BACKGROUND

Limited information is available regarding intervertebral disc herniation (IVDH) and its treatment in cats.

OBJECTIVES

Describe outcomes after surgical or conservative treatment of cats with thoracolumbar and lumbosacral IVDH.

ANIMALS

Ninety-two cats from 2 referral populations (2012-2022) with compressive IVDH between the T3 and S1 vertebrae.

METHODS

Retrospective cohort study evaluating outcomes of surgical (49 cats) and conservative (36 cats) management of IVDH; 7 cats were euthanized at diagnosis. Outcome was assessed using hospital and referring veterinarian records and client questionnaires. Successful outcome was defined as regained or improved ambulation, urinary and fecal continence, and no requirement for analgesic medication.

RESULTS

Incidence of IVDH during the study period was 0.44% (92/20849). Surgical treatment resulted in 62% (6 weeks) and 74% success (6 months). Conservative treatment resulted in 54% (6 weeks) and 65% success (6 months). Neurological grade at presentation was higher in cats treated surgically (median, 2; range, 1-5) than in those treated conservatively (median, 2; range, 0-4; P = .001). Regardless of treatment type, cats suffering trauma were more likely to have a successful outcome 6 weeks after treatment compared with those without history of trauma (odds ratio, 5.3; 95% confidence interval, 1.05-26.78; P = .04). Neurological deficits remained in the majority of cats for both treatment types (92%, conservative; 86%, surgical at 6 weeks). Acute-on-chronic IVDH with characteristics of both extrusion and protrusion were identified in 10% of cats.

CONCLUSIONS AND CLINICAL IMPORTANCE

Conservative treatment could be as effective as surgical decompression in cats with thoracolumbar or lumbosacral IVDH.

Use of chin sling for conservative treatment of mandibular fracture in a guinea pig (Cavia porcellus)

OBJECTIVE

To describe a treatment for a mandibular fracture in a guinea pig (Cavia porcellus).

ANIMAL

A 6-month-old sexually intact male guinea pig referred for a 24-hour history of hyporexia.

CLINICAL PRESENTATION, PROGRESSION, AND PROCEDURES

Physical examination showed lateral displacement of the incisors and inflammation and crepitation during mandible lateralization. Imaging tests revealed a minimally displaced complete oblique fracture of the left mandible with fracture of the left mandibular first premolar tooth and incisor tooth.

TREATMENT AND OUTCOME

Conservative treatment was established by placing a chin sling (CS) to immobilize the jaw and a nasogastric tube for nutritional support. Imaging tests repeated 3 weeks later showed initial callus formation, and the conservative treatment was discontinued. Follow-up examinations showed appetite and progressive weight gain. Five months later, the clinical crown of the left mandibular incisor was absent and a resorptive lesion on the left mandibular first premolar tooth was detected. Complete ossification of the fracture without premolar and moler teeth elongation was observed on control imaging tests. Ten months after initial examination, the patient was reportedly healthy with no signs of pain or dental disease.

CLINICAL RELEVANCE

Jaw fracture treatments in guinea pigs are poorly described in the literature. Surgical treatment can be challenging in this species due to its skull and dental anatomy. Although CS was originally employed to increase the congruency of premolar and molar teeth after coronal reduction, this device yielded satisfactory results as a noninvasive, inexpensive treatment of a mandibular fracture in this guinea pig. Alopecia on the back of the head was the only undesired adverse effect associated with the CS.

Rupture of the gastrocnemius muscle at its distal musculotendinous junction: conservative treatment and outcomes in 11 dogs

CASE HISTORY

Medical records from three veterinary referral centres and a university veterinary teaching hospital in Australia and the USA were reviewed to identify dogs with a diagnosis of distal gastrocnemius musculotendinous junction rupture (DGMJR) that were treated without surgery between 2007 and 2020.

CLINICAL AND IMAGING FINDINGS

All dogs (n = 11) presented with unilateral, pelvic limb lameness and bruising, swelling or pain on palpation at the distal musculotendinous junction. The diagnosis was confirmed with ultrasound or MRI in six dogs; radiographs were used to excluded stifle and tarsus pathology in four dogs; and five dogs were diagnosed on physical examination findings.

TREATMENT AND OUTCOME

All dogs were managed conservatively, either with complete confinement alone (n = 10; median 9 weeks), external coaptation alone (n = 1), or a combination of both (n = 4). Sporting dogs (n = 7) were completely confined (median 22 weeks) for longer periods than companion dogs (n = 3; median 5 weeks).A good to excellent outcome was achieved for all cases in this cohort. The seven sporting dogs achieved an excellent outcome; returning to their previous level of sport, with complete resolution of lameness and recovery of a normal tibiotarsal stance. The four companion dogs achieved a good outcome; returning to their previous level of activity but with persistently increased tibiotarsal standing angle compared to the contralateral limb.

CLINICAL RELEVANCE

Conservative treatment represents a viable treatment option for dogs with a rupture of the gastrocnemius muscle at its distal musculotendinous junction.

Conservative management of equine tarsal collateral ligament injuries may allow return to normal performance

OBJECTIVE

To describe type and distribution of tarsal collateral ligament (CL) injuries and to assess the long-term outcome in horses treated conservatively.

ANIMALS

78 horses (median age, 7 years [IQR, 4 to 9.75 years]) of different breeds and disciplines.

PROCEDURES

Retrospective analysis (2000 through 2020) of horses with tarsal CL lesions diagnosed on ultrasound. The resting time, ability to return to work, and performance level after the injury were compared between horses having a single ligament (group S) or multiple ligaments (group M) affected and according to the case severity.

RESULTS

Most of the horses (57/78) presented a single CL injury, while 21 had multiple CLs affected simultaneously, for a total of 108 CLs injured and 111 lesions. In both groups, the short lateral CL (SLCL) was the most commonly affected (44/108), followed by the long medial CL (LMCL; 27/108). Enthesopathies (72.1%) were more frequent than desmopathies alone (27.9%) and involved mostly the proximal insertion of the SLCL and the distal attachment of the LMCL. Conservative treatment (n = 62) consisted mainly of stall rest. The median resting time (120 days [IQR, 60 to 180 days]) did not significantly differ between the 2 groups (group S vs M) or according to the severity. Most horses (50/62) were able to return to work within 6 months. Horses that did not return (12/62) were more likely to have severe lesions (P = .01). Thirty-eight horses were able to perform at a level equal to or higher than before the injury.

CLINICAL RELEVANCE

This study highlights the importance of thorough ultrasound assessment of tarsal CL injuries and demonstrates that conservative management is a viable option to allow these horses to return to previous performance level.

Intralesional bone marrow and superior check desmotomy is superior to conservative treatment of equine superficial digital flexor tendonitis

BACKGROUND

Superficial digital flexor tendon (SDFT) injury is common in racehorses and a significant cause of lost training days and wastage in the industry.

OBJECTIVES

To compare the post-injury performance of Thoroughbred and Standardbred racehorses diagnosed with SDFT tendonitis treated with intralesional bone marrow and superior check desmotomy or managed conservatively and further to compare this performance with that of uninjured racehorses.

STUDY DESIGN

Retrospective and case-controlled.

METHODS

Medical and race records of racehorses treated surgically or managed conservatively for SDFT tendonitis were collated. Signalment, lesion severity and treatment were identified and performance post-injury compared. Performance of the treatment groups was further assessed by comparison with uninjured racehorses matched for age, sex, number of starts pre-injury and randomly selected from the cases' last races.

RESULTS

The study population comprised 114 racehorses divided into surgical (39/114), conservative (38/114) and control groups (37/114). Horses that had surgery were more likely to return to racing than those managed conservatively (OR 4.7 95% CI [1.6-14.3], P = .006). Standardbreds were more likely to return to race compared with Thoroughbreds (OR 4.0 95% CI [1.2-13.3], P = .03). There was no statistically significant difference in the average number of placings, average number of wins and post-injury earnings between the surgically treated and conservatively managed groups (P = .9, P = .9 and P = .7, respectively). The average number of lifetime starts post-injury/post-selection between surgery, conservative and control groups were not statistically significantly different (P = .2). Surgically treated horses had a statistically significantly shorter time to start post-injury compared with the conservative group (P = .04).

MAIN LIMITATIONS

The retrospective nature of the study precludes an actual fit as a nonrandomised clinical trial and the nonrandomised nature of the allocation of the treatment groups is biased.

CONCLUSIONS

Surgical intervention of superficial digital flexor tendonitis in racehorses suffering flexor tendon injury showed a higher likelihood of return to racing than conservative treatment.

Conservative management of sacroiliac luxation in 17 dogs: Radiographic changes and long-term owner follow-up

The long-term outcome of dogs with sacroiliac (SI) luxation treated conservatively was evaluated in this study. The cranial displacement of the ilial wing relative to sacral length was measured. Long-term follow-up was conducted via owner telephone interview. Short-term radiographic changes were analyzed. Seventeen dogs with a mean radiographic follow-up time of 8 weeks ± 1.9 weeks and mean survey follow-up time of 63 months ± 51 months were included. Mean ilial cranial displacement at the time of injury was 42.1% ± 21.4% (range: 9% to 86%). At recheck examination, 7/9 had no worsening of displacement. Thirteen of 17 dogs were bearing weight within 2 weeks. Fourteen dogs (82%) had complete resolution of lameness within 3 months. Fifteen owners (88%) reported an excellent recovery, indicating no current lameness. No dogs were reported to have a poor outcome. Dogs with SI luxation can have excellent long-term outcomes when managed conservatively.

Conservative Management of Hip Dysplasia

Hip dysplasia (HD) is a common orthopedic condition seen in small animal patients that leads to osteoarthritis of the coxofemoral joint. The disease can be managed conservatively or surgically. The goals of surgical treatment in the immature patient are to either prevent the clinical signs of HD or to prevent or slow the progression of osteoarthritis. In mature patients surgery is used as a salvage procedure to treat debilitating osteoarthritis. Conservative management can be used in dogs with mild or intermittent clinical signs and includes nutritional management and weight control, exercise modification, physical rehabilitation, pain management and disease-modifying agents.

Physical Rehabilitation for the Management of Canine Hip Dysplasia

Hip dysplasia is among the most common orthopedic conditions affecting dogs. Joint laxity is responsible for abnormal development of the femoral head and acetabulum, leading to excessive wear of the articular cartilage. Wear leads to secondary osteoarthritis. Rehabilitation is either conservative or after surgical management. Conservative rehabilitation therapies are directed at decreasing pain, improving hip range of motion (ROM), and building or maintaining muscle mass. Postoperatively, rehabilitation focuses on decreasing postoperative pain and inflammation, improving comfort and limb use, and protecting the surgical site. Once the patient has healed, rehabilitation is directed at improving ROM and promoting muscle mass.

Retrospective Evaluation of Nail Trimming as a Conservative Treatment for Ulcerative Dermatitis in Laboratory Mice

Ulcerative dermatitis (UD) is an idiopathic disease that affects C57BL/6 mice and those having a B6 background. The hallmark of UD is pruritus, which leads to self-mutilation and epidermal ulceration typically in the intrascapular region. Although several treatments for UD have been published, some involve the use of pharmacologic agents that might confound research results. In this retrospective study, we evaluated nail trimming to determine whether this conservative treatment approach improved the resolution rate of UD at our institution compared with that of untreated mice or those that received oral or topical antibiotics. Our findings show that the incidence of resolution of UD was significantly greater and that the time to resolution was shorter in mice treated with nail trimming compared with other groups. These findings support the use of nail trimming as an effective conservative treatment option for UD in B6 mice.