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.

ACVIM consensus statement on diagnosis and management of acute canine thoracolumbar intervertebral disc extrusion

Domestic animals with severe spontaneous spinal cord injury (SCI), including dogs and cats that are deep pain perception negative (DPP-), can benefit from specific evaluations involving neurorehabilitation integrative protocols In human medicine, patients without deep pain sensation, classified as grade A on the American Spinal Injury Association (ASIA) impairment scale, can recover after multidisciplinary approaches that include rehabilitation modalities, such as functional electrical stimulation (FES), transcutaneous electrical spinal cord stimulation (TESCS) and transcranial direct current stimulation (TDCS) This review intends to explore the history, biophysics, neurophysiology, neuroanatomy and the parameters of FES, TESCS, and TDCS, as safe and noninvasive rehabilitation modalities applied in the veterinary field Additional studies need to be conducted in clinical settings to successfully implement these guidelines in dogs and cats

/pdf/nervous-system-modulation-through-electrical-stimulation-in-21rcqy0j9n.pdf

Nervous system modulation through electrical stimulation in companion animals.

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

/pdf/acute-traumatic-spinal-cord-injury-in-humans-dogs-and-other-4myztpq8an.pdf

Acute Traumatic Spinal Cord Injury in Humans, Dogs, and Other Mammals: The Under-appreciated Role of the Dura.

Abstract 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.

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

Objective The aim of this study was to describe the surgical technique and outcomes of dogs with congenital thoracic vertebral body malformations (CTVBM) treated with unilateral vertebral distraction and stabilization with monocortical screws and polymethylmethacrylate (PMMA). Study Design Medical records of 10 client-owned dogs with CTVBM were retrospectively searched for signalment, history, neurological examination, neurological grade based on the modified Frankel scale (MFS), diagnostic method, CTVBM location, Cobb's angle, and vertebral canal angle (VCA), surgical procedure, complications and long-term follow-up. Results One dog suffered cardiac arrest 24 hours post-surgery and died. Median follow-up in nine dogs was 26.5 months (12–50 months). Cobb's angle improved from 33–83 to 10–46 degrees and the VCA ratio from 97–138 to 122–164 degrees. The MFS improved from 3 (n = 3)–4 (n = 7) to 4 (n = 2)–6 (n = 7). Seven dogs recovered full function. Nine dogs improved after surgery compared with preoperative status, recovering ambulation when lost or achieving normal neurological examination in seven cases. No complications were reported during the follow-up period (12–50 months). Conclusion Unilateral transthoracic vertebral distraction and stabilization with monocortical screws and PMMA for treatment of compressive myelopathy due to CTVBM achieved long-term neurological improvement in 9 of 10 dogs.

Transthoracic Vertebral Distraction and Stabilization in 10 Dogs with Congenital Thoracic Vertebral Malformations

Intervertebral disc extrusion (IVDE) is one of the most common neurologic problems encountered in veterinary clinical practice. The purpose of this manuscript is to provide an overview of the literature related to treatment of acute canine thoracolumbar IVDE to help construct a framework for standard care of acute canine thoracolumbar IVDE where sufficient evidence exists and to highlight opportunities for future prospective veterinary clinical research useful to strengthen care recommendations in areas where evidence is low or non-existent. While there exist a number of gaps in the veterinary literature with respect to standards of care for dogs with acute thoracolumbar IVDE, recommendations for standard care can be made in some areas, particularly with respect to surgical decompression where the currently available evidence supports that surgery should be recommended for dogs with nonambulatory paraparesis or worse. While additional information is needed about the influence on timing of decompression on outcome in dogs that are deep pain negative for longer than 48 h duration, there is no evidence to support treatment of the 48 h time point as a cut off beyond which it becomes impossible for dogs to achieve locomotor recovery. Surgical decompression is best accomplished by either hemilaminectomy or mini-hemilaminectomy and fenestration of, at a minimum, the acutely ruptured disc. Adjacent discs easily accessed by way of the same approach should be considered for fenestration given the evidence that this substantially reduces future herniation at fenestrated sites. Currently available neuroprotective strategies such as high does MPSS and PEG are not recommended due to lack of demonstrated treatment effect in randomized controlled trials, although the role of anti-inflammatory steroids as a protective strategy against progressive myelomalacia and the question of whether anti-inflammatory steroids or NSAIDs provide superior medical therapy require further evaluation.

/pdf/current-approaches-to-the-management-of-acute-thoracolumbar-36t1r5681a.pdf

Current Approaches to the Management of Acute Thoracolumbar Disc Extrusion in Dogs

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Current Approaches to the Management of Acute Thoracolumbar Disc Extrusion in Dogs