Physiotherapy in the Recovery of Paraplegic Dogs without Nociception Due to Thoracolumbar Intervertebral Disc Extrusion Treated Surgically.

Several authors have advocated for the role of physiotherapy in canine intervertebral disc extrusion, and it is routinely recommended by various veterinary neurologists. However, veterinary literature does not unanimously support the routine use of physiotherapy to ensure an increase in locomotor return in dogs with IVDE. The aim of the study was to investigate whether physiotherapy can influence the functional recovery of paraplegic dogs with loss of nociception (LN) affected by thoracolumbar IVDE (Hansen type I) and treated surgically. The animals were divided into two groups: the physiotherapy group (PG), which included those that underwent decompressive surgery and postoperative physiotherapy; and the control group (CG), which included dogs that did not undergo any physiotherapy after surgery. A total of 51 dogs were included, with 30 in the PG and 21 in the CG. The number of physiotherapy sessions ranged from 6 to 60. The rate of functional recovery in dogs within 21 days postoperatively (PO) was 10% (3/30) in the PG and 19% (4/21) in the CG. After 21 days PO, the recovery rate was 43.33% (13/30) in the PG and 61.9% (13/21) in the CG, with no significant difference observed between the groups (p = 0.258). Based on the findings of this study, it was concluded that physiotherapy in paraplegic dogs with LN due to thoracolumbar IVDE does not appear to influence functional recovery compared to the group without physiotherapy.

Surgical complications associated with hemilaminectomy and intervertebral disc fenestration: prospective study of 64 dogs / Complicações associadas à hemilaminectomia toracolombar e fenestração de disco intervertebral: estudo prospectivo em 64 cães

Hemilaminectomy and intervertebral disc fenestration are commonly used to treat intervertebral disc extrusion (IVDE); however, they are associated with surgical complications. Sixty-four dogs were assessed during the intraoperative, immediate postoperative, and late postoperative periods to evaluate complications resulting from these surgical procedures. During this study, 15.62% (n=10) of the dogs presented with complications during at least one of the evaluations. Iatrogenic rhizotomy, access to the spinal canal contralateral to the lesion, and cardiorespiratory arrest were observed intraoperatively. Abdominal wall flaccidity, neurological worsening, hematoma, dehiscence, and superficial wound infections were observed during the immediate postoperative period. Adverse reactions to the surgical thread, scar adhesion, and superficial wound infection were the most frequent complications during the late postoperative period. Dogs that undergo hemilaminectomy and intervertebral disc fenestration because of IVDE may experience complications during the intraoperative, immediate postoperative, and late postoperative periods. However, these complications are often transitory and rarely cause death.

A hemilaminectomia e a fenestração do disco intervertebral são os procedimentos cirúrgicos geralmente empregados no tratamento da extrusão do disco intervertebral (EDIV), os quais podem desencadear complicações cirúrgicas. Foram avaliadas complicações em 64 cães nos períodos intra e pós-operatório imediato e tardio. Dos pacientes incluídos no estudo, 15,62% (n=10) apresentaram alguma ocorrência em pelo menos uma das etapas avaliadas. Das complicações, no período intraoperatório foram observadas rizotomia iatrogênica, abertura do canal vertebral contralateral e parada cardio-respiratória. No pós-operatório imediato foram verificadas a flacidez da parede abdominal lateral, piora neurológica, hematoma, deiscência de ferida cirúrgica e infecção superficial da ferida de pele. No pós-operatório tardio foram verificadas reação ao fio cirúrgico, aderência cicatricial e flacidez da parede abdominal lateral como problemas mais frequentes. Conclui-se que cães submetidos à hemilaminectomia e fenestração do disco intervertebral envolvido em decorrência da EDIV podem apresentar complicações nos períodos intraoperatório, pós-operatório imediato e tardio, sendo transitórias e com mínimas chances de ocasionar óbito.

Surgical complications associated with hemilaminectomy and intervertebral disc fenestration: Prospective study of 64 dogs / Complicações associadas à hemilaminectomia toracolombar e fenestração de disco intervertebral: estudo prospectivo em 64 cães

ABSTRACT: Hemilaminectomy and intervertebral disc fenestration are commonly used to treat intervertebral disc extrusion (IVDE); however, they are associated with surgical complications. Sixty-four dogs were assessed during the intraoperative, immediate postoperative, and late postoperative periods to evaluate complications resulting from these surgical procedures. During this study, 15.62% (n=10) of the dogs presented with complications during at least one of the evaluations. Iatrogenic rhizotomy, access to the spinal canal contralateral to the lesion, and cardiorespiratory arrest were observed intraoperatively. Abdominal wall flaccidity, neurological worsening, hematoma, dehiscence, and superficial wound infections were observed during the immediate postoperative period. Adverse reactions to the surgical thread, scar adhesion, and superficial wound infection were the most frequent complications during the late postoperative period. Dogs that undergo hemilaminectomy and intervertebral disc fenestration because of IVDE may experience complications during the intraoperative, immediate postoperative, and late postoperative periods. However, these complications are often transitory and rarely cause death.

RESUMO: A hemilaminectomia e a fenestração do disco intervertebral são os procedimentos cirúrgicos geralmente empregados no tratamento da extrusão do disco intervertebral (EDIV), os quais podem desencadear complicações cirúrgicas. Foram avaliadas complicações em 64 cães nos períodos intra e pós-operatório imediato e tardio. Dos pacientes incluídos no estudo, 15,62% (n=10) apresentaram alguma ocorrência em pelo menos uma das etapas avaliadas. Das complicações, no período intraoperatório foram observadas rizotomia iatrogênica, abertura do canal vertebral contralateral e parada cardio-respiratória. No pós-operatório imediato foram verificadas a flacidez da parede abdominal lateral, piora neurológica, hematoma, deiscência de ferida cirúrgica e infecção superficial da ferida de pele. No pós-operatório tardio foram verificadas reação ao fio cirúrgico, aderência cicatricial e flacidez da parede abdominal lateral como problemas mais frequentes. Conclui-se que cães submetidos à hemilaminectomia e fenestração do disco intervertebral envolvido em decorrência da EDIV podem apresentar complicações nos períodos intraoperatório, pós-operatório imediato e tardio, sendo transitórias e com mínimas chances de ocasionar óbito.

Adenocarcinoma de saco anal com metástase vertebro-medular em um Cocker Spaniel / Anal sac adenocarcinoma with vertebromedullary metastasis in a Cocker Spaniel

Background: Several neoplasms can affect the perianal region, being the hepatic adenoma and the anal sac adenocarcinoma (ASAC), which is considered the most frequent. The ASAC is a malignant neoplasm originating from the secretory epithelium of the perianal apocrine glands and is rarely seen in veterinary medicine. The ASAC occurs mainly in adult to elderly canines with high metastasis rates. Patients may be asymptomatic or manifest discomfort and behavioral changes. In the presence of metastasis, the most frequent clinical signs are inappetence, coughing, dyspnea, and colorectal obstruction. Given this scenario, this paper aims to describe the clinical presentation, diagnostic examination, and necropsy findings of a Cocker Spaniel with ASAC and metastasis in the vertebral body, spinal cord, and cauda equina. Case: A 8-year-old neutered male Cocker Spaniel (12 kg of body mass) with a clinical history of non-ambulatory paraparesis was evaluated. The patient also presented tenesmus, difficulty to defecate, and the presence of nodules in the anal sac area. On the neurological examination, asymmetrical changes compatible with injury between L4-S3 were found. A complete blood count, serum biochemistry, and imaging exams such as plain radiography, abdominal ultrasonography (US), and magnetic resonance imaging (MRI) were requested. Blood count revealed anemia and neutrophilic leukocytosis and hypercalcemia. The liver showed increased echogenicity and thickened pancreas in the abdominal US scan. A slightly heterogeneous, vascularized mass with irregular borders was identified in the topographic region of the sublumbar lymph nodes; MRI images demonstrated an expansile formation in the ventral region of the lumbosacral spine, corresponding to the sublumbar lymph nodes and interruption of the cerebrospinal fluid at L5, suggestive of compression of the spinal cord and cauda equina. A presumptive diagnosis of perianal neoplasm with metastasis was made based on the complementary exams. The dog was referred to necropsy, which revealed a 4 cm tumor in the perianal region that invaded the pelvic canal. Multifocal nodules were present on the lung surface, liver, and kidneys, suggesting metastasis. On the cross-section of the spine, one could note the presence of the tumor in the vertebral bodies, spinal cord, and cauda equina from L5 to S3. Even with histopathological evaluation of the tumor, only the immunohistochemical analysis allowed us to confirm the anal sac adenocarcinoma. Discussion: Adenomas and carcinomas are perianal gland neoplasms common in adult and elderly male dogs; the Cocker Spaniel breed is among the most affected. The clinical signs presented by the patient, such as tenesmus and difficulty in adopting the posture of defecation, are common, although neurological changes are rare. As for metastasis, carcinomas of the perianal region present high chances of metastasis to organs including the liver, kidneys, and lungs, both lymphatically and hematogenously, but few studies have related these factors to neurological alterations due to metastasis. We concluded that metastases from carcinomas to the spine must be considered a possible differential diagnosis in cases of patients presenting clinical signs that are compatible with spinal cord compression and a history of previous neoplasm.

Empiema epidural espinhal em gato com suspeita de linfoma em canal vertebral / Spinal epidural empyema in a cat with suspect of spinal canal lymphoma

Background: Spinal epidural empyema (SEE) is a rare disease in cats that has been described as a cause of severe compressive myelopathy. It is characterized by accumulation of purulent exudate in the form of an abscess in the epidural space. Neurological signs range from spinal hyperesthesia to rapidly progressive paraplegia and may be associated with systemic signs. Spinal lymphoma is the most common neoplasm affecting the central nervous system of cats and can mimic different neoplasms and non-neoplastic diseases, such as SEE. The aim of this study is to report a case of SEE in a cat and highlight the similarities in neurological, laboratory, and imaging findings between this disease and spinal lymphoma. Case: A 8-month-old male neutered mixed-breed cat was referred to the Veterinary Medical Teaching Hospital (HVU) of the UFSM with acute, non-progressive paraplegia. On neurological examination, the patient was paraplegic with no nociception, normal spinal reflexes, increased muscle tone in the pelvic limbs, absence of cutaneous trunci reflex, and spinal hyperesthesia between T13-L1, demonstrating injury in the T3-L3 spinal cord segment. The differential diagnoses included acute spinal cord trauma, neoplasm (lymphoma), and infectious diseases. Hemogram showed lymphocytosis (8062/µL); the biochemical examinations were unremarkable. Tests for antibodies against feline immunodeficiency virus (FIV) and feline leukemia virus (FeLV) antigens were negative. Simple radiography, abdominal ultrasonography, and cerebrospinal fluid findings were also normal. Myelography showed left dorsolateral extradural spinal cord compression from T12 to L1. Based on these findings, the presumptive diagnosis was spinal lymphoma and chemotherapy was initiated. After 2 days, the animal began to show hyporexia, adipsia, vomiting, and diarrhea, in addition to an increase in subcutaneous volume in the thoracolumbar region. Antibiotic therapy was initiated; however, the patient died. Necropsy revealed an abscess in the left dorsolateral extradural space at T12-T13 and T13-L1. Bacterial cultures revealed the presence of Neisseria spp. that was resistant to various antibiotics. On the basis of these findings, the animal was diagnosed with SEE. Discussion: This case report aims to inform veterinarians about the diagnosis of SEE. SEE is a rare condition in cats compared to spinal lymphoma; however, their presentation is similar. Even in imaging examinations, such as magnetic resonance imaging, it is not possible to differentiate between these 2 conditions. The evolution of clinical signs made the diagnosis of the present case difficult since it was acute and not progressive. All cases of SEE reported in the literature were progressive, acute, or chronic. Although testing for FeLV was negative, only 56% of cats with spinal lymphoma test positive for this virus. Clinical signs reported by the owner after the start of chemotherapy may be related to adverse effects, such as immunosuppression, which led to worsening of the condition, culminating in the appearance of a subcutaneous abscess. Subsequently, SEE was suspected; however, surgical decompression was not performed as the animal died soon after. The authors of this report reinforce the need for a definitive and non-presumptive diagnosis of spinal lymphoma to initiate chemotherapy because it mimics different neoplasms and non-neoplastic diseases, such as SEE. Surgical removal of the compressive mass in the spinal cord and histopathological analyses are necessary.

Extrusão de disco intervertebral intradural em um cão / Intradural disc extrusion in a dog

Background: Intervertebral disc extrusion is an important cause of spinal cord dysfunction in dogs. Intradural localizationof the extruded disc material is rare, and is generally associated with a traumatic event or with recurrence of disc extrusionat a previously affected site. We report the clinical presentation, diagnostic workup, and treatment of a dog with intraduralintervertebral disc extrusion not preceded by a traumatic event.Case: A 6-year-old male Dachshund was referred for neurological evaluation due to acute onset of hind-end paralysispreceded by claudication of the left hindlimb. The patient had been receiving conservative treatment to no effect. Neurological examination revealed asymmetric non-ambulatory paraparesis, absence of postural reactions and decreased muscletone in both hindlimbs, a bilaterally diminished patellar reflex, and a hindlimb withdrawal reflex which was normal onthe right and greatly diminished to absent on the left. The lower back was tender to epaxial palpation. Plain radiographsof the lumbar spine in the lateral projection showed calcified material within the spinal canal between the third and fourthlumbar vertebrae. Myelography was suggestively abnormal at the same level, with epidural leakage of contrast at L3-L4.Considering the clinical history, breed, age, neurological signs, and radiographic findings, intervertebral disc disease wassuspected despite the inconclusive myelography findings. A dorsolateral lumbar hemilaminectomy was performed. Intraoperatively, the diagnosis was confirmed by visualization of a discolored spinal cord and absence of extradural material.The intradural space was accessed via durotomy. A firm, straw-yellow material was seen compressing the spinal cord andremoved. Subsequent histopathological...(AU)

Extrusão de disco intervertebral intradural em um cão / Intradural disc extrusion in a dog

Background: Intervertebral disc extrusion is an important cause of spinal cord dysfunction in dogs. Intradural localizationof the extruded disc material is rare, and is generally associated with a traumatic event or with recurrence of disc extrusionat a previously affected site. We report the clinical presentation, diagnostic workup, and treatment of a dog with intraduralintervertebral disc extrusion not preceded by a traumatic event.Case: A 6-year-old male Dachshund was referred for neurological evaluation due to acute onset of hind-end paralysispreceded by claudication of the left hindlimb. The patient had been receiving conservative treatment to no effect. Neurological examination revealed asymmetric non-ambulatory paraparesis, absence of postural reactions and decreased muscletone in both hindlimbs, a bilaterally diminished patellar reflex, and a hindlimb withdrawal reflex which was normal onthe right and greatly diminished to absent on the left. The lower back was tender to epaxial palpation. Plain radiographsof the lumbar spine in the lateral projection showed calcified material within the spinal canal between the third and fourthlumbar vertebrae. Myelography was suggestively abnormal at the same level, with epidural leakage of contrast at L3-L4.Considering the clinical history, breed, age, neurological signs, and radiographic findings, intervertebral disc disease wassuspected despite the inconclusive myelography findings. A dorsolateral lumbar hemilaminectomy was performed. Intraoperatively, the diagnosis was confirmed by visualization of a discolored spinal cord and absence of extradural material.The intradural space was accessed via durotomy. A firm, straw-yellow material was seen compressing the spinal cord andremoved. Subsequent histopathological...