Multi-Center Retrospective Evaluation of Screw and Polymethylmethacrylate Constructs for Atlantoaxial Fixation in Dogs.

OBJECTIVE: To evaluate outcome and adverse events following ventral stabilization of the atlantoaxial (AA) joint in dogs with clinical AA subluxation using screw/polymethymethacrylate (PMMA) constructs in a retrospective, multi-center cohort study. STUDY DESIGN: Historical cohort study. ANIMALS: 35 client-owned dogs. METHODS: Medical records from 3 institutions were reviewed to identify dogs with AA subluxation treated with ventral screw and PMMA constructs. Data on signalment, pre- and postoperative neurologic status, imaging performed, and adverse events were retrieved. Neurologic examination data were abstracted to generate a modified Frankel score at admission, discharge, and re-examination. Telephone interview of owners >180 days postoperative was conducted. RESULTS: Thirty-five dogs with AA subluxation treated with ventral screw/PMMA constructs were included. Most dogs were young (median age 1 year), small breed dogs with acute onset of neurologic signs (median duration 22.5 hours). Most dogs were non-ambulatory at the time of admission (median modified Frankel score 3). Adverse events were identified in 15/35 dogs including 9 dogs with major adverse events. Four dogs required a second surgery due to vertebral canal violation (n = 2) or implant failure (n = 2). Re-examination at 4-6 weeks postoperative reported 15/28 dogs with improved neurologic status and 19/28 dogs were ambulatory. Telephone follow-up was available for 23/35 dogs with 23/23 reported as ambulatory (median follow-up 390 days). CONCLUSIONS: Ventral application of screw and PMMA constructs for AA subluxation, as described here, is associated with clinical improvement in the majority of dog. Major adverse events are infrequent and the technique is considered relatively safe.

Use of the T2*-weighted gradient recalled echo sequence for magnetic resonance imaging of the canine and feline brain.

T2*-weighted magnetic resonance imaging (MRI) has been reported to help improve detection of intracranial hemorrhage and is widely used in human neuroimaging. To assess the utility of this technique in small animals, interpretations based on this sequence were compared with those based on paired T2-weighted and fluid-attenuated inversion recovery (FLAIR) sequences in 200 dogs and cats that underwent brain MRI for suspected intracranial disease. Two sets of images (T2 + FLAIR and T2*) were reviewed separately in random order unaccompanied by patient information and were interpreted as normal or abnormal based on whether intracranial abnormalities were seen. The number and location of intracranial lesions were recorded. Eighty-five studies were considered normal and 88 were considered abnormal based on both sets of images, with good agreement (κ = 0.731) between the two. Susceptibility artifact was present in 33 cases (16.5%) on T2*-weighted images. In 12 cases (6%) a total of 69 lesions were seen on T2*-weighted images that were not seen on T2/FLAIR, all of which were associated with susceptibility artifact caused by presumed intracranial hemorrhage. Pseudolesions were seen on T2*-weighted images in five cases, none of which were associated with susceptibility artifact. Abnormalities were seen on T2/FLAIR images that were not seen on T2*-weighted images in 35 cases, confirming that T2* does not replace standard spin echo sequences. These results support inclusion of T2*-weighted sequences in small animal brain MRI studies and indicate that that a large number of abnormalities (especially hemorrhagic lesions) can go undetected if it is not performed.

Transient depression of pelvic limb reflexes in dogs with acute focal thoracolumbar myelopathy.

OBJECTIVE To determine the prevalence of depressed pelvic limb reflexes and changes in those reflexes over time in dogs with acute thoracolumbar myelopathy. DESIGN Prospective study. ANIMALS 34 dogs. PROCEDURES Dogs with acute pelvic limb paralysis caused by acute noncompressive nucleus pulposus extrusion (ANNPE), fibrocartilaginous embolism (FCE), or compressive intervertebral disk herniation (IVDH) within the T3-L3 spinal cord segments were enrolled in the study. Dogs with depressed or absent pelvic limb withdrawal reflexes as determined by 2 examiners were classified as affected and underwent additional testing to rule out multifocal lesions. Pelvic limb reflexes of affected dogs were reassessed every 12 hours until they returned to normal. Neurologic examinations were performed at 4 and 8 weeks after initial examination for some dogs. RESULTS Compressive IVDH, ANNPE, and FCE were diagnosed in 30, 1, and 3 dogs, respectively. Nine (5 with compressive IVDH and all 4 with FCE or ANNPE) of 34 (26%) dogs were classified as affected. Patellar reflexes were depressed in 2 of 9 affected dogs. The median time required for withdrawal reflexes to return to normal was 60 hours (range, 12 to 156 hours). Onset duration of paralysis was negatively associated with the odds of a dog being classified as affected. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that dogs with focal thoracolumbar spinal cord lesions, especially those with peracute onset of paralysis, can develop transient depression of pelvic limb reflexes. Awareness of this phenomenon is important for veterinarians to accurately localize lesions and develop appropriate diagnostic plans and prognoses.