Evaluation of different computed tomography techniques and myelography for the diagnosis of acute canine myelopathy.

Forty-six dogs with either cervical (C1-C5 or C6-T2) or thoracolumbar (T3-L3) acute myelopathy underwent prospective conventional computed tomography (CT), angiographic CT, myelography, and CT myelography. Findings were confirmed at either surgery or necropsy. Seventy-eight percent of lesions were extradural, 11% were extradural with an intramedullary abnormality, 7% were intramedullary, 2% were intradural-extramedullary, and 2% had nerve root compression without spinal cord compression. Intervertebral disc herniation was the most frequent abnormality regardless of signalment or neurolocalization. Twenty-one of 23 Hansen type I disc extrusions but none of the Hansen type II disc protrusions were mineralized. Two chondrodystrophic dogs had acute myelopathy attributable to extradural hemorrhage and subarachnoid cyst. CT myelography had the highest interobserver agreement, was the most sensitive technique for identification of compression, demonstrating lesions in 8% of dogs interpreted as normal from myelography and enabling localization and lateralization in 8% of lesions incompletely localized on myelography due to concurrent spinal cord swelling. None of the imaging techniques evaluated permitted definitive diagnosis of spinal cord infarction or meningomyelitis but myelography and CT myelography did rule out a surgical lesion in those cases. While conventional CT was adequate for the diagnosis and localization of mineralized Hansen type I disc extrusions in chondrodystrophic breeds, if no lesion was identified, plegia was present due to concurrent extradural compression and spinal cord swelling, or the dog was nonchondrodystrophic, CT myelography was often necessary for correct diagnosis.

Use of the ventrodorsal myelographic view to predict lateralization of extruded disk material in small-breed dogs with thoracolumbar intervertebral disk extrusion: 104 cases (2004-2005).

OBJECTIVE: To determine whether the ventrodorsal myelographic view can be used to accurately predict the circumferential location of extruded disk material in dogs with thoracolumbar intervertebral disk extrusion (IVDE) and to describe paradoxical contrast obstruction (PCO). DESIGN: Retrospective case series. ANIMALS: 104 dogs with Hansen type I IVDE. Procedures-Ventrodorsal myelographic views were reviewed, and contrast patterns were categorized according to 8 predetermined patterns. Agreement among observers was compared, and the predicted location of extruded disk material was compared with surgical findings. RESULTS: Agreement regarding myelographic pattern and location of extruded disk material was moderate (kappa = 0.74 and 0.80, respectively) among the 4 observers. Ninety-three (89%) dogs had myelographic evidence of lateralized extrusion, and in 83 of the 93 (89%), predicted location of extruded disk material matched the surgically confirmed location. In 33 of the 40 (83%) dogs with bilateral contrast column gaps of unequal length, disk material was found to be located on the side with the shorter, rather than the longer, contrast gap, a phenomenon described as PCO. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that the ventrodorsal myelographic view could be used to predict the circumferential location of extruded disk material in dogs with thoracolumbar IVDE more often than previously reported. The PCO phenomenon may be useful in determining the side of lateralization when contrast material does not outline the extruded disk material.

The role of acute decompression and restoration of spinal alignment in the prevention of post-traumatic syringomyelia: case report and review of recent literature.

STUDY DESIGN: Case report. INTRODUCTION: Acute post-traumatic syringomyelia formation after spinal cord injury has been considered a rare complication. At this writing, most recent reports have surfaced in neurosurgical journals. As an entity, post-traumatic syringomyelia has not been widely appreciated. It has been confused with conditions such as Hansen's disease or ulnar nerve compression at the cubital tunnel. One study also demonstrated that the occurrence of syrinx is significantly correlated with spinal stenosis after treatment, and that an inadequate reduction of the spine may lead to the formation of syrinx. This reported case describes a patient in whom post-traumatic syringomyelia began to develop 3 weeks after injury, which improved neurologically after adequate decompression. SUMMARY OF BACKGROUND DATA: A 30-year-old man sustained a 20-foot fall at work. He presented with a complete spinal cord injury below T4 secondary to a T4 fracture dislocation. The patient underwent open reduction and internal fixation of T1-T8. After 3 weeks, the patient was noted to have ascending weakness in his bilateral upper extremities and some clawing of both hands. METHODS: A computed tomography myelogram demonstrated inability of contrast to pass through the T4-T5 region from a lumbar puncture. An incomplete reduction was noted. The canal showed significant stenosis. A magnetic resonance image of the patient's C-spine showed increased signal in the substance of the cord extending into the C1-C2 area. The patient returned to the operating room for T3-T5 decompressive laminectomy and posterolateral decompression including the pedicles, disc, and posterior aspect of the body. Intraoperative ultrasound monitoring showed a good flow of cerebrospinal fluid past the injured segment. RESULTS: On postoperative day 1, the clawing posture of the patient's hands was significantly diminished, and the patient noted an immediate improvement in his hand and arm strength. Over the next few days, the patient's strength in the bilateral upper extremities increased to motor Grade 4/5 on manual testing. A magnetic resonance image 4 weeks after decompression showed significant improvement in the cord diameter and signal. CONCLUSIONS: Post-traumatic syringomyelia has not been reported at so early a stage after injury. This disorder is an important clinical entity that must be recognized to prevent potentially fatal or devastating complications. As evidenced by the reported patient and the literature, if this disorder is discovered and treated early, permanent deficit can be avoided. The prevention of post-traumatic syringomyelia requires anatomic realignment and stabilization of the spine without stenosis, even in the case of complete injuries, to maintain the proper dynamics of cerebrospinal fluid flow.

Hansen type I disk disease at T1-2 in a dachshund.

A 7-year-old Dachshund was presented with chronic left thoracic limb lameness and acute neurological deficits to the hind limbs following trauma. A lesion was suspected between C7 and T2 on the basis of neurological examinations. Radiography and myelography identified a calcified intervertebral disk at C7-T1 and an extradural unilateral compressive lesion at T1-2. Computed tomography scans of the cranial thoracic spine revealed extrusion of disk material from the T1-2 intervertebral space resulting in marked spinal cord compression. Intervertebral disk disease is rarely reported at this location. The neurological condition deteriorated after a second myelogram, which was done to examine the thoracolumbar spine. A modified dorsal decompression of T1-2 was performed. The dog was euthanased due to further neurological deterioration 8 days after surgery.

Hemilaminectomy for the treatment of thoracolumbar disc disease in the dog: a follow-up study of 40 cases.

A study was made of dogs with Hansen type I thoracolumbar disc extrusions that had been treated by hemilaminectomy and fenestration of the affected disc. Follow-up information was available for 40 dogs undergoing treatment over a five-year period. The follow-up period ranged from 12 to 72 months (mean 34 months). The case details and the results of treatment of these 40 dogs are presented. All dogs were graded according to the degree of neurological dysfunction at the time of initial presentation and at the conclusion of the study period. Twenty-seven dogs (68 per cent) had no detectable signs of neurological dysfunction or thoracolumbar pain at the final assessment and a further eight dogs (20 per cent) had mild ambulatory paraparesis but were regarded by their owners as functional pets. Recurrence of neurological signs consistent with thoracolumbar disc disease was seen in five dogs (13 per cent) and was successfully resolved completely in one of three dogs that were treated.

Incidence of contralateral versus ipsilateral neurological signs associated with lateralised Hansen type I disc extrusion.

Asymmetrical neurological signs were noted in 50 dogs presenting with Hansen type I thoracolumbar disc extrusion. Thoracolumbar myelograms and surgical decompression were performed in all cases. Dogs were divided into two groups (acute and chronic) based on the duration of clinical signs prior to presentation to the University of Georgia. Lateralising extradural cord compressive lesions were noted on all myelograms. In the acute group, 35 per cent of the dogs had asymmetrical neurological signs contralateral to the myelographic and surgical lesion, while in the chronic group only 11 per cent had neurological signs contralateral to the lesion. There was found to be no significant difference in frequency of contralateral asymmetrical clinical signs between the two groups (Fischer's exact test; P = 0.095). The high frequency of contralateral signs documents the importance of thoracolumbar myelography for accurate localisation of the disc material before decompressive surgery.

Cervical perineurial cyst, a red herring (case report).

Leprous mononeuropathy may present without demonstrable maculoanesthetical patches. A case is described in whom wasting of the right hand was initially attributed to C8 T1 entrapment radiculopathy caused by cervical perineurial cysts. On the basis of the benign nature of the perineurial cysts and questionable right ulnar nerve thickening, the patient was given a trial of anti-leprosy drugs. A follow-up clinico-electrophysiological evaluation favored the diagnosis of leprotic ulnar mononeuropathy.