Abstract
The management of degenerative lumbosacral stenosis (DLSS) in dogs usually requires aggressive, costly surgical treatments that may themselves present complications, while do not fully resolve the symptoms of the disease. In this study, the dog diagnosed with severe DLSS, with hind limb paresis, was treated using a new and least invasive treatment. Cultured autologous adipose tissue-derived mesenchymal stem cells (AT-MSCs) were injected bilaterally at the level of L7-S1, in the vicinity of the external aperture of the intervertebral foramen of DLSS patient. In the previously described treatments of spontaneous intervertebral disc degeneration in dogs, intradiscal injections of MSCs did not lead to positive effects. Here, we report a marked improvement in clinical outcome measures related to the ability of a dog to walk and trot, which were expressed by a numeric rating scale based on a veterinary assessment questionnaire. The improved status persisted throughout the observed time course of 4.5 years after the AT-MSC transplantation. To the best of our knowledge, this is the first case of successful therapy, with long-term positive effect, of spontaneously occurring canine DLSS using presented treatment that, we believe, represents a contribution to current knowledge in this field and may shape both animal and human DLSS treatment options.
Highlights
Canine degenerative lumbosacral stenosis (DLSS) is a syndrome of low back pain that includes various levels of neurologic dysfunction, and it has been defined as an acquired narrowing of the vertebral duct, the vertebral aperture, or both, resulting in compressive radiculopathy of cauda equina [1, 2]
The degeneration of the intervertebral disc (IVD) L7-S1 is thought to be the cause of DLSS that occurs as a result of prolonged stress, along with the activity and age of the animal
It was shown that the pain relief was detected within 6 weeks in 81% of animals, while positive neurological outcomes were observed in 62.5% of treated dogs within the follow-up of 30 weeks [10]; recovery has been reported for 33% of dogs after 2 months following the treatment, with follow-up period of up to 4 years [11]; clinical improvement has been reported for 76.8% animals during the follow-up period of 9–41 months [12]; and the 53% of dogs were totally cured during the mean follow-up of 30 months [13]
Summary
Canine degenerative lumbosacral stenosis (DLSS) is a syndrome of low back pain that includes various levels of neurologic dysfunction, and it has been defined as an acquired narrowing of the vertebral duct, the vertebral aperture, or both, resulting in compressive radiculopathy of cauda equina [1, 2]. The degeneration of the intervertebral disc (IVD) L7-S1 is thought to be the cause of DLSS that occurs as a result of prolonged stress, along with the activity and age of the animal. The loss of normal biomechanical properties of the disc and the resulting degenerative changes in the supporting soft tissue and bony structures at the lumbosacral junction are the main contributors to the compression of sacral and caudal nerve roots [3]. This report proposes a novel and least invasive strategy, the transplantation of autologous adipose tissue-derived MSCs (AT-MSCs) in the vicinity of the external aperture of the intervertebral foramen of DLSS patient instead of intradiscally. Our aim was to avoid the harsh microenvironment within the IVD, assuming that the proposed route of application would allow AT-MSCs to exhibit their most important characteristics—trophic and homing effects at their full potential
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