Ambulatory Paraparesis Research Articles

Lumbosacral transitional vertebrae in cats and its relationship to lumbosacral vertebral canal stenosis.

Although a clear relationship has been demonstrated between the presence of lumbosacral transitional vertebrae and the development of lumbosacral stenosis in dogs, this relationship has not been evaluated in cats. The aim of this study was to investigate the relationship between the presence of lumbosacral transitional vertebrae and lumbosacral stenosis in cats. The medical records and diagnostic imaging studies of 13 cats diagnosed with lumbosacral stenosis were retrospectively reviewed for lumbosacral abnormalities and compared with findings of 405 cats that underwent CT for reasons unrelated to spinal disease. Clinical signs associated with lumbosacral stenosis included lumbosacral pain, low tail carriage, difficulty jumping, and urinary or faecal incontinence. Neurological signs included proprioceptive deficits, ambulatory paraparesis, pelvic limb ataxia, reduced spinal reflexes and reduced perianal reflex. Duration of clinical signs ranged from 1 day to 10 months (mean 3 months). Of the 13 cats with lumbosacral stenosis, seven (53.8%) were diagnosed with lumbosacral transitional vertebrae. In the control population of 405 cats, 24 (5.9%) were diagnosed with lumbosacral transitional vertebrae. Results indicated that lumbosacral transitional vertebrae were significantly ( P <0.0001) more prevalent in cats with lumbosacral stenosis compared with the control feline population (odds ratio 18.52, 95% confidence interval 6.1-62.1). Development of clinical signs of lumbosacral stenosis in cats with lumbosacral transitional vertebrae (mean 10.8 years) was not significantly different from that of cats without lumbosacral transitional vertebrae (mean 12.7 years). Likewise, there was no significant influence of breed ( P >0.99) or sex ( P = 0.29) on the occurrence of lumbosacral transitional vertebrae. Despite lumbosacral stenosis being a rare spinal condition in cats, lumbosacral transitional vertebrae can be considered a risk factor for its development.

Spinal nephroblastoma at an uncommon localization in a dog

A 7-month-old intact male Otterhound was presented for diagnosis of progressive hindlimb paresis. The neurological examination revealed a severe ambulatory paraparesis localised to the left-sided region of the lower motor neuron (L4-S1). Magnetic resonance imaging was suggestive for an intradural-extramedullary neoplasia at the fifth lumbar vertebra. Surgical exploration demonstrated an intradural-extramedullary mass, which partially invaded the spinal cord. The mass was removed with the exception of the intramedullar part, and the diagnosis of a nephroblastoma was made histopathologically. Following radiation therapy, the dog fully recovered and displayed no signs of neurological dysfunction 9 months after surgery.

Uso do Clamp and Rod Internal Fixation pedicular na estabilização da coluna lombossacra em felino: relato de caso

RESUMO Objetivou-se reportar, pela primeira vez descrita até então, a fixação de uma fratura de sétima vértebra lombar (L7) com luxação de L7-S1, por meio de fixação pedicular, utilizando-se Clamp and Rod Internal Fixation (CRIF) em um gato. Um felino de um ano de idade, macho, SRD, foi atendido com histórico de atropelamento havia sete dias, apresentando paraparesia não ambulatória secundária à fratura da sétima vértebra lombar e compressão da cauda equina. Após avaliação geral do paciente, no dia seguinte, ele foi submetido à cirurgia descompressiva por meio de laminectomia dorsal e posterior estabilização pedicular entre L7 e S1, utilizando-se CRIF bilateralmente. O paciente apresentou evolução favorável com deambulação normal após 15 dias do procedimento cirúrgico.

IMAGING DIAGNOSIS—IMAGING AND HISTOPATHOLOGIC CHARACTERISTICS OF A VERTEBRAL HAMARTOMA IN A CAT

A 9-month-old domestic shorthair cat had progressive ambulatory paraparesis, proprioceptive ataxia, and thoracolumbar hyperesthesia. An extradural mass affecting the left pedicle and lamina of the second lumbar vertebra (L2) causing marked spinal cord impingement was identified in magnetic resonance (MR) images. The mass was predominantly calcified in computed tomographic (CT) images. A hemilaminectomy was performed to resect the mass. Clinical signs were greatly improved at 12-month follow-up. The histopathologic diagnosis was vascular hamartoma. To our knowledge, this is the first report describing the MR characteristics of a vascular hamartoma associated with the vertebral column.

Surgical treatment of dorsal hemivertebrae associated with kyphosis by spinal segmental stabilisation, with or without decompression

This retrospective case series examined the effectiveness of spinal segmental stabilisation, with or without decompression, in nine dogs with neurological deficits associated with dorsal hemivertebrae. Data on signalment, preoperative neurological status, imaging findings, surgical techniques and outcome were evaluated.All cases occurred in young or adult, small-breed dogs with neurological signs ranging from progressive moderate pelvic limb ataxia to non-ambulatory paraparesis. Six dogs also showed urinary and faecal incontinence. In each dog, one or more dorsal thoracic hemivertebra(e) were detected by radiography and MRI. In all dogs, hemivertebra(e) were associated with kyphosis and reduced vertebral canal diameter. All dogs were surgically managed with spinal segmental stabilisation, using Steinmann pins and orthopaedic wires and/or sutures attached to the spinous processes. Three dogs also underwent additional decompressive surgery. Post-operative follow-up ranged from 1.5 to 5.5 years.Immediate or delayed post-operative complications occurred in three dogs, including implant migration or loosening. Eight dogs showed long-term gait improvement, with resolution of incontinence if previously present. At 2–6 years post-surgery, four dogs were neurologically normal, three had mild residual ataxia, one had moderate ambulatory paraparesis, and one dog relapsed 3.5 years after surgery, resulting in severe paraparesis. Spinal segmental stabilisation techniques, with or without decompression, can result in satisfactory outcomes in small dogs with hemivertebrae and mild to moderate neurological signs. Further adaptations might be required to avoid implant loosening and allow continued growth in immature dogs.

Paraparesis in a Golden Retriever

A 7-year-old female spayed Golden Retriever dog presented with fever and a 10-day history of neurological signs, including ambulatory paraparesis and pelvic limb ataxia. Neurological examination initially revealed a T3-L3 myelopathy. Thoracic radiographs revealed a diffuse miliary pulmonary pattern. Endotracheal washes and fine-needle aspirates from several organs aimed at identifying a potential infectious agent or neoplastic process were all unsuccessful. Due to worsening of the clinical signs, euthanasia was elected. Necropsy findings included multifocal, pale to dark red, firm nodules infiltrating the lungs, heart, mesentery, pancreas, small intestine, brain, and spinal cord. Cytological examination of impression smears obtained from the pulmonary nodules during necropsy revealed clusters of epithelioid cells admixed with fewer spindle cells, erythrocytes, and scattered leukocytes. Clinical signs and cytological findings initially suggested the possibility of a widespread granulomatous disease or a metastatic epithelial neoplasm as possible clinical differentials in this case. The final diagnosis was based on the gross and histological findings, with confirmation following histochemistry and immunohistochemistry.

IMAGING DIAGNOSIS—SPINAL EPIDURAL HEMANGIOSARCOMA IN A DOG

An 8-year-old, male Boxer was examined for an acute onset of ambulatory paraparesis. Neurologic examination was consistent with a T3-L3 myelopathy. Myelography revealed an extradural spinal cord compression in the region of the T10-T13 vertebrae. On magnetic resonance (MR) imaging, a well-defined epidural mass lesion was detected. The mass was mildly hyperintense on T1-weighted, hyperintense on T2-weighted and STIR images compared to normal spinal cord and enhanced strongly and homogenously. Postmortem examination confirmed a primary epidural hemangiosarcoma. Findings indicated that the MRI characteristics of spinal epidural hemangiosarcoma may mimic other lesions including meningioma and epidural hemorrhages/hematomas of non-neoplastic etiology.

Amelioration of caudal thoracic syringohydromyelia following surgical management of an adjacent arachnoid cyst

A nine-year-old male, neutered, pug was presented for investigation of progressive ambulatory paraparesis and pelvic limb ataxia of three months' duration. Magnetic resonance imaging was suggestive of caudal thoracic syringohydromyelia with an adjacent intradural arachnoid cyst. The cyst was marsupialised following dorsal laminectomy. Neurological status had improved 10 weeks following surgery when repeat magnetic resonance imaging revealed reduced spinal cord compression both as a result of resolution of the cyst and reduction in size of the syringohydromyelia. At 17 months following surgery, the dog showed further improvements in neurological status, exhibiting mild pelvic limb ataxia and proprioceptive deficits. Improved cerebrospinal fluid flow following surgery may have played a role in the improvement in both conditions. The presence of syringohydromyelia in this context does not preclude a favourable clinical outcome following surgical management.

Acute clinical onset chronic inflammatory demyelinating polyneuropathy in a dog

We report a case of acute-onset ambulatory paraparesis with electrophysiological abnormalities compatible with axonal and demyelinating lesions in a Rottweiler dog. Although the clinical findings were compatible with acute canine idiopathic polyneuropathy, postmortem investigations revealed a chronic demyelinating polyneuropathy affecting the nerve roots. Due to the combination of acute clinical presentation and chronic pathologic features, this case is consistent with the acute-onset form of chronic inflammatory demyelinating polyneuropathy (A-CIDP).

Diagnosis of an Abdominal Splenosis in a Case of Ambulatory Paraparesis of the Hind Limbs in a Ferret ( Mustela putorius furo)

A 2-year-old spayed female ferret ( Mustela putorius furo) was presented with a 2-day history of ambulatory paraparesis of the hind limbs. On physical examination a mass was palpated in the cranial abdominal region, caudal to the stomach. A complete blood cell count revealed a normocytic normochromic anemia and reactive lymphocytes. A hypoechoic abdominal mass was observed during an ultrasound examination of the abdomen. An exploratory laparotomy was recommended and performed during which a pyramidal mass resembling a lobe of fatty liver tissue, plus omental torsion, was removed. The histopathologic diagnosis of the surgically removed mass was splenosis. The abdominal pain and ambulatory paraparesis resolved after surgery, which suggests that the paraparesis was due to pain. The findings in this report indicate that splenosis should be included as a differential diagnosis when a ferret presents with an abdominal mass and acute abdominal pain.

What Is Your Diagnosis?

HistoryA 1.5-year-old spayed female English Bulldog was referred for further evaluation because of a 2-week history of paraparesis. Abnormal neurologic findings included ambulatory paraparesis, which was more pronounced on the right; decreased postural reactions in the pelvic limbs; and hyperpathia on manipulation of the midlumbar region of the vertebral column, consistent with a lesion in the lumbar region. Pertinent laboratory abnormalities at the time of admission included mild neutrophilia (10,890 cells/μL; reference range, 2,060 to 10,600 cells/μL), lymphopenia (605 cells/μL; reference range, 690 to 4,500 cells/μL), and hyperglobulinemia (4.5 g/dL; reference range, 1.6 to 3.6 g/dL). Radiographs of the

Compressive Myelopathy of the Cervical Spine in Komodo Dragons (Varanus komodoensis)

Cervical subluxation and compressive myelopathy appears to be a cause of morbidity and mortality in captive Komodo dragons (Varanus komodoensis). Four cases of cervical subluxation resulting in nerve root compression or spinal cord compression were identified. Three were presumptively induced by trauma, and one had an unknown inciting cause. Two dragons exhibited signs of chronic instability. Cervical vertebrae affected included C1-C4. Clinical signs on presentation included ataxia, ambulatory paraparesis or tetraparesis to tetraplegia, depression to stupor, cervical scoliosis, and anorexia. Antemortem diagnosis of compression was only confirmed with magnetic resonance imaging or computed tomography. Treatment ranged from supportive care to attempted surgical decompression. All dragons died or were euthanatized, at 4 days to 12 mo postpresentation. Studies to define normal vertebral anatomy in the species are necessary to determine whether the pathology is linked to cervical malformation, resulting in ligament laxity, subsequent instability, and subluxation.

Chronic intervertebral disk herniation associated with fused vertebrae treated by vertebral lateral corpectomy in a cat

A 10-year-old Domestic Shorthair cat was admitted for chronic ambulatory paraparesis and a spinal malformation. The clinical examination revealed paraparesis accentuated on the left side. Thoracolumbar radiographs revealed a spinal malformation with a narrowed intervertebral space between L1 and L2, and a dorsal fusion at the level of L2-L3 with a common dorsal process. Magnetic resonance imaging (MRI) revealed an intervertebral disk herniation with a ventral compression of the spinal cord at the level of L1/2. A standard vertebral lateral corpectomy with a foraminotomy was performed with a good outcome.

Evaluation of a proposed therapeutic protocol in 12 dogs with tentative degenerative myelopathy

The objective of this work was to evaluate the long-term efficacy of a proposed therapeutic protocol in 12 dogs with a tentative diagnosis of degenerative myelopathy, followed-up for a 6-month period. Twelve dogs fulfilling the antemortem inclusion criteria (breed, age, adequate vaccination, history of progressive posterior ataxia and/or paraparesis, no radiographic and myelographic abnormalities in the spinal cord and vertebral column) were allocated. All these dogs presented signs of thoracolumbar syndrome (T3-L3), scored as grade I (mild to moderate ataxia and paraparesis) in 10 and grade II (severe ataxia and ambulatory paraparesis) in 2 cases. Treatment included the use of epsilon-aminocaproic acid and N-acetylcysteine, supplemented with vitamins B, C and E. Prednisolone was given for the first two weeks and upon worsening of neurological signs. Daily exercise, performed as walking or swimming, was strongly recommended. Clinicopathological evaluation was normal in all 12 dogs, and survey radiographs and myelograms did not show spinal cord compression. Magnetic resonance imaging (MRI), performed only in 4 dogs, did not disclose compressive disorders or intramedullary lesions. Neurological signs were progressively worsening in all 12 animals, eventually resulting in severe paraparesis (grade III) or paraplegia (grade IV). The applied medications do not appear to be an attractive alternative to conservative management (physiotherapy) or euthanasia in canine degenerative myelopathy, irrespective of its chronicity.

DOES MILD INTERVERTEBRAL DISC DEGENERATION REALLY CAUSE INSTABILITY?

A 7-year-old, female spayed, domestic shorthair cat was presented for ambulatory paraparesis. No trauma history was reported. Myelography and subsequent computed tomography revealed multiple ventrally located extradural spinal cord compressive lesions possibly due to intervertebral disc disease. Compression at the level of Th3–Th4 intervertebral disc space was considered responsible for the paraparesis. The lesion was approached via a right-sided lateral partial corpectomy as described for dogs. Complete spinal decompression was achieved, as documented intraoperatively by visual inspection and palpation of the spinal canal. No surgery related complications were encountered and the cat improved gradually within 8 weeks after the procedure. At 1 year follow-up only a slight proprioceptive deficit in the right hind limb could be noted. This is the first report of partial lateral corpectomy in a cat and should encourage the use of this technique even in small patients.

Surgical Decompression in Dogs with Thoracolumbar Intervertebral Disc Disease and Loss of Deep Pain Perception: A Retrospective Study of 46 Cases

The case details and outcome after surgical decompression of 46 dogs with thoracolumbar intervertebral disc disease with loss of deep pain perception prior to surgery were reviewed. Nineteen dogs (41.3%) recovered with a median follow-up period of 12.5 months. Recovery was defined as an ambulatory paraparesis, or better, with urinary and fecal continence. There was a better outcome in dogs with loss of deep pain for less than 24 hours prior to surgery (19/41; 46.3% recovered) than in dogs without deep pain perception for more than 24 hours (0/5; 0% recovered). Dogs with deep pain perception present at two weeks postoperatively had significantly higher success rate (8/12; 66.7% recovered) than dogs without deep pain perception at this time period (1/10; 10.0% recovered). The return of deep pain perception by two weeks postoperatively can be a useful positive prognostic indicator.

Hemilaminectomy for the treatment of thoracolumbar disc disease in the dog: a follow‐uo studv 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.