Extradural Compression Research Articles

Lumbosacral Intervertebral Disk Disease in Six Cats

Medical records of six cats diagnosed with lumbosacral intervertebral disk disease were reviewed. Clinical signs included reluctance to jump, low tail carriage, elimination outside the litter box, reluctance to ambulate, pelvic-limb paresis, urinary incontinence, and constipation. All cats had lumbosacral hyperpathia on palpation. Computed tomography in four cats revealed evidence of extradural spinal cord compression at the seventh lumbar (L(7)) to first sacral (S(1)) vertebral interspace. Compression was confirmed via myelography in three of these four cats, with confirmation in the fourth cat at the time of decompressive laminectomy. Each of the six cats underwent dorsal decompressive laminectomy at the L(7) to S(1) interspace. Postoperative clinical follow-up lasted 3 to 35 months, with most cats having excellent outcomes.

Cervical Chondroid Chordoma in a Shetland Sheep Dog

A spayed female Shetland sheep dog aged 12 years was presented for examination with ataxia and hindlimb paralysis. Extradural spinal cord compression was found at the level of vertebrae C6-C7 by radiography and myelocomputed tomography. A jelly-like mass (0.6 x 1.3 cm) was removed surgically. Histopathological findings were characterized by proliferation of vacuolated polygonal cells (physaliphorous cells) in a mucinous matrix and the presence of chondroid tissue shown immunohistochemically to express S-100. The physaliphorous cells were immunolabelled strongly for vimentin and S-100, and weakly for cytokeratin. A diagnosis of canine cervical chondroid chordoma was made. This is considered to be the first report of a chondroid chordoma originating from the cervical region of the spine in the dog.

Conus medullaris syndrome due to an intradural disc herniation: A case report

A 70-year-old male patient developed acute paraplegia due to conus medullaris compression secondary to extrusion of D12-L1 disc. After negative epidural examination intraoperatively, a durotomy was performed and an intradural disc fragment was excised. Patient did not regain ambulatory status at two-year follow-up. Intraoperative finding of negative extradural compression, tense swollen dura and CSF leak from ventral dura should alert the surgeon for the possibility of intradural disc herniation. A routine preoperative MRI is misleading and a high index of suspicion helps to avoid a missed diagnosis.

Clip Compression Model Is Useful for Thoracic Spinal Cord Injuries

Experimental investigation of an acute thoracic spinal cord injury model in rats involving acute clip compression that simulates human injury. To assess the dose-response of this model for the relationship between the force of injury on the rat thoracic spinal cord and histological and functional outcome measures. Acute extradural clip compression injury has been a reliable model for producing acute experimental cervical spinal cord injury; however, this model has not been formally evaluated with dose-response curves for acute injury of the thoracic spinal cord. After laminectomy at T2 in Sprague-Dawley rats, a modified aneurysm clip exerting a closing force of 20, 26, or 35 g was applied extradurally around the spinal cord at T2, and then rapidly released with cord compression persisting for 1 minute. These forces were selected to simulate acute compression injuries of mild to moderate, moderate, and moderate to severe degrees, respectively (n = 8/group). Motor activity was assessed weekly for 4 weeks with the Basso, Beattie, and Bresnahan (BBB) open field locomotor test. The injured spinal cord was then examined histologically including quantification of cavitation. A significant main effect was observed for clip force and BBB score (F(2,20) = 5.42, P = 0.013). For 4 weeks after injury, the BBB scores for the 20 g and 35 g clip injury groups were significantly different (P < 0.05). The cavitation volume at 4 weeks was directly proportional to the severity of injury: the 20 g group had significantly smaller cavities than the 35 g group (P < 0.05), and the cavitation volume correlated with the BBB scores. The rat thoracic cord clip compression model is a reproducible, clinically relevant spinal cord injury model. This is the first time that the force of clip compression injury in the rat thoracic cord has been correlated with both functional and histologic outcome measures.

Reduced HO-1 Protein Expression is Associated with More Severe Neurodegeneration after Transient Ischemia Induced by Cortical Compression in Diabetic Goto—Kakizaki Rats

Pronounced hyperglycemia provoked by extradural compression (EC) of the sensorimotor cortex was recently described in the non-insulin dependent Goto-Kakizaki (GK) diabetic rat. Compared with control Wistar rats, GK rats exhibited more extensive brain damage after cortical ischemia at 48 h of reperfusion (Moreira et al, 2007). We hypothesized that the enhanced brain injury in GK rats could be caused by differential regulation of the heme degrading enzyme heme oxygenase (HO)-1, known to interact with the expression of other target genes implicated in antioxidant defense, inflammation and neurodegeneration, such as superoxide dismutase (SOD)-1, -2, inducible nitric oxide synthase (iNOS), and tumor necrosis factor-alpha (TNFalpha). At 48 h after ischemia, relative mRNA expression of such target genes was compared between ipsilateral (compressed) and contralateral (uncompressed) hemispheres of GK rats, along with baseline comparison of sham, uncompressed GK and Wistar rats. Immunohistochemistry was performed to detect cellular and regional localization of HO-1 at this time point. Baseline expression of HO-1, iNOS, and TNFalpha mRNA was increased in the cortex of sham GK rats. GK rats showed pronounced hyperglycemia during EC and transient attenuation of regional cerebral blood flow recovery. At 48 h after reperfusion, HO-1 mRNA expression was 7- to 8-fold higher in the ischemic cortex of both strains, being the most upregulated gene under study. Heme oxygenase-1 protein expression was significantly reduced in diabetic rats and was found in perilesional astrocytes and rare microglial cells, in both strains. The reduced HO-1 protein expression in GK rats at 48 h after reperfusion combined with more extensive neurodegeneration induced by EC, provides further in vivo evidence for a neuroprotective role of HO after brain ischemia.

Anti-Apoptotic Effect of Insulin in the Control of Cell Death and Neurologic Deficit after Acute Spinal Cord Injury in Rats

Recent studies confirmed that the new cell survival signal pathway of Insulin-PI3K-Akt exerted cyto-protective actions involving anti-apoptosis. This study was undertaken to investigate the potential neuroprotective effects of insulin in the pathogenesis of spinal cord injury (SCI) and evaluate its therapeutic effects in adult rats. SCI was produced by extradural compression using modified Allen's stall with damage energy of 40 g-cm force. One group of rats was subjected to SCI in combination with the administration of recombinant human insulin dissolved in 50% glucose solution at the dose of 1 IU/kg day, for 7 days. At the same time, another group of rats was subjected to SCI in combination with the administration of an equal volume of sterile saline solution. Functional recovery was evaluated using open-field walking, inclined plane tests, and motor evoked potentials (MEPs) during the first 14 days post-trauma. Levels of protein for B-cell lymphoma/leukemia-2 gene (Bcl-2), Caspase-3, inducible nitric oxide synthase (iNOS), and cyclooxygenase-2 (COX-2) were quantified in the injured spinal cord by Western blot analysis. Neuronal apoptosis was detected by TUNEL, and spinal cord blood flow (SCBF) was measured by laser-Doppler flowmetry (LDF). Ultimately, the data established the effectiveness of insulin treatment in improving neurologic recovery, increasing the expression of anti-apoptotic bcl-2 proteins, inhibiting caspase-3 expression decreasing neuronal apoptosis, reducing the expression of proinflammatory cytokines iNOS and COX-2, and ameliorating microcirculation of injured spinal cord after moderate contusive SCI in rats. In sum, this study reported the beneficial effects of insulin in the treatment of SCI, with the suggestion that insulin should be considered as a potential therapeutic agent.

Tuberculosis of the Spine

We analyzed 124 papers published in the English language literature to define the indications and timing of surgery in spinal TB and to evaluate the outcome of various surgical procedures for kyphosis and neural outcome. Surgery in spinal tuberculosis is indicated for diagnostic dilemma, neural complications, and prevention of kyphosis progression. Up to 76% canal encroachment is compatible with a normal neurologic state as the spinal cord tolerates gradually developing compression. Patients with relatively preserved cord size, but with edema/myelitis and predominantly fluid compression on MRI respond well to nonoperative treatment. We believe patients with extradural compression by granulation tissue with little fluid component compressing or constricting the cord circumferentially with cord edema/myelitis or myelomalacia need early surgical decompression. Transthoracic transpleural anterior decompression and extrapleural anterolateral decompression have similar results in the dorsal spine. Instrumented stabilization helps prevent graft-related complications when postdébridement defects exceed two disc spaces (4-5 cm). Progression of kyphosis may occur in a short-segment disease despite instrumented stabilization. Its outcome in a long-segment disease needs observation. The correction of healed kyphosis requires multistage surgery and is fraught with complications. Prospective studies are needed to define surgical approach, steps, stages, problems, and obstacles to correct severe kyphosis in spinal TB.

Conservative treatment of an atlantoaxial degenerative articular cyst: case report

Background Atlantoaxial degenerative articular cysts are rare lesions that can cause extradural compression of the cervicomedullary junction. When symptomatic, they usually require surgical treatment. We report an unusual case of spontaneous regression of an atlantoaxial degenerative articular cyst after conservative treatment with an external cervical brace along with a systemic therapy with nonsteroidal anti-inflammatory drugs (NSAIDs) and steroids. We also discuss the potential pathogenetic mechanisms involved. Purpose To describe a case of significant volume reduction of an atlantoaxial articular degenerative cyst in a patient treated with a Philadelphia collar and anti-inflammatory drugs. Study design Case report with analysis of the literature. Methods A 80-year-old patient was admitted to our institution with a history of progressive tetraparesis, ataxic gait, and cervical pain. A cervical spine magnetic resonance imaging (MRI) scan showed an extradural mass lesion behind the dens of C2 causing significant compression of the cervicomedullary junction, suggesting the diagnosis of atlantoaxial degenerative articular cyst. The patient refused surgery in favour of a conservative treatment with a Philadelphia collar and a short-term course of NSAIDs and corticosteroids. Results After 6 weeks, the patient's neurological condition improved, and a 6-month follow-up cervical spine MRI scan revealed an almost complete regression of the atlantoaxial cystic lesion. At a 1-year follow-up, his clinical condition was further improved. Conclusions Atlantoaxial articular degenerative cysts are rare lesions that should be included in the differential diagnosis of those extradural lesions that can cause a ventral or ventrolateral compression of the cervicomedullary junction. They most commonly occur in elderly female patients affected by diffuse arthrosic degeneration of the cervical spine, with or without clear radiological signs of atlantoaxial instability, and have a typical appearance on MRI imaging. Surgery, with direct excision of the cyst and/or a C1–C2 fusion, is the first treatment of choice. Nevertheless, our report points out the possibility of a significant spontaneous regression of these lesions following a simple conservative strategy based on the use of an external cervical brace together with a systemic anti-inflammatory therapy.

INTERVERTEBRAL DISC EXTRUSION AND SPINAL DECOMPRESSION IN A BINTURONG (ARCTICTIS BINTURONG)

A 10-yr-old binturong (Arctictis binturong) developed an acute onset of hind limb paralysis. Neurological examination revealed sensorimotor paraplegia. Myelography and computed tomography demonstrated a ventrolateral extradural compression of the spinal cord centered over the L3-L4 intervertebral disc space. Spinal decompression was performed via hemilaminectomy and excision of degenerate nucleus pulposus, confirmed by histopathologic examination. The binturong regained slight motor function by day 8 postoperatively but succumbed to pancreatitis 19 days postoperatively.

Is anatomical distribution helpful for differentiating TB spondylitis from neoplastic causes of extradural spinal cord compression in children? A pilot study

Background. Extradural spinal cord compression in children may be the result of infection/inflammation or neoplasia. It is vital to differentiate between the two as there is considerable difference in the management of these entities. Objective. The aim of this paper is to determine whether there are significant differences between TB spondylitis and neoplasia causing extradural compression of the cord with regard to the anatomical distribution and compartmentalisation. Materials and methods. A group of 16 children between the ages of 4 months and 14.2 years who had magnetic resonance (MR) evaluation of the spine consecutively were analysed retrospectively. Results. A wide variety of neoplasms demonstrated an anatomical site and compartment on MRI that s ‘characteristic\' of TB spondylitis. Conclusion. Anatomical distribution alone does not assist in narrowing the differential diagnosis. There is still need for biopsy in children with extradural compression by a mass. South African Journal of Radiology Vol. 11 (4) 2007: pp. 80-84

Electro-acupuncture and Chinese herbs for treatment of cervical intervertebral disk disease in a dog

A non-ambulatory dog with tetraparesis following a pain episode that had evolved over 2 months was submitted for medical treatment and diagnosed with intervertebral disk disease at C3-C4 and dorsal extradural compression at C1-C2 and C3-C4 using myelography and computed tomography. The dog experienced ambulation recovery after 15 days of treatment with only electroacupuncture and Chinese herbal medicine, with marked improvement occurring after only 10 treatments. Six months of follow-up demonstrated that the dog was stable and had no recurrence of symptoms. Therefore, it was concluded that the combination of electroacupuncture and Chinese herbal medicine was responsible for motor rehabilitation.

Diabetic Goto-Kakizaki rats display pronounced hyperglycemia and longer-lasting cognitive impairments following ischemia induced by cortical compression

Hyperglycemia has been shown to worsen the outcome of brain ischemia in several animal models but few experimental studies have investigated impairments in cognition induced by ischemic brain lesions in hyperglycemic animals. The Goto-Kakizaki (GK) rat naturally develops type 2 diabetes characterized by mild hyperglycemia and insulin resistance. We hypothesized that GK rats would display more severe cerebral damage due to hyperglycemia-aggravated brain injury and, accordingly, more severe cognitive impairments. In this study, recovery of motor and cognitive functions of GK and healthy Wistar rats was examined following extradural compression (EC) of the sensorimotor cortex. For this purpose, tests of vestibulomotor function (beam-walking) and combined tests of motor function and learning (locomotor activity from day (D) 1 to D5, operant lever-pressing from D14 to D25) were used. EC consistently reduced cerebral blood flow in both strains. Anesthesia-challenge and EC resulted in pronounced hyperglycemia in GK but not in Wistar rats. Lower beam-walking scores, increased locomotor activity, impairments in long-term habituation and learning of operant lever-pressing were more pronounced and observed at later time-points in GK rats. Fluoro-Jade, a marker of irreversible neuronal degeneration, revealed consistent degeneration in the ipsilateral cortex, hippocampus and thalamus at 2, 7 and 14 days post-compression. The amount of degeneration in these structures was considerably higher in GK rats. Thus, GK rats exhibited marked hyperglycemia during EC, as well as longer-lasting behavioral deficits and increased neurodegeneration during recovery. The GK rat is thus an attractive model for neuropathologic and cognitive studies after ischemic brain injury in hyperglycemic rats.

Functional and Pharmacokinetic Outcomes after a Single Intravenous Infusion of Recombinant Human Erythropoietin in Patients with Malignant Extradural Spinal Cord Compression

Aims To determine the cerebrospinal fluid concentrations and the functional and pain outcomes after a single intravenous infusion of erythropoietin at the start of a standard radiotherapy and steroid protocol. Materials and methods Ten paraparetic patients with malignant extradural spinal cord compression who were eligible for radiotherapy, lumbar puncture and intravenous epoetin alpha were enrolled. The patients received epoetin alpha 1500 IU/kg intravenously over 30 min followed by a standardised dexamethasone and radiotherapy protocol. A lumbar puncture and venipuncture were carried out 24–30 h after the epoetin alpha infusion. The patients were followed closely at defined intervals. Results Erythropoietin was detectable in the cerebrospinal fluid in all eight patients sampled (median 92.5 mIU/ml, range 17.8–214.0 mIU/ml). Before treatment, eight patients were non-ambulatory and two patients were ambulatory with assistance. After treatment, eight (80%, 95% confidence interval [CI] 44–97%) improved at least one functional class and recovered or maintained ambulation. Five of seven patients (71%; 95% CI 29–96%) with objective sensory deficits and one of seven (14%; 95% CI 0–58%) catheter-dependent patients recovered. Overall, 78% (95% CI 40–97%) had a pain response. Conclusions After an intravenous infusion of epoetin alpha, radiotherapy and steroids, high concentrations of erythropoietin were detectable in the cerebrospinal fluid. Patients with malignant extradural spinal cord compression showed encouraging improvements in neurological function and pain.

Cost-effectiveness of surgery plus radiotherapy versus radiotherapy alone for metastatic epidural spinal cord compression

A recent randomized clinical trial has demonstrated that direct decompressive surgery plus radiotherapy was superior to radiotherapy alone for the treatment of metastatic epidural spinal cord compression. The current study compared the cost-effectiveness of the two approaches. In the original clinical trial, clinical effectiveness was measured by ambulation and survival time until death. In this study, an incremental cost-effectiveness analysis was performed from a societal perspective. Costs related to treatment and posttreatment care were estimated and extended to the lifetime of the cohort. Weibull regression was applied to extrapolate outcomes in the presence of censored clinical effectiveness data. From a societal perspective, the baseline incremental cost-effectiveness ratio (ICER) was found to be $60 per additional day of ambulation (all costs in 2003 Canadian dollars). Using probabilistic sensitivity analysis, 50% of all generated ICERs were lower than $57, and 95% were lower than $242 per additional day of ambulation. This analysis had a 95% CI of -$72.74 to 309.44, meaning that this intervention ranged from a financial savings of $72.74 to a cost of $309.44 per additional day of ambulation. Using survival as the measure of effectiveness resulted in an ICER of $30,940 per life-year gained. We found strong evidence that treatment of metastatic epidural spinal cord compression with surgery in addition to radiotherapy is cost-effective both in terms of cost per additional day of ambulation, and cost per life-year gained.

Ectopic Fascioliasis in the Dorsal Spine

Parasitic myelopathy is rare. We report ectopic infestation of the spine by Fasciola hepatica. A young woman presented with gradual onset paraplegia with bladder and bowel involvement. A magnetic resonance imaging scan showed an epidural mass lesion that was isotense on T1-weighted images and hyperintense on T2-weighted images, extending from T4-T7 vertebra with extradural cord compression. She was diagnosed with cord compression, possibly owing to tubercular epidural granulation tissue. During surgery, a mobile, flat, leaf-like, pink parasite was found in the epidural space. Morphological and histological indices confirmed the parasite as Fasciola hepatica. Ectopic spinal localization of Fasciola may occur during the transmigration path of the parasite through peritoneum or from the liver through portal venous system.

Posterior Spinal Cord Compression

Prospective, comparative study of neurologic outcome in patients with posterior extradural cord compression. To compare the results of surgical decompression in patients presenting with neurologic deficit due to posterior element tuberculosis with those due to other causes. Posterior cord compression is a relatively uncommon entity with not much literature published on it. Over a period of 5 years, 14 patients with extradural posterior cord compression with neurologic deficit were divided into two etiologic groups: 9 patients had Koch's and 5 had other pathologies. All these cases were surgically decompressed posteriorly and the results compared. While results of surgery in patients with Koch's were good, with 7 of the 9 patients showing full recovery, outcome in patients with compression due to other causes (tumor/pyogenic infection) was not very satisfactory even after adequate mechanical decompression, with 3 of the 5 cases remaining paraplegic even after surgery. Posterior cord compression due to nontuberculous causes frequently mimics the picture of Koch's both clinically and radiologically. Prognosis of surgical decompression is good in tuberculous compression but not in other cases.

Evaluation of Polyethylene Glycol as a Neuroprotective Strategy for Acute Spinal Cord Injury

The pathophysiology of traumatic spinal cord injury (SCI) involves abnormal activation of the proteolytical enzymes calpain-1 and caspase-3. In the present study we examined the effect of a single intravenous injection of the putative neuroprotective compound polyethylene glycol (PEG) on cytoskeletal protection following cervical SCI in mature Wistar rats. PEG (2000 Da; 30% w/w in sterile lactate ringers (SLR)) or SLR vehicle was administered in the rat tail vein at times 1 or 4 hours after a 35g clip extradural compression injury at C7/T1. To assess the neuroprotective efficacy of PEG in the acute setting postinjury, we measured the levels of dephosphorylated neurofilament 200 (NF200) together with the accumulation of spectrin break down product 150 (SBDP 150) at times 2, 4, 8, or 24 hours post-SCI using Western blot approaches to assess calpain-1 activity. Western blots were also used to assess caspase-3 activity at 24 hours post-SCI via measurement of the accumulation of processed 17-kDa caspase-3 fragments. The mean ± SEM relative optical density values for dephosphorylated NF200 corresponding to the SLR and PEG treatments at times 2, 4, 8, and 24 hours post-SCI were 0.64 ± 0.049 and 0.48 ± 0.166, 0.3 ± 0.028 and 0.48 ± 0.134, 0.33 ± 0.077 and 0.46 ± 0.076, and 0.24 ± 0.018 and 0.38 ± 0.040, respectively. Moreover, the levels of dephosphorylated NF200 were significantly greater following PEG-treatment by 24 hours post-SCI ( p = 0.0362). Moreover, PEG-mediated preservation of dephosphorylated NF200 was correlated with reduced calpain-1 activity at 2 and 4 hours post-SCI. Furthermore, PEG treatment resulted in reduced levels of accumulated 17-kDa caspase-3 fragments. In conclusion, these data obtained in a clinically relevant model of cervical SCI suggest that PEG protects the injured cord by preserving cytoskeletal protein NF200, possibly through reducing calpain-1 and caspase-3 activities. Moreover, the protective effects afforded by PEG may occur within a relevant therapeutic window of opportunity, as the efficacy of PEG treatments occurred even when the drug was administered 4 hours postinjury. These data are critical in establishing the therapeutic potential for translation of PEG into the clinical arena.

Magnetic resonance imaging findings of a metastatic chemodectoma in a dog : clinical communication

A 6-year-old, male, Collie-cross was presented with a non-weight bearing right thoracic limb lameness, right m. deltoideus, m. infraspinatus and m. supraspinatus atrophy, and severe neck pain with spasm of the cervical epaxial muscles. MRI revealed complete destruction of the 5th and 6th cervical vertebral bodies with lateral extradural spinal cord compression at the level of the 4th and 5th cervical vertebrae. These lesions were very clearly demonstrated on magnetic resonance images, while only subtle changes were seen on survey radiographs. Post mortem investigation revealed a large heart base chemodectoma with multiple smaller tumours in the cranial mediastinum and a single tumour nodule on the thoracic aorta. The 5th cervical vertebral body had necrotic, haemorrhagic and lytic changes. Histopathology of the heart base tumour, the nodules in the cranial mediastinum and on the thoracic aorta and samples from the 5th cervical vertebra confirmed the presence of a malignant aortic or carotid body tumour originating from the chemoreceptor organs. Diagnostic imaging features and post mortem findings are described. To our knowledge, this is the first report of the magnetic resonance features of a metastatic chemodectoma in a dog.

Effects of Clotrimazole on Experimental Spinal Cord Injury

We examined a possible neuroprotective effect of clotrimazole on spinal cord clip compression injury. Rivlin and Tator's acute extradural clip compression injury (CCI) model was used for producing SCI on 24 albino Wistar rats weighing 180-250 g. All rats were anesthetized with 30 mg/kg ketamine HCl intraperitoneally and were breathing spontaneously without tracheal intubation. Total laminectomy of T8-T12 was performed on all rats under operation microscope, and CCI was performed on all rats (expect those in group 1) with a 50-g closing force aneurysm clip for 1 min. Three hours later, all of the rats were killed with sodium pentobarbital. Spinal cords were excised for a length of 2 cm; 1 cm rostrally and caudally to the injury site and deep frozen at -76 degrees C for biochemical studies. Treatment with clotrimazole decreased MDA levels in rats with SCI with a statistically significant difference. To our knowledge, this the first study that shows the effects of clotrimazole on spinal cord clip compression injury. Clotrimazole was found to be effective on spinal cord clip compression injury, but further investigations are mandatory.

Spinal Epidural Empyema in Seven Dogs

To characterize the clinical signs, diagnostic and surgical findings, and outcome in dogs with spinal epidural empyema (SEE). Retrospective study. Seven dogs. Dogs with SEE between 1992 and 2001 were identified from a computerized medical record system. Inclusion criteria were: neurologic examination, vertebral column radiographs, myelography, antimicrobial culture and susceptibility of material collected surgically from the vertebral canal, a definitive diagnosis of SEE confirmed by surgery, and microscopic examination of tissue from the vertebral canal. Common signs were lethargy, fever, anorexia, apparent spinal pain, and paraparesis/plegia. Common laboratory abnormalities were peripheral neutrophilia, and neutrophilic pleocytosis in cerebrospinal fluid (CSF). Three dogs had concurrent discospondylitis and 1 of these had vertebral luxation. On myelography, extradural spinal cord compression was focal (2 dogs), multifocal (3), or diffuse (2). Bacteria were isolated not from CSF but from blood, surgical site, pleural fluid, or urine in 6 dogs. Dogs were administered antibiotics and had surgical decompression by hemilaminectomy. Five dogs improved neurologically and had a good long-term outcome. Two dogs were euthanatized, 1 because of worsening of neurologic signs and pneumonia, and the other because of herniation of a cervical intervertebral disc 1 month postoperatively, unrelated to the SEE. Dogs with SEE may have a good outcome when treated by surgical decompression and antibiotic administration. SEE should be included in a list of possible causes for dogs with fever, apparent spinal pain, and myelopathy.