Osseous-associated Cervical Spondylomyelopathy Research Articles

Prevalence, clinical presentation, and etiology of myelopathies in 224 juvenile dogs.

Intervertebral disc herniation is widely recognized as the most common cause of myelopathy in dogs older than 2 years; however, the prevalence of various causes of myelopathy in younger dogs has not been reported. To describe the prevalence, clinical presentation, and etiology of myelopathy in dogs aged 18 months or less. Secondarily, to investigate which clinical features were associated with each of the most common etiologies. Two hundred twenty-four dogs aged 18 months or less with myelopathy were included in the study. Retrospective review of clinical records from 4 referral institutions. Multivariable logistic regression analyses assessed which clinical features were associated with each diagnosis. French bulldogs (n = 51, 22.8%), pugs (n = 18, 8.0%), crossbreeds (n = 12, 5.4%), and English bulldogs (n = 11, 4.9%) were the most frequently affected breeds. Overall, 31 diagnoses were reached. The 5 most frequent diagnoses were vertebral malformation (VM; n = 42, 18.8%), spinal arachnoid diverticulum (SAD; n = 28, 12.5%), traumatic fracture of the vertebral column (n = 22, 9.8%), atlantoaxial instability (n = 18, 8.0%), and osseous-associated cervical spondylomyelopathy (n = 17, 7.6%). Intervertebral disc extrusion (IVDE) accounted for 4.5% of cases (n = 10). A final diagnosis of VM was associated with younger, screw-tailed, and pug breeds with chronic signs of T3-L3 myelopathy. SAD was associated with screw-tailed and pug breeds with nonpainful clinical signs. Intervertebral disc extrusion was associated with older, screw-tailed, and pug breeds with shorter duration of clinical signs. Prioritization of differential diagnoses for dogs presenting with signs of myelopathy when aged 18 months or less should differ to those for older dogs, with IVDE not the most common cause in the former.

Head tilt as a clinical sign of cervical spinal or paraspinal disease in dogs: 15 cases (2000-2021).

To characterise head tilt as a rare clinical sign of cervical spinal or paraspinal disease in dogs. Retrospective single-centre case-series study of dogs with head tilt and cervical spinal or paraspinal disease in the absence of intracranial abnormalities. Descriptive statistics were used. Fifteen dogs met the inclusion criteria of this study. Median age at onset was 6 years (range 2.5 to 12 years). Onset of neurological signs was mainly chronic (9/15, 60%). Most common presenting complaints included head tilt (9/15, 60%) and cervical hyperaesthesia (8/15, 53%). Most common neurological findings included head tilt (15/15, 100%), generalised proprioceptive ataxia and tetraparesis (6/15, 40%) and cervical hyperaesthesia (8/15, 53%). Diagnoses included post-operative complication of C2 spinal nerve root mass removal (2/15, 13%), C3-C4 intervertebral disc extrusion (2/15, 13%), cervical paraspinal myositis (2/15, 13%) and one of each: C2 vertebral malformation, C2 spinal nerve root mass, C1-C2 meningioma, C2 vertebral fracture, C4-C5 intervertebral disc extrusion, C4 vertebral body mass, C5-C7 osseous-associated cervical spondylomyelopathy, and concurrent C5-C6 and C6-C7 intervertebral disc protrusions. Two dogs were euthanased shortly after diagnosis and two of 15 were dogs lost to follow-up. No post-mortem examination was performed for these cases. For the 11 of 15 remaining dogs, head tilt resolved in eight of 15 (53%) dogs after treatment of the underlying condition and in three of 15 (20%) dogs, it remained static. Head tilt can be a rare clinical sign of cervical spinal or paraspinal disease in dogs.

Magnetic resonance imaging and neurologic characterization of combined osseous- and disc-associated cervical spondylomyelopathy in dogs.

Although both disc- or osseous-associated forms of cervical spondylomyelopathy (CSM) are observed in the same dogs, this combined form has not been thoroughly evaluated. To describe imaging characteristics of dogs with concurrent disc- and osseous CSM and investigate an association between findings on neurological examination and imaging. Sixty dogs with disc and osseous-associated CSM from 232 CSM-affected dogs. Retrospective study. Dogs diagnosed via high-field MRI with a combination of intervertebral disc (IVD) protrusion and osseous proliferation of articular processes, dorsal lamina, or both were identified. Large and giant breed dogs were grouped according to whether combined compressions were at the same site or different sites. Statistical methods were used to investigate the association and relationship between variables. Thirty-five out of 60 (58%) were large breeds and 22/60 (37%) were giant breeds. Mean and median age was 6.6 and 7 years respectively (range, 0.75-11 years). Forty of the 60 dogs (67%) had concurrent osseous and disc-associated spinal cord compression in the same location. This was considered the main compression site in 32/40 (80%) dogs. Dogs with osseous- and disc-associated compressions at the same site were more likely to have a higher neurologic grade (P = .04). A substantial percentage of dogs with CSM present with concomitant IVD protrusion and osseous proliferations, most at the same site. Characterizing this combined form is important in the management of dogs with CSM because it could affect treatment choices.

Association of neurologic signs with high-field MRI findings in 100 dogs with osseous-associated cervical spondylomyelopathy.

Although osseous-associated cervical spondylomyelopathy (OA-CSM) findings have been well described using magnetic resonance imaging (MRI), there are no large-scale published studies on the associations between dog size, age, high-field MRI and neurologic findings. Using a retrospective, observational study design, we aimed to investigate an association between neurologic and high-field MRI characteristics in OA-CSM. Records were reviewed for dogs diagnosed with OA-CSM using high-field MRI. One-hundred dogs were included: 73/100 (73%) were giant breeds, 27/100 (27%) large breeds. Mean and median ages were, respectively, 3.1 and 2 years (0.3-9.75 years), with 2.6 and 2 years for giant-breed; and 4.4 and 4 years for large-breed dogs. The majority of dogs were male (75%) with chronic presentation (89%), more than one site of spinal cord compression (78%) and foraminal stenosis (91%). Dogs with multiples sites of spinal cord compression were more likely to have severe spinal cord compression (p<0.001), severe foraminal stenosis (p<0.001) and ligamentum flavum/soft tissue proliferation (p=0.03) than those with a single compressive site. There was a weak correlation between neurologic grade and severity of spinal cord compression (r=0.27; p=0.007), number of affected sites (r=0.24; p=0.0183) and spinal cord T2W hyperintensity (r=0.24; p=0.0152). Intervertebral disc degeneration was seen in 80% of dogs. Age did not appear to have a prominent role in the manifestation of OA-CSM. This study showed that OA-CSM affects a sizeable proportion of young large-breed, in addition to giant-breed dogs.

Long-term clinical and magnetic resonance imaging follow-up of dogs with osseous-associated cervical spondylomyelopathy.

BackgroundOsseous‐associated cervical spondylomyelopathy (OA‐CSM) is a complex disorder with limited long‐term survival. The longitudinal progression is currently unknown.ObjectiveTo describe changes on magnetic resonance imaging (MRI) over a 2‐year minimum period. We hypothesized that spinal lesions would progress in the majority of dogs.AnimalsEleven dogs previously diagnosed with OA‐CSM were prospectively studied. Nine dogs were treated medically, whereas 2 were treated surgically.MethodsClinical and MRI follow‐up were performed with a median time between MRI studies of 30 months (range, 24‐54). Morphologic assessment evaluated vertebral canal stenosis, spinal cord compression, foraminal stenosis, and articular processes, among other variables. Morphometric assessment included vertebral canal area, spinal cord area, area of the articular processes, and foraminal height.ResultsOn follow‐up MRI, the most affected site at the initial examination in medically treated dogs had progressed in 4 of 9 dogs, improved in 4, and was unchanged in 3. Clinically, all dogs except 2 medically treated dogs were unchanged to improve at follow‐up. Initially, 50 of 60 (83.3%) intervertebral spaces had vertebral canal stenosis, whereas in the follow‐up MRI 82.3% did. Of the sites with stenosis, 45.7% were unchanged, 18.6% improved, and 38.9% worsened. Morphometry identified significant decreases in vertebral canal and spinal cord areas at C4‐C5 through C6‐C7, and significant progression of articular process irregularities at C3‐C4 and C6‐C7.Conclusions and Clinical ImportanceThis long‐term follow‐up study of dogs with OA‐CSM did not identify clinical or MRI progression of lesions in the majority of dogs.

Surgical management and long-term outcome of dogs with cervical spondylomyelopathy with an anchored intervertebral titanium device.

To assess the short- and long-term outcome of an anchored intervertebral titanium device (C-LOX) for the treatment of 10 dogs with disc-associated cervical spondylomyelopathy (DACSM) and 1 dog with osseous-associated cervical spondylomyelopathy. Retrospective case series. Dogs were included if they were diagnosed with either DACSM or osseous-associated cervical spondylomyelopathy via myelography with or without advanced imaging and underwent surgical distraction and stabilisation of the affected intervertebral disc with a C-LOX implant. Assessment included short-term neurological outcome, radiography immediately and 6 weeks' postsurgery, owner questionnaire and veterinary clinical assessment. The mean follow-up time was 12 months. Improvement in neurological status was noted in 10 of 11 dogs. Screw loosening or subsidence occurred in five dogs. Revision surgery was performed in two dogs due to implant fracture (n = 1) and recurrence of spinal cord compression due to endplate subsidence around the implant (n = 1). Adjacent segment disease occurred in three dogs (30%) with DACSM at a mean of 11 months postsurgery. The use of the C-LOX implant for dogs with cervical spondylomyelopathy resulted in a high rate of initial neurological improvement; however, there is a moderate incidence of minor and major complications that is comparable to previously described distraction-stabilisation techniques.

Neurologic and magnetic resonance imaging features of German Shepherd Dogs with cervical spondylomyelopathy: 10 cases (2006-2018).

To describe the neurologic signs and MRI findings for German Shepherd Dogs (GSDs) with cervical spondylomyelopathy (CSM). 10 GSDs with confirmed CSM. Medical records from January 2006 through July 2018 were reviewed to identify dogs with CSM. For each CSM-affected dog, information regarding age, duration of clinical signs, presence of neurologic signs, and treatments administered were obtained; the main site and cause of spinal cord compression and other vertebral and spinal cord changes were identified on MRI images. Data for 9 male and 1 female (mean age, 6.2 years) GSDs with CSM were assessed. Dogs were classified as having chronic (n = 9) or acute (1) CSM. Nine dogs had ataxia; 1 dog had only signs of cervical hyperesthesia. Neurologic examination findings localized the lesion to the cervical portion of the vertebral column in each dog. The main spinal cord compression site was at the C6-7 (n = 5), C5-6 (4), or C4-5 (1) intervertebral spaces; osseous proliferation of the articular processes was the sole or a contributory cause of these compressions for 6 of the 10 dogs. Eight dogs also had dorsal compression of the spinal cord as the result of ligamenta flava hypertrophy. The 10 GSDs of the present retrospective case series had CSM that was often characterized by osseous changes and a ligamentous component and were older than dogs of other breeds (eg, Great Dane and Mastiff) with osseous-associated CSM described in previous reports. Cervical spondylomyelopathy should be a differential diagnosis for GSDs with ataxia, paresis, or signs of cervical hyperesthesia.

Development of a finite element model of the ligamentous cervical vertebral column of a Great Dane

Cervical spondylomyelopathy (CSM), also known as wobbler syndrome, affects mainly large and giant-breed dogs, causing compression of the cervical spinal cord and/or nerve roots. Structural and dynamic components seem to play a role in the development of CSM; however, pathogenesis is not yet fully understood. Finite element models have been used for years in human medicine to study the dynamic behavior of structures, but it has been mostly overlooked in veterinary studies. To our knowledge, no specific ligamentous spine models have been developed to investigate naturally occurring canine myelopathies and possible surgical treatments. The goal of this study was to develop a finite element model (FEM) of the C2-C7 segment of the ligamentous cervical vertebral column of a neurologically normal Great Dane without imaging changes. The FEM of the intact C2-C7 cervical vertebral column had a total of 188,906 elements (175,715 tetra elements and 12,740 hexa elements). The range of motion (in degrees) for the FEM subjected to a moment of 2Nm was approximately 27.94 in flexion, 25.86 in extension, 24.14 in left lateral bending, 25.27 in right lateral bending, 17.44 in left axial rotation, and 16.72 in right axial rotation. We constructed a ligamentous FEM of the C2-C7 vertebral column of a Great Dane dog, which can serve as a platform to be modified and adapted for studies related to biomechanics of the cervical vertebral column and to further improve studies on osseous-associated cervical spondylomyelopathy.

Evaluation of osseous‐associated cervical spondylomyelopathy in dogs using kinematic magnetic resonance imaging

Osseous-associated cervical spondylomyelopathy in dogs is characterized by both static and dynamic spinal cord compression; however, standard MRI methods only assess static compression. In humans with cervical spondylotic myelopathy, kinematic MRI is commonly used to diagnose dynamic spinal cord compressions. The purpose of this prospective, analytical study was to evaluate kinematic MRI as a method for characterizing the dynamic component of osseous-associated cervical spondylomyelopathy in dogs. We hypothesized that kinematic MRI would allow visualization of spinal cord compressions that were not identified with standard imaging. Twelve client-owned dogs with osseous-associated cervical spondylomyelopathy were enrolled. After standard MRI confirmed a diagnosis of osseous-associated cervical spondylomyelopathy, a positioning device was used to perform additional MRI sequences with the cervical vertebral column flexed and extended. Morphologic and morphometric (spinal cord height, intervertebral disc width, spinal cord width, vertebral canal height, and spinal cord area) assessments were recorded for images acquired with neutral, flexion, and extension imaging. A total of 25 compressions were seen with neutral positioning, while extension identified 32 compressions. There was a significant association between extension positioning and presence of a compressive lesion at C4-C5 (p = 0.02). Extension was also associated with a change in the most severe site of compression in four out of 12 (33%) dogs. None of the patients deteriorated neurologically after kinematic imaging. We concluded that kinematic MRI is a feasible method for evaluating dogs with osseous-associated cervical spondylomyelopathy, and can reveal new compressions not seen with neutral positioning.

Osseous-associated cervical spondylomyelopathy in dogs: 27 cases (2000-2012).

To evaluate the signalment, neurologic examination and imaging findings, and outcome in dogs treated medically or surgically for osseous-associated cervical spondylomyelopathy (OACSM). Retrospective case series. 27 client-owned dogs. Medical records for dogs with OACSM (diagnosis made in 2000 through 2012) were reviewed. Collected data included signalment, neurologic examination findings (graded from 0 [normal] to 5 [tetraplegia]), imaging findings, treatment, and outcome. From MRI and CT images, measurements were obtained for subjective grading of spinal cord compression. Among the 27 dogs, the median age was 2 years; there were 15 Great Danes, 3 Mastiffs, 3 Newfoundlands, and 6 other large-breed dogs. For medically treated dogs (n = 7), the median initial neurologic grade was 2; for surgically treated dogs (20), the median initial neurologic grade was 3. Magnetic resonance imaging revealed dorsolateral spinal cord compression in 22 dogs and lateral spinal cord compression in 5 dogs. Dogs with more severe compressions were slightly more likely to undergo surgical than medical treatment. Median survival time of medically treated dogs was 43 months, and that of surgically treated dogs was 60 months. Fifteen of 19 dogs treated surgically had improved neurologic grades at 4 to 8 weeks after surgery and had a good to excellent long-term outcome. Surgical treatment of dogs with OACSM resulted in neurologic improvement and was associated with a good long-term outcome. For dogs that received medical treatment, neurologic deterioration continued but some patients did well for several years.

Cervical spondylomyelopathy in Great Danes: A magnetic resonance imaging morphometric study

Morphometric investigations comparing normal and affected animals increase our understanding of spinal diseases in dogs. The aim of this study was to generate morphometric data for osseous-associated cervical spondylomyelopathy (CSM) in Great Danes (GDs). Magnetic resonance imaging (MRI) morphometric features of the cervical vertebral column of GDs with and without clinical signs of CSM were characterized and compared. Thirty client-owned GDs were prospectively enrolled, including 15 clinically normal and 15 CSM-affected GDs. All dogs underwent MRI of the cervical to thoracic vertebral column (C2-C3 through T1-T2). Areas of the cranial and caudal articular processes, and the height, width and areas of the vertebral canal and spinal cord were determined. Middle foraminal heights were measured. Intervertebral disc width was measured before and after traction. Intraobserver and interobserver agreement were calculated. CSM-affected GDs had larger areas of the caudal articular processes from C2-C3 through T1-T2. In CSM-affected GDs, the vertebral canal and spinal cord areas were significantly smaller at C5-C6 and C6-C7, the vertebral canal width was significantly narrower at C6-C7 and C7-T1, and the spinal cord width was significantly narrower at C5-C6 and C6-C7. Middle foraminal height was smaller in CSM-affected GDs from C3-C4 through C7-T1. Neutral intervertebral disc widths were smaller in CSM-affected GDs. It was concluded that the cervical vertebral canal dimensions are significantly different between normal and CSM-affected GDs. Absolute vertebral canal stenosis and severe foraminal stenosis involving the cervical vertebrae distinguish CSM-affected from clinically normal GDs. These findings are relevant to the pathogenesis of osseous-associated CSM and should be taken into consideration when performing imaging studies and planning surgery.

EVALUATION OF TRADITIONAL AND NOVEL RADIOGRAPHIC VERTEBRAL RATIOS IN GREAT DANES WITH VERSUS WITHOUT CERVICAL SPONDYLOMYELOPATHY

Great Danes are predisposed to osseous-associated cervical spondylomyelopathy (Wobbler syndrome). The first aim of this prospective study was to compare values measured using previously published intravertebral and intervertebral ratio methods and a novel ventrodorsal ratio method in radiographs of clinically normal and affected Great Danes. The second aim was to determine whether these ratios could be used as predictors of sites of spinal cord compression based on magnetic resonance imaging (MRI). Thirty dogs (15 normal, 15 affected) were prospectively enrolled. Lateral and ventrodorsal radiographs were obtained and six measurements were recorded from C3-T1. For each vertebral location, intravertebral ratios and intervertebral ratios were calculated from lateral views, and the ratio of the distance between the articular process joints vs. vertebral body width (novel ventrodorsal ratio) was calculated from ventrodorsal views. Values for these three ratios were compared, by vertebral location and dog group. Intravertebral and intervertebral ratios did not differ between dog groups. The ventrodorsal ratio was significantly smaller in affected Great Danes at C5-6 (P = 0.005) and C6-7 (P < 0.001). The ventrodorsal ratio was significantly associated with MRI presence of spinal cord compression. For each 0.1 unit increase in this ratio value, there was a 65% decrease in the odds of spinal cord compression being present at that site, independent of vertebral location (P = 0.002). Findings from this study supported use of the novel ventrodorsal ratio as an initial radiographic screening method for Great Danes with suspected cervical spondylomyelopathy.