20TH ANNIVERSARY
10 October 1999
CE Refereed Peer Review
FOCAL POINT
★ Understanding relevant anatomy
and underlying pathophysiology
can aid in the diagnosis of and
treatment planning for acute
thoracolumbar disk extrusion.
KEY FACTS
■ Minimizing the magnitude of
secondary injury mechanisms
in acute spinal cord trauma may
improve functional recovery
rates.
■ The use of iohexol or
iopamidol reduces the incidence
of complications associated
with myelography.
■ On a lateral view, an extradural
lesion elevating the ventral
contrast column and causing
narrowing or absence of the
dorsal contrast column is the
classic myelographic lesion
indicating spinal cord
compression at that site.
■ Dogs that retain deep pain
sensation to the pelvic limbs
have an excellent prognosis
for neurologic recovery with
surgical intervention.
Vol. 21, No.
Acute Thoracolumbar
Disk Extrusion in
Dogs—Part I
The Pet Practice, Hamilton, New Zealand
Richard M. Jerram, BVSc, MRCVS
Texas A&M University
Curtis W. Dewey, DVM, MS
ABSTRACT: Thoracolumbar intervertebral disk (IVD) extrusion is common in dogs and is fre-
quently associated with severe neurologic dysfunction. Acute IVD extrusion can occur in many
breeds of dogs; however, the chondrodystrophoid breeds are at greater risk. Dogs commonly
present with various degrees of paresis or paralysis in the pelvic limbs. Voluntary bladder con-
trol is often lost and pain sensation is altered, depending on the degree of spinal cord injury.
T
horacolumbar intervertebral disk (IVD) extrusion, a common disease en-
countered in dogs, is often associated with severe neurologic dysfunction.
Presenting clinical signs include spinal hyperesthesia, ataxia, paresis, and
paralysis. In severe cases, loss of deep pain perception (nociception) to the pelvic
limbs may occur.
In 1952, Hansen classified IVD disease into two types of disk herniation.1
Type I lesions refer to the extrusion of material from the central portion of the
disk through the outer fibrous layers into the vertebral canal.1–9 Type I disk dis-
ease is usually described in small, typically chondrodystrophoid breeds of dogs
(e.g., dachshunds, Pekingese, beagles). However, a recent report indicates that
type I extrusions may also occur with some frequency in larger, nonchondrodys-
trophoid breeds.10 Type II lesions refer to the protrusion of the outer fibrous lay-
ers of the disk and result from alterations in the normal biomechanical proper-
ties of the disk that cause it to protrude into the vertebral canal.1–9 Type II disk
disease may be asymptomatic or may present as a chronic condition with a slow
progression of neurologic signs.
Degeneration can occur in all disks of the vertebral column.3,7,11 When a type I
lesion occurs in the thoracolumbar spine, clinical signs are usually acute and
neurologic deficits can be dramatic. Part I of this two-part presentation reviews
the relevant anatomy, pathophysiology, clinical signs, and diagnosis of acute tho-
racolumbar disk extrusion in dogs. Part II will concentrate on methods of treat-
ment, both medical and surgical, and will briefly discuss the postoperative man-
agement of surgical patients.
Compendium October 1999 20TH ANNIVERSARY Small Animal/Exotics

ANATOMY Spinous process

Intervertebral disks are located in every in-
tervertebral space along the spinal column,
except in the atlantoaxial joint (C1-2).2,3,6–9,12 Epidural space
Each disk comprises three distinct anatomic Caudal articular
process
Mamillary process
regions: the annulus fibrosus, nucleus pul-
2 Cranial articular
posus, and cartilaginous endplates. The process
Accessory
dorsal and ventral longitudinal ligaments process Subarachnoid space

bind the IVD dorsally and ventrally2,7–9,12

(Figure 1). Spinal cord
The annulus fibrosus encircles the nucleus Dorsal and
ventral branches Dorsal longitudinal
pulposus and consists of lamellae of fibro- of spinal nerve ligament
2,3,6–9,12
cartilaginous tissue. The direction of
the fibrous bundles in each lamellar layer al-
ternates sequentially, enabling fibers to slide Transverse
process
Nucleus pulposus
Annulus fibrosus
on each other during biomechanical load-
2,8
ing. The fibers become more tightly Vertebral venous Ventral longitudinal ligament
plexus
packed as compressive load increases, result- Dura mater

ing in increased stiffness of the annulus fi- Figure 1—The canine L-1 vertebra and the T13-L1 disk, showing the normal
brosus and thereby preventing collapse.2 intervertebral disk and associated anatomic structures. (From Dewey CW,
The nucleus pulposus is an amorphous, Coates JR, Hoffman AG, Ducoté J: A Practical Guide to Canine and Feline
gelatinous mass consisting of water, collagen Neurology. College Station, TX, Texas A&M University Press, 1999 [in
fibers, proteoglycan molecules, and a variety press]. Reproduced with permission.)
of other cells (e.g., chondrocytes, fibro-
cytes).2 The majority of the force of a com-
pressive load is absorbed by the nucleus pulposus.2,6,7 been described in only the peripheral third of the annu-
For the cervical and lumbar regions of the vertebral col- lus fibrosus; however, the dorsal longitudinal ligament
umn, the nucleus is located eccentrically in the disk, is richly innervated.2,8
with the ventral aspect of the annulus fibrosis being The spinal cord is located within the bony vertebral
two to three times wider than the dorsal aspect.2,3,7–9,12 canal and is further protected by the meninges (dura
This eccentric location correlates with the neutral zone mater, arachnoid membrane, pia mater).7,9 The cere-
between the tensile and compressive forces that act on brospinal fluid (CSF) is contained within the subarach-
the vertebral column during normal activity.2 noid space.7,9
The cartilaginous endplates resemble hyaline carti-
lage and form the cranial and caudal boundaries of the PATHOPHYSIOLOGY
disk.2 Nutrients diffuse across the surface of these end- The term chondroid metaplasia has been used to de-
plates.2 Fibers from the annulus fibrosus, nucleus pul- scribe IVD degeneration in chondrodystrophoid breeds
posus, and cartilaginous endplates become interwoven of dogs.3–9,11 Biochemical analyses have shown that by
with the bony trabeculae of the vertebral body end- the time dogs reach 1 year of age, the IVDs in chon-
plates to form the strong attachment of the disk to the drodystrophoid breeds have up to five times more colla-
bone.2 gen than do disks in nonchondrodystrophoid breeds.11,13,14
From the second to the tenth thoracic vertebra, the In addition, there are fewer proteoglycan molecules
intercapital ligament between opposite rib heads lies and hence less water content in the nucleus pulposus
ventral to the dorsal longitudinal ligament and dorsal in chondrodystrophoid breeds.11 From data obtained
2,3,6,7,12
to the disks. This thick ligament is thought to be by postmortem evaluation, Hansen reported that 60%
the reason disk extrusion is uncommon in the cranial to 70% of IVDs were calcified in chondrodystrophoid
thoracic area.2,3,6,7 The paired vertebral sinuses lie in a dogs older than 2 years of age.1 As the disk ages, areas
ventrolateral position along the floor of the vertebral of the nucleus pulposus show signs of cellular necrosis,
canal.7,9 In the thoracolumbar region, these vessels di- disintegration of the matrix, and calcification.11 The
verge at each disk space and converge over the vertebral poor biomechanical properties of the degenerating nu-
body.7 Hemorrhage from the vertebral sinuses can ac- cleus pulposus result in disruption of the lamellae of
company disk extrusion or can obstruct visualization the annulus fibrosus, which progresses until the calci-
during surgical decompression.7,9 Nerve endings have fied nuclear material erupts dorsally through the outer

ANNULUS FIBROSUS ■ NUCLEUS PULPOSUS ■ CARTILAGINOUS ENDPLATES

Small Animal/Exotics 20TH ANNIVERSARY Compendium October 1999

increase in free radicals causes disruption of

Spinous process
cell membranes and the formation of lipid
peroxides that can further damage neuronal
Caudal articular process
tissue.15–19 Although clinicians can do little
to control the severity of the primary insult
to the spinal cord, interrupting the effects of
Cranial articular
process
these secondary injury mechanisms may im-
prove spinal cord parenchymal survival. The
Compressed spinal cord
first few hours after trauma are the most
critical.15–18
Dorsal and
ventral branches Extruded nucleus The degree of spinal cord damage from
pulposus
of spinal nerve an acute compressive lesion can vary from
mild demyelination to irreversible necrosis
of both gray and white matter.6,7,9 The larg-
Transverse er, heavily myelinated fibers that mediate
process Nucleus pulposus
proprioception are affected first, followed (in
Annulus fibrosis descending order) by the intermediate-sized
fibers involved in voluntary motor function;
Figure 2—Diagram of the T13-L1 disk space, demonstrating the typical ap- the slightly smaller fibers that mediate su-
pearance of an extrusion of the nucleus pulposus impinging on the spinal perficial pain sensation; and, finally, the
cord. (From Dewey CW, Coates JR, Hoffman AG, Ducoté J: A Practical small, unmyelinated fibers that mediate deep
Guide to Canine and Feline Neurology. College Station, TX, Texas A&M pain sensation.7,9 After treatment, recovery
University Press, 1999 [in press]. Reproduced with permission.) of neurologic function occurs in the reverse
order (i.e., proprioception is the last neuro-
logic function to return).7,9
layers of the annulus fibrosus and impacts on the Uncommonly, a progressive hemorrhagic myeloma-
spinal cord11 (Figure 2). Obesity, muscular fitness, and lacia may occur associated with an acute IVD extru-
spinal length (i.e., long spine compared with leg length sion.3,4,6,7 A combination of ischemia and infarction of
[e.g., dachshunds]) are other factors that have been the spinal cord parenchyma results in diffuse softening,
implicated in increasing the risk of intervertebral her- extensive demyelination, and marked inflammatory in-
niation.8 filtrate of the spinal cord.3,4,6,7 This process is generally
The force and volume of extruded nuclear material rapidly progressive cranially or caudally along the
cause concussion and compression of the spinal cord.3–9,11 spinal cord. Rapid neurologic dysfunction is noted,
Simultaneous rupture of the vertebral sinuses can oc- and death due to respiratory failure may follow in 3 to
cur. The initial trauma of a disk rupture damages neu- 10 days.3,4,6,7
ronal and vascular structures in the spinal cord, causing
inflammation, focal hemorrhage, and edema resulting SIGNALMENT AND CLINICAL SIGNS
in extensive spinal cord swelling.3,4,6–9,15 This primary Acute IVD disease occurs in all breeds of dogs; how-
trauma initiates several secondary injury mechanisms.15–17 ever, chondrodystrophoid breeds are at greater risk.2–9
Specifically, the release of vasoconstrictive substances The dachshund reportedly has a 10- to 12-fold greater
(e.g., prostaglandin PGF2α, thromboxane A2) and any sys- risk than all other breeds combined.6–8 Approximately
temic hypotension following injury may cause a decline 75% of disk herniations occur in animals between 3
in spinal cord blood flow, leading to neuronal ische- and 6 years of age.6,7 Eighty-five percent of all disk her-
15–18
mia. At the same time, the transmembrane calcium niations occur in the thoracolumbar region, and the
channels associated with certain glutamate receptors are most frequent sites are from T11-12 to L2-3.6–8
held open after acute spinal cord injury, resulting in an Although most animals with acute IVD extrusion
increase in intracellular calcium.15–18 This elevation in usually present with serious neurologic dysfunction,
the level of calcium within neurons has toxic effects on spinal pain may be the only presenting clinical sign in
the Golgi apparatus and mitochondria, consequently some patients.20 Dogs commonly present nonambula-
15
impairing their cellular metabolism. In addition, the tory in the pelvic limbs. Voluntary bladder control is
effects of the trauma and ischemia overwhelm the an- often lost and pain sensation is altered, depending on
tioxidant and scavenging systems for removing free rad- the degree of spinal cord injury. Less severely affected
icals produced by cellular metabolism.15,16 The resultant dogs may present with varying degrees of ataxia and

NEURONAL ISCHEMIA ■ LIPID PEROXIDES ■ MYELOMALACIA

Compendium October 1999 Small Animal/Exotics
Atlas of Breed-Related
Canine Ocular Disorders
the ultimate visual diagnostic guide

Atlas of
Breed-Related
Canine Ocular
Disorders

Figure 3—The typical presentation of a dog paralyzed by

Kerry L. Ketring
acute thoracolumbar disk extrusion. Mary B. Glaze

paresis that, if left untreated, can progress to complete 140 pages,

85
paraplegia (Figure 3). gloss-coated cover
$ and pages, all col-
A more lateral disk extrusion that compresses the ex-
iting spinal nerves can occasionally occur.5 Clinically, or, fall 1998
these animals have paresis and hyperesthesia associated
with one pelvic limb, which can be confused with an
$95* Kerry L. Ketring • Mary B. Glaze

orthopedic injury.5 A thorough orthopedic examination

should be included in the diagnostic workup of such
10% off!

A
unique compilation of exceptional-quality, full-
animals.
color photographs illustrating the full range of
DIAGNOSIS inherited ocular diseases recognized in the dog.
Signalment, history, and physical examination should A lifetime resource that will never go out of date by two
allow veterinarians to make a tentative diagnosis of noted experts, one university affiliated, the other in pri-
acute thoracolumbar disk extrusion. Diagnostic differen- vate referral practice! Serves as a companion to Ocular
tials include spinal fracture/luxation, fibrocartilaginous
Disorders Presumed to be Inherited in Purebred Dogs, the
embolism, diskospondylitis, meningitis/myelitis, degen-
erative myelopathy, and neoplasia.3,5,7 These disease con- report of the Genetics Committee of the American Col-
ditions should be ruled out on the basis of neurologic, lege of Veterinary Ophthalmology.
radiographic, and clinicopathologic evaluations.
FEATURES
Neurologic Examination ■ Concise and well-organized by
A complete neurologic examination should be per- Appropriate
anatomic feature for general
formed in all cases of suspected acute thoracolumbar
IVD extrusion to accurately localize the lesion. The ■ Over 350 color images enhanced practitioners,
neurologic examination should be performed in a sys- by arrows students/residents
tematic manner, usually beginning with evaluation of ■ Captions discuss history, signs, in training, and
the cranial nerves; dogs with IVD extrusion should evaluation, and case highlights breeders
have normal cranial nerves. Postural reactions in all ■ Separate index of all included
four limbs should be assessed using placing or hopping Second in a series
breeds by the authors of
tests. Proprioception should be normal in the thoracic
limbs but is frequently abnormal in the pelvic limbs in ■ High-gloss finish and spiral bind- Atlas of Feline
dogs with thoracolumbar IVD extrusion. ing—ideal for use as a diagnostic Ophthalmology
Spinal reflexes, including myotactic reflexes (triceps, guide and client education tool
biceps, patellar, gastrocnemius), and withdrawal reflexes ■ Extensive current bibliography for further information
should be evaluated in all four limbs. The perineal re- on treatment
flex should also be tested. Animals with disk extrusion
in the spinal cord segments T3-L3 may have normal or CALL OR FAX TODAY TO ORDER
hyperreflexic patellar, gastrocnemius, withdrawal, and
perineal reflexes, supportive of upper motor neuron 800-426-9119 • Fax: 800-556-3288
Price applies only within US, Canada, and the Caribbean.
International prices upon request.
Email: books.vls@medimedia.com
VLS
VE T E R I N A RY
BOOKS
L E A R N I NG SYS T E M S

POSTURAL REACTIONS ■ SPINAL REFLEXES

Small Animal/Exotics 20TH ANNIVERSARY Compendium October 1999

(UMN) disease.3,4,6,21 Disk ex- evidence of a lesion in the

trusion in spinal cord seg- thoracolumbar spinal cord
ments L4-S3 may have de- but is not an indication of
creased to absent patellar, prognosis. An assessment of
gastrocnemius, withdrawal, bladder function should also
and perineal reflexes, indica- be obtained during the his-
tive of lower motor neuron tory and via abdominal pal-
(LMN) disease.3,4,6,21 A posi- pation. Care should be tak-
tive crossed extensor reflex is en not to interpret urinary
a sign of UMN disease.4,21 overflow as normal urina-
Palpation of the paraspinal tion. In an animal with an
musculature may demon- acute onset of clinical signs,
strate the presence of hyper- a large, distended bladder
esthesia in the area of the Figure 4—Assessing pain sensation using a toe pinch. The that is not easily expressed
affected disk space. The cu- dog is consciously reacting to the applied stimulus, demon- indicates the presence of a
taneous trunci (panniculus) strating the presence of deep pain sensation. UMN lesion.7 Based on the
reflex can be useful in local- findings of the neurologic
izing a lesion; the level of lack examination, dogs with sus-
of contraction of the subcu- Grading System Based on Neurologic Signs pected thoracolumbar disk
taneous muscles suggests a extrusion can be classified
spinal cord lesion that is one Grade 1 Spinal hyperesthesia (pain) only using a five-stage grading
to four segments more cra- Grade 2 Mild ataxia with enough motor function system (see Grading System
nial.4,6,21 for weight-bearing Based on Neurologic Signs).
The neurologic examina- Grade 3 Severe ataxia without weight-bearing
tion should conclude with the Radiography
ability
evaluation of conscious pain Survey radiographs are
sensation in the affected limbs. Grade 4 No motor function, but deep pain not helpful in unanesthetized
Superficial pain sensation sensation is present animals with thoracolumbar
can be evaluated by a gentle Grade 5 No deep pain sensation is present disk extrusions because of the
pinch with fingers or with a difficulty in accurate patient
hemostat on the skin of the positioning.4,6,7,23 In anesthe-
distal aspect of the limbs. If tized patients, plain radiog-
superficial pain sensation is raphy aids in ruling out such
present, it can be assumed diagnostic differentials as
that deep pain sensation is diskospondylitis, vertebral
also present, and further nox- neoplasia, and spinal frac-
ious stimuli can be avoided. ture/luxation.7 In addition,
Deep pain sensation is evalu- radiographic signs indicative
ated by pinching a hemostat of thoracolumbar disk dis-
across the bone of a digit. It ease may be evident on plain
is important not to confuse radiographs: Narrowing or
a normal spinal withdrawal wedging of the IVD space,
reflex with pain sensation; narrowing of the interverte-
an animal should show defi- bral foramen, radioopaque
nite signs of having per- Figure 5—Plain radiograph of a dog with thoracolumbar disk material (calcified disk mate-
extrusion, demonstrating calcified disk material in the inter-
ceived the painful stimulus vertebral disk spaces. The L2-3 intervertebral foramen ap- rial) in the intervertebral
(e.g., turning of the head, pears to contain some radioopaque material consistent with foramen, and collapse of the
vocalization, dilation of the disk extrusion. articular facets are evidence
pupils; Figure 4).22 that a disk extrusion is pre-
Clinical signs (rigid tho- sent6,7,23 (Figure 5). However,
racic limbs and flaccid pelvic limbs) consistent with in three studies that compared plain radiography with
Schiff-Scherrington syndrome are occasionally seen in myelography, plain radiographs failed to accurately de-
dogs with disk extrusion. The presence of these signs is termine the site of disk herniation in 28% to 43% of

ASSESSING PAIN SENSATION ■ SCHIFF-SCHERRINGTON SYNDROME ■ RADIOGRAPHIC SIGNS

Compendium October 1999 Small Animal/Exotics

Your comprehensive
guide to diagnostic
ultrasonography
Nautrup and Tobias

Figure 6—Myelography in the same dog as in Figure 5 dem-

onstrates an extradural spinal cord compressive lesion at the
L2-3 intervertebral disk space consistent with an extrusion of
the disk material.

the 156 patients evaluated.24–26 It is our opinion that if

surgical decompression is being considered in the treat-
ment of the disease, then myelography is indicated to
further elucidate the site of disk extrusion.
New
Myelography
In the three studies mentioned previously, the site of
disk extrusion was correctly determined in 85% to 97%

149
of patients in which myelography was performed.24–26 In
most cases in which the site of the lesion was not accu- $
rately identified, the lesion was surgically located at an
adjacent disk space.24–26 Other less common causes of Robert E. Cartee, Editor
myelographic inaccuracies included technical error and
400 pages, hard cover
atypical disease process.25,26
Myelography is performed under general anesthesia 1597 illustrations
and requires the injection of a radioopaque contrast
agent into the subarachnoid space. Reports of side ef- ■ Sonographic diagnosis in dogs and cats,
fects (e.g., seizures, respiratory arrest, worsening of neu- including ultrasound, M-mode, pulsed
rologic signs, death) following myelography have been and color Doppler echography
published27–32; however, use of the superior contrast
medium iohexol or iopamidol has dramatically reduced ■ Echocardiography, abdominal and pelvic
these complications.27–32 The site of the subarachnoid sonography, and fetal ultrasonography
puncture can also affect the likelihood of complications
with myelography.27,28,32 Iatrogenic damage to the spinal ■ Case illustrations using conventional
cord with a needle is more severe at the cisternal level radiography, computed microfocal
than if the puncture is made in the lumbar (L4-5, L5- tomography, specimen photography,
6) region.27,28,32 Injection into the cisternal area also cre-
ates a greater risk of contrast agent entering the ventri- and line drawings
cles of the brain, which increases the incidence of ■ Recognition of the disease process and
central nervous system disturbances.27,28 Lumbar myel-
ography, although more technically demanding, is our
courses of treatment
preferred method.28 Cervical and lumbar myelographic
techniques are well described.27,28,32
Before injecting the contrast medium, CSF can fre- CALL OR FAX TODAY TO ORDER
quently be collected. CSF analysis in cases of acute tho- 800-426-9119 • Fax: 800-556-3288
racolumbar disk extrusion has shown increases in pro-
Price valid only in the US, Canada, Mexico, and
tein levels and leukocyte numbers.33 The elevation of the Caribbean. Request international pricing.
Email: books.vls@medimedia.com

CONTRAST MEDIA ■ LUMBAR MYELOGRAPHY

Small Animal/Exotics 20TH ANNIVERSARY Compendium October 1999

protein levels in CSF collected from the lumbar region
appears to be proportional to the severity and acuteness
of neurologic deficits.33 The increase in the leukocyte
count probably results from the inflammatory changes
in the meninges and spinal cord following disk extru-
sion.33 The nucleus pulposus has also been shown ex-
perimentally to produce an inflammatory response in
the dura mater and spinal cord.34
On a lateral view, an extradural lesion elevating the
acute spinal cord trauma.1–41 Surgical intervention may
also be indicated in dogs with grade 1 and 2 disease
that have recurrent episodes of pain and ataxia.3,20,21
As previously mentioned, secondary injury mecha-
nisms influence spinal cord survival.15 Progression of
spinal cord parenchymal tissue damage can become ir-
reparable within 24 hours; therefore, both medical and
surgical treatments should ENDIU
be performed during this MP

M’
20th

CO

S

ventral contrast column and causing narrowing or ab- time. 15,18 At Texas A&M 9 - 1
9 9 9
1 9 7

sence of the dorsal contrast column is the classic myelo- University, the presence of
graphic lesion indicating spinal cord compression at that acute thoracolumbar disk ex-
site32 (Figure 6). Disk material can be extruded dorsolat-
erally, causing medial displacement of the dura mater.32
trusion in grades 3, 4, and 5
is regarded as a surgical emer-
The use of ventrodorsal and 45˚ oblique views can aid gency. The success rate for
in determining the exact location or lateralization of the
return to normal neurologic
disk extrusion.32 In patients with substantial spinal cord function in dogs that retain
swelling, the contrast column may be absent over several deep pain sensation before
IVD spaces, obscuring the precise site of the lesion.32 surgery reportedly ranges
from 65% to 96%36–41; most
Other Imaging Modalities reports list a success rate in
Computed tomography and magnetic resonance excess of 85%.36–38,40,41 The
imaging are frequently used in humans to localize the subjective nature of the neu-
site of lesions in the vertebral canal. The use of these ad- rologic evaluation, the type
vanced imaging techniques is increasing in veterinary of surgical procedure per-
medicine and has been recommended to more accurate- formed, and postoperative
ly locate the exact site of disk extrusion.24 At our clinic, management of patients can
computed tomography is occasionally used after myel- explain the variation in re-
ography to more precisely define the location and type
sults. In our experience, dogs
of lesion that is suspected on the myelogram. in this category have an ex-
cellent prognosis.
DECISION MAKING AND PROGNOSIS The duration of the ab-
Perhaps the most challenging aspect of evaluating sence of deep pain sensation
dogs with acute thoracolumbar disk extrusion is decid- as a prognostic indicator for
ing on the best course of treatment. Controversy sur- thoracolumbar disk extru-
rounds the decisions of when to proceed with medical sion has been the subject of
or surgical management and which specific surgical a number of clinical re-
procedure is indicated. The experience of the clinician ports.36,37,42,43 Overall recov-
and the surgeon’s personal preference often dictate the ery rates for dogs with loss
course of action. of deep pain sensation range
The decision to perform spinal cord decompressive from 25% to 76%.7,37,42,43 It
surgery is generally based on findings of the neurologic
has been generally accepted
examination and the myelogram. Several neurologic that loss of deep pain per-
grading systems have been reported.4,7,8,23–25,35–39 In our ception for longer than 48
experience, the system outlined in Grading System hours is associated with a
Based on Neurologic Signs has been beneficial. We be- grave prognosis (less than
lieve that dogs with grade 1 and 2 disease are candi- 5% success rate).6–8,36,37,39 In
dates for appropriate medical management and that one study, however, recovery
dogs exhibiting clinical signs consistent with grades 3, was observed following hemi-
4, and 5 are candidates for decompressive spinal surgery. laminectomy in two patients
This opinion is based on detailed evaluation of the rele- with deep pain sensation loss
vant scientific literature regarding clinical reports on for more than 48 hours.42
IVD extrusion treatment and experimental studies of In some cases, an accu-
ANNIVERSARY
A LookBack
Over the past 20 years, there
has been an increase in the
demand for neurologic and
neurosurgical services in
veterinary practice. At the
forefront of this demand has
been the requirement for
veterinary practitioners to
develop and maintain a high
level of understanding in the
diagnosis and treatment of
spinal cord disease. Although
intervertebral disk disease is not
a new disease, the expectation of
our clients for quality patient
care has grown. A better
appreciation of the secondary
spinal cord injury mechanisms
at the cellular level has shown
that prompt medical and
surgical intervention can greatly
improve neurologic recovery
rates. Myelography has
effectively superseded plain
radiography in the diagnosis of
intervertebral disk disease
largely due to the introduction
of contrast agents with
dramatically reduced incidence
of side effects.

COMPUTED TOMOGRAPHY ■ CHOOSING TREATMENT ■ SURGICAL SUCCESS RATES

Small Animal/Exotics 20TH ANNIVERSARY
rate estimate of when deep pain sensation was lost may
not be attainable. The use of electrodiagnostic tech-
niques as potential prognostic indicators has been stud-
ied in dogs. The recording of somatosensory evoked po-
tentials from tibial-nerve stimulations correlated well
with clinical grading35; however, further studies evaluat-
ing the clinical usefulness of this technique are not
available. Another study determined that motor evoked
potential recordings in the cranial tibial muscle were
not good predictors of neurologic recovery.44 A recent
study demonstrated that a loss of the myelographic
contrast column greater than five times the length of
the second lumbar vertebra (L-2) was a moderately
negative prognostic indicator.43 Development of pro-
gressive hemorrhagic myelomalacia carries a grave prog-
nosis.3,4,6,7
At our clinic, decompressive or exploratory spinal
surgery is generally offered for animals that have lost
deep pain sensation. Owners are advised that neuro-
logic recovery may not occur and that structural loss
of spinal cord integrity based on findings of a duroto-
my indicates a grave prognosis. Animals with loss of
ambulation that are not considered candidates for
surgery because of concurrent health problems or the
financial constraints of owners can be managed medi-
cally, although owners should be aware that such
treatment might not be optimal for satisfactory re-
covery.
CONCLUSION
Acute thoracolumbar disk extrusion in dogs is seen
frequently in clinical veterinary practice. Small chon-
drodystrophoid dog breeds predominate, although the
disease does occur in larger breeds. Clinical signs, in-
cluding spinal hyperesthesia, paresis, and paralysis, re-
sult from a sudden extrusion of degenerated nucleus
pulposus impacting the spinal cord. A complete neuro-
logic examination is indicated in all suspected cases,
and precise localization of the lesion is established by
myelography. Decisions on whether to proceed with
surgical or medical treatment are generally based on the
degree of neurologic dysfunction.
REFERENCES
1. Hansen HJ: A pathologic-anatomical study on disk degener-
ation in the dog. Acta Orthop Scand Suppl 11, 1952.
2. Bray JP, Burbidge HM: The canine intervertebral disk. Part
One: Structure and function. JAAHA 34:55–63, 1998.
3. Shores A: Intervertebral disk syndrome in the dog. Part I.
Pathophysiology and management. Compend Contin Educ
Pract Vet 3(7):639–647, 1981.
4. Trotter EJ: Canine intervertebral disk disease, in Kirk RW
(ed): Current Veterinary Therapy VI. Philadelphia, WB Saun-
ders Co, 1977, pp 841–848.
TIBIAL-NERVE STIMULATION ■
Compendium October 1999
5. Bagley RS, Tucker R, Harrington ML: Lateral and foraminal
disk extrusion in dogs. Compend Contin Educ Pract Vet 18
(7):795–804, 1996.
6. Braund KG: Intervertebral disk disease, in Bojrab MJ (ed):
Disease Mechanisms in Small Animal Surgery. Philadelphia,
Lea & Febiger, 1993, pp 960–970.
7. Toombs JP, Bauer MS: Intervertebral disc disease, in Slatter
D (ed): Textbook of Small Animal Surgery, ed 2. Philadelphia,
WB Saunders Co, 1993, pp 1070–1086.
8. Simpson ST: Intervertebral disc disease. Vet Clin North Am
Small Anim Pract 22(4):889–897, 1992.
9. Toombs JP: Cervical intervertebral disk disease in dogs.
Compend Contin Educ Pract Vet 14(11):1477–1486, 1992.
10. Cudia SP, Duval JM: Thoracolumbar intervertebral disk dis-
ease in large, nonchondrodystrophic dogs: A retrospective
study. JAAHA 33:456–460, 1997.
11. Bray JP, Burbidge HM: The canine intervertebral disk. Part
Two: Degenerative changes—Nonchondrodystrophoid ver-
sus chondrodystrophoid disks. JAAHA 34:135–144, 1998.
12. Evans HE: Arthrology, in Miller’s Anatomy of the Dog, ed 3.
Philadelphia, WB Saunders Co, 1993, pp 219–257.
13. Ghosh P, Taylor TKF: The collagenous and non-collage-
nous protein of the canine intervertebral disc and their varia-
tion with age, spinal level and breed. Gerontology 22:124–
134, 1976.
14. Ghosh P, Taylor TKF, Braund KG, Larsen LH: A compara-
tive chemical and histochemical study of the chondrodys-
trophoid and nonchondrodystrophoid canine intervertebral
disc. Vet Pathol 13:414–427, 1976.
15. Coughlan AR: Secondary injury mechanisms in acute spinal
cord trauma. J Small Anim Pract 34:117–122, 1993.
16. Meintjes E, Hosgood G, Daniloff J: Pharmaceutic treatment
of acute spinal cord trauma. Compend Contin Educ Pract Vet
18(6):625–635, 1996.
17. Kraus KH: The pathophysiology of spinal cord injury and
its clinical implications. Semin Vet Med Surg (Small Anim)
11(4):201–207, 1996.
18. Janssens LAA: Mechanical and pathophysiological aspects of
acute spinal trauma. J Small Anim Pract 32:572–578, 1991.
19. Coates JR, Sorjonen DC, Simpson ST, et al: Clinicopatho-
logic effects of a 21-aminosteroid compound (U74389G)
and high-dose methylprednisolone on spinal cord function
after simulated spinal cord trauma. Vet Surg 24:128–139,
1995.
20. Sukhiani HR, Parent JM, Atilola MAO, Holmberg DL: In-
tervertebral disk disease in dogs with signs of back pain alone:
25 cases (1986–1993). JAVMA 209(7):1275–1279, 1996.
21. Oliver JE Jr, Lorenz MD, Kornegay JN: Pelvic limb paresis,
paralysis, or ataxia, in Handbook of Veterinary Neurology, ed
3. Philadelphia, WB Saunders Co, 1997, pp 129–172.
22. Oliver JE Jr, Lorenz MD, Kornegay JN: Neurologic history
and examination, in Handbook of Veterinary Neurology, ed 3.
Philadelphia, WB Saunders Co, 1997, pp 3–46.
23. Seim HB III: Conditions of the thoracolumbar spine. Semin
Vet Med Surg (Small Anim) 11(4):235–253, 1996.
24. Schulz KS, Walker M, Moon M, et al: Correlation of clini-
cal, radiographic, and surgical localization of intervertebral
disc extrusion in small-breed dogs: A prospective study of 50
cases. Vet Surg 27:105–111, 1998.
25. Olby NJ, Dyce J, Houlton JEF: Correlation of plain radio-
graphic and lumbar myelographic findings with surgical
findings in thoracolumbar disc disease. J Small Anim Pract
ADVISING OWNERS
Small Animal/Exotics 20TH ANNIVERSARY
35:345–350, 1994.
26. Kirberger RM, Roos CJ, Lubbe AM: The radiological diag-
nosis of thoracolumbar disc disease in the dachshund. Vet
Radiol Ultrasound 33(5):255–261, 1992.
27. Widmer WR, Blevins WE: Veterinary myelography: A re-
view of contrast media, adverse effects, and technique. JAAHA
27:163–175, 1991.
28. Kirberger RM: Recent developments in canine lumbar myelog-
raphy. Compend Contin Educ Pract Vet 16(7):847–854,
1994.
29. Wood AKW: Iohexol and iopamidol: New nonionic con-
trast media for myelography in dogs. Compend Contin Educ
Pract Vet 10(1):32–36, 1988.
30. Lewis DD, Hosgood G: Complications associated with the
use of iohexol for myelography of the cervical vertebral col-
umn in dogs: 66 cases (1988–1990). JAVMA 200(9):1381–
1384, 1992.
31. van Bree H, Van Rijssen B, Van Ham L: Comparison of
nonionic contrast agents iohexol and iotrolan for cisternal
myelography in dogs. Am J Vet Res 52:926–933, 1991.
32. Lamb CR: Common difficulties with myelographic diagno-
sis of acute intervertebral disc prolapse in the dog. J Small
Anim Pract 35:549–558, 1994.
33. Thompson CE, Kornegay JN, Stevens JB: Canine interverte-
bral disc disease: Changes in the cerebrospinal fluid. J Small
Anim Pract 30:685–688, 1989.
34. McCarron RF, Wimpee MW, Hudkins PG, Laros GS: The
inflammatory effect of nucleus pulposus. Spine 12(8):760–
764, 1987.
35. Poncelet L, Michaux C, Balligand M: Somatosensory poten-
tials in dogs with naturally acquired thoracolumbar spinal
cord disease. Am J Vet Res 54:1935–1941, 1993.
36. Schulman A, Lippincott CL: Dorsolateral hemilaminectomy
in the treatment of thoracolumbar intervertebral disk disease
in dogs. Compend Contin Educ Pract Vet 9(3):305–310,
1987.
37. Gambardella PC: Dorsal decompressive laminectomy for treat-
ment of thoracolumbar disc disease in dogs: A retrospective
Compendium October 1999
study of 98 cases. Vet Surg 9(1):24–26, 1980.
38. Black AP: Lateral spinal decompression in the dog: A review
of 39 cases. J Small Anim Pract 29:581–588, 1988.
39. Brown NO, Helphrey ML, Prata RG: Thoracolumbar disk
disease in the dog: A retrospective analysis of 187 cases.
JAAHA 13:665–672, 1977.
40. Yovich JC, Read R, Eger C: Modified lateral spinal decom-
pression in 61 dogs with thoracolumbar disc protrusion.
J Small Anim Pract 35:351–356, 1994.
41. Muir P, Johnson KA, Manley PA, Dueland RT: Compari-
son of hemilaminectomy and dorsal laminectomy for thora-
columbar intervertebral disc extrusion in dachshunds. J Small
Anim Pract 36:360–367, 1995.
42. Anderson SM, Lippincott CL, Gill PJ: Hemilaminectomy in
dogs without deep pain perception. Calif Vet 45(10):24–28,
1991.
43. Duval J, Dewey CW, Roberts R, Aron D: Spinal cord
swelling as a myelographic indicator of prognosis: A retro-
spective study in dogs with intervertebral disc disease and
loss of deep pain perception. Vet Surg 25:6–12, 1996.
44. Sylvestre AM, Cockshutt JR, Parent JM, et al: Magnetic mo-
tor evoked potentials for assessing spinal cord integrity in
dogs with intervertebral disc disease. Vet Surg 22(1):5–10,
1993.
About the Authors
When this article was submitted for publication, Drs. Jer-
ram and Dewey were both affiliated with the Department
of Small Animal Medicine and Surgery, College of Veteri-
nary Medicine, Texas A&M University, College Station,
Texas. Dr. Dewey remains at Texas A&M University, but
Dr. Jerram is now affiliated with The Pet Practice, Hamil-
ton, New Zealand. Dr. Dewey is a Diplomate of the Amer-
ican College of Veterinary Surgeons and the American
College of Veterinary Internal Medicine (Neurology).