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Evolution of clinical signs and predictors of outcome after conservative medical treatment for disk-associated cervical spondylomyelopathy in dogs

Steven De DeckerDepartments of Medicine and Clinical Biology of Small Animals, Faculty of Veterinary Medicine, Ghent University, 9820 Merelbeke, Belgium

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Ingrid M. V. L. GielenMedical Imaging of Domestic Animals, Faculty of Veterinary Medicine, Ghent University, 9820 Merelbeke, Belgium

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Luc DuchateauPhysiology and Biometry, Faculty of Veterinary Medicine, Ghent University, 9820 Merelbeke, Belgium

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Anna OevermannNeurocenter, Division of Experimental Clinical Research, Faculty of Veterinary Medicine, University of Bern, 3001 Bern, Switzerland

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Ingeborgh PolisDepartments of Medicine and Clinical Biology of Small Animals, Faculty of Veterinary Medicine, Ghent University, 9820 Merelbeke, Belgium

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Iris Van SoensDepartments of Medicine and Clinical Biology of Small Animals, Faculty of Veterinary Medicine, Ghent University, 9820 Merelbeke, Belgium

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Henri J. J. van BreeMedical Imaging of Domestic Animals, Faculty of Veterinary Medicine, Ghent University, 9820 Merelbeke, Belgium

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Luc M. L. Van HamDepartments of Medicine and Clinical Biology of Small Animals, Faculty of Veterinary Medicine, Ghent University, 9820 Merelbeke, Belgium

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Abstract

Objective—To evaluate the evolution of clinical signs and their correlation with results of magnetic resonance imaging (MRI) and transcranial magnetic stimulation (TMS) and to assess potential prognostic variables after conservative medical treatment for disk-associated cervical spondylomyelopathy (DA-CSM) in dogs.

Design—Prospective cohort study.

Animals—21 client-owned dogs with DA-CSM.

Procedures—After neurologic grading, dogs underwent low-field MRI and TMS with measurement of onset latencies and peak-to-peak amplitudes from the extensor carpi radialis and cranial tibial muscles. Dimensions calculated from MRI images were remaining spinal cord area, spinal cord compression ratio, vertebral occupying ratio, vertebral canal height-to-body height ratio, vertebral canal height-to-body length ratio, and vertebral canal compromise ratio. Intraparenchymal signal intensity changes were graded. Dogs were reevaluated 1, 3, 6, 12, and 24 months after initial diagnosis.

Results—Outcome was successful in 8 of 21 dogs. Negative outcomes were characterized by rapid progression of clinical signs. All dogs with more severe clinical signs of DA-CSM 1 month after diagnosis had unsuccessful outcomes. Outcome was associated with the remaining spinal cord area and vertebral canal compromise ratio. Prognosis was not associated with severity of clinical signs or results of TMS. There were no significant correlations among clinical signs, MRI findings, and TMS results.

Conclusions and Clinical Relevance—Conservative medical treatment of DA-CSM was associated with a guarded prognosis. Selected MRI variables and clinical evolution 1 month after diagnosis can be considered prognostic indicators. The lack of correlation among clinical signs, results of diagnostic imaging, and results of electrophysiologic evaluation in dogs with DA-CSM warrants further investigation.

Abstract

Objective—To evaluate the evolution of clinical signs and their correlation with results of magnetic resonance imaging (MRI) and transcranial magnetic stimulation (TMS) and to assess potential prognostic variables after conservative medical treatment for disk-associated cervical spondylomyelopathy (DA-CSM) in dogs.

Design—Prospective cohort study.

Animals—21 client-owned dogs with DA-CSM.

Procedures—After neurologic grading, dogs underwent low-field MRI and TMS with measurement of onset latencies and peak-to-peak amplitudes from the extensor carpi radialis and cranial tibial muscles. Dimensions calculated from MRI images were remaining spinal cord area, spinal cord compression ratio, vertebral occupying ratio, vertebral canal height-to-body height ratio, vertebral canal height-to-body length ratio, and vertebral canal compromise ratio. Intraparenchymal signal intensity changes were graded. Dogs were reevaluated 1, 3, 6, 12, and 24 months after initial diagnosis.

Results—Outcome was successful in 8 of 21 dogs. Negative outcomes were characterized by rapid progression of clinical signs. All dogs with more severe clinical signs of DA-CSM 1 month after diagnosis had unsuccessful outcomes. Outcome was associated with the remaining spinal cord area and vertebral canal compromise ratio. Prognosis was not associated with severity of clinical signs or results of TMS. There were no significant correlations among clinical signs, MRI findings, and TMS results.

Conclusions and Clinical Relevance—Conservative medical treatment of DA-CSM was associated with a guarded prognosis. Selected MRI variables and clinical evolution 1 month after diagnosis can be considered prognostic indicators. The lack of correlation among clinical signs, results of diagnostic imaging, and results of electrophysiologic evaluation in dogs with DA-CSM warrants further investigation.

Contributor Notes

Dr. De Decker's present address is Department of Veterinary Clinical Sciences, Royal Veterinary College, University of London, North Mymms, Hertfordshire, AL9 7TA, England.

Supported by the Institute for the Promotion of Innovation by Science and Technology.

Presented in part as a poster presentation at the 23rd Annual Symposium of the European Society of Veterinary Neurology, Cambridge, England, September 2010, and as an oral presentation at the 29th Forum of the American College of Veterinary Internal Medicine, Denver, June 2011.

Address correspondence to Dr. De Decker (Sdedecker@rvc.ac.uk).