Long-term outcome following lateral foraminotomy as treatment for canine degenerative lumbosacral stenosis

Lateral foraminotomy has been described as an effective surgical treatment for foraminal stenosis in the treatment of degenerative lumbosacral stenosis (DLSS) in dogs. Clinical records were reviewed from 45 dogs which had undergone lateral foraminotomy at the lumbosacral junction either alone or in combination with decompressive midline dorsal laminectomy. Short-term outcome at six weeks was assessed by the surgeon to be good (11.1 per cent) or excellent (88.9 per cent) in all 45 cases. Long-term outcome beyond six months for lumbosacral syndrome was assessed by the owner as excellent in all 34 cases for which follow-up was available despite recurrence in five cases. Recurrence of clinical signs was not related to re-establishment of foraminal compression at the surgical site when assessed on repeat MRI and was managed by either contralateral foraminotomy in one case or conservative management with excellent response. This study confirms lateral foraminotomy as an effective procedure in the management of DLSS-affected dogs suffering from foraminal stenosis and demonstrates that initial good short-term results are maintained long term despite some treatable recurrences. Lateral foraminotomy is an effective procedure when used appropriately in DLSS with foraminal stenosis either alone or in combination with midline dorsal laminectomy

Gainfully employing descending controls in acute and chronic pain management

Specific primary afferent fibres termed nociceptors are responsible for transmitting nociceptive information. Centrally the axonal terminals of these fibres synapse with secondary projection neurones in the spinal dorsal horn to transmit nociceptive information to the higher centres in the brain. Irrespective of the presence or absence of nociceptive inflow the activity of dorsal horn neurones is modulated by, amongst other things, local interneurones and descending midbrain and brainstem networks which can inhibit or facilitate dorsal horn transmission. These pathways therefore set the threshold for information inflow to the CNS. This review article summarises the anatomy, physiology and pharmacology particularly of these descending inhibitory and facilitatory pathways and explains why the study of descending modulation is essential if we are to develop more efficacious interventions for treating pain and relieving suffering

Traumatic rib head subluxation through the intervertebral foramen causing spinal cord contusive injury in a cat

Case summaryA 4-year-old cat involved in a road traffic accident presented with paraparesis, which was worse on the right-hand side. Neurolocalisation was to the T3–L3 spinal cord segments. Survey radiographs showed rib fractures but no definitive diagnosis for the paraparesis. CT revealed fracture of the dorsal rim and a T9 rib subluxation through the intervertebral foramen at T8–T9. This caused a contusive spinal injury. Treatment consisted of rest and analgesia. The cat recovered well, with the owner reporting no abnormalities 5 months following the injury.Relevance and novel informationRoad traffic accidents are a common cause of injury in the cat population, with a significant number having thoracic injuries. These include rib injures such as fractures. This is the first reported case of a traumatic rib subluxation causing a contusive injury in the spinal cord of any species. Previously reported rib subluxations have been seen in humans with spinal deformities. Conservative management in this case was sufficient

Assessing the Educational Value of a Zoo Placement for Veterinary Students: A Report on Student Feedback and Perceptions

Zoological medicine is an expanding field with limited practical training opportunities for veterinary students. Those training programs that do exist require significant financial and resource investment by both veterinary schools and the zoological organizations involved. This article summarizes the findings of a retrospective survey of students carried out to ascertain the educational value of a compulsory 5-day-long zoo clinical placement for final-year veterinary students. We aimed to explore the placement’s potential impact on students’ knowledge and attitudes toward zoological medicine and the role of modern zoos and conservation. Data were collected by means of an end-of-placement questionnaire (N = 200) and statistically analyzed for pre- versus post-placement changes and the effect of pre-placement interest and experience on student responses. Despite the placement’s short time frame and lack of opportunity for in-depth comprehensive training in zoological medicine, students reported that the placement had a positive educational impact. More than 90% of students stated that their understanding about modern zoos was good or excellent at the end of the placement (compared with 35.0% before the placement), and 43.0% reported that the placement had a positive impact on their attitudes toward zoos. Students self-reported an increased understanding of the work of zoo clinicians, and there was a highly significant positive change in the students’ reported opinions regarding wildlife conservation in general. We provide preliminary evidence to suggest that even short-duration but immersive zoo-based practical training has positive educational value for veterinary students

Association of magnetic resonance assessed disc degeneration and late clinical recurrence in dogs treated surgically for thoracolumbar intervertebral disc extrusions

BackgroundRadiographic signs of intervertebral disc mineralization are thought to indicate sites of future recurrence of disc extrusion (Hansen type I) but the relationship between evidence of disc degeneration on magnetic resonance imaging (MRI) and future disc extrusion with recurrence of clinical signs has not been examined.ObjectivesTo examine the relationship between MRI-assessed degeneration of thoracolumbar intervertebral discs and late recurrence of clinical signs in dogs presented with acute thoracolumbar intervertebral disc extrusion and treated by hemilaminectomy alone.AnimalsNinety-two client-owned dogs presented to 2 referral hospitals between 2009 and 2014.MethodsRetrospective analysis of association between clinical signs consistent with recurrent thoracolumbar intervertebral disc extrusion and MRI evidence of disc degeneration in dogs undergoing hemilaminectomy for acute thoracolumbar intervertebral disc extrusion. Univariable and multivariable Cox regression analyses were used to explore associations between recurrence of clinical signs and several characteristics of T10-L3 discs at initial diagnosis.ResultsNinety-two cases were included, of which 42 (46%) were Dachshunds and median age was 5.3 years. Clinical signs recurred in 33/92 (36%) dogs. Finding a completely degenerate disc in the T10 to L3 region (in addition to the operated site) at the time of surgery was associated with a hazard ratio of 2.92 (95% confidence interval: 1.37-6.20) for recurrence of clinical signs.Conclusions and clinical importanceOur results suggest that in cases of thoracolumbar intervertebral disc extrusion in dogs, recurrence of signs is likely if at least 1 completely degenerate disc in addition to the currently symptomatic disc is visible on MRI

Imaging features of discospondylitis in cats

ObjectivesThis study describes the imaging features of feline discospondylitis on MRI, comparing them to CT and radiographic findings where available.MethodsThe medical records of cats diagnosed with discospondylitis, presented to three referring institutions, were reviewed. MRI, CT and radiographic features were assessed by two of the authors independently.ResultsFourteen sites of discospondylitis were retrospectively identified in 13 cats. The L7–S1 intervertebral disc space (IVDS) was affected in 7/14 (50%) cases. Characteristic MRI features included a hyperintense nucleus pulposus signal on T2-weighted (T2W) imaging (n = 10/14 [71%]) and short tau inversion recovery (STIR) imaging (n = 11/13 [85%]), with contrast enhancement in all (n = 11/11); involvement of adjacent vertebral endplates (n = 11/14 [79%]) and hyperintense neighbouring soft tissue on T2W (n = 11/14 [79%]) and STIR (n = 10/13 [77%]), with contrast enhancement in all (n = 11/11); and the presence of spondylosis deformans (n = 10/14 [71%]). Other features included narrowed or collapsed IVDS (n = 8/14 [57%]), contrast enhancement of vertebral bodies (n = 5/11 [46%]), epidural space involvement (n = 5/14 [36%]), compression of the spinal cord or nerve roots (n = 5/14 [36%]), paraspinal abscessation (n = 3/14 [21%]) and meningeal signal intensity abnormalities with contrast enhancement (n = 5/6 [83%]). These latter findings may indicate secondary focal meningitis. Radiographs were available covering five sites (in four cats) and CT covering three sites (in two cats). The most common radiological features were collapse or narrowing of the affected IVDS (80%) and endplate erosion (60%). No changes suggestive of discospondylitis were identifiable on radiography or CT in two sites (one cat), despite being identifiable on MRI. Repeated radiography in one case did not reveal complete radiological resolution following 9 months of treatment.Conclusions and relevanceThe results of this study indicate consistent MRI features of feline discospondylitis that should be considered in the diagnosis of this condition

Cytosine arabinoside constant rate infusion without subsequent subcutaneous injections for the treatment of dogs with meningoencephalomyelitis of unknown origin

Background: The administration of cytosine arabinoside (CA) by continuous rate infusion (CRI) at the time of diagnosis has been shown to improve the 3-month survival of dogs diagnosed with meningoencephalomyelitis of unknown origin (MUO), compared to subcutaneous administration. The benefit of administering subsequent sequential CA subcutaneous injections is unknown. This study compares the outcomes of a CA CRI protocol with (CRI+subcutaneous group) or without (CRI group) follow-up CA subcutaneous injections; both groups received adjunctive prednisolone. Methods: Forty-two dogs diagnosed with MUO were recruited (CRI group) and compared with 41 historical control dogs (CRI+subcutaneous group) in a prospective, controlled clinical trial with 36 months of follow-up. Results: Success rates were respectively 64.3 per cent and 65 per cent in the CRI and the CRI+subcutaneous groups at 40 weeks following diagnosis, and 32.5 per cent and 35.9 per cent at 36 months following diagnosis. The median time to relapse was 299 and 285 days for the CRI and the CRI+subcutaneous groups, respectively. No statistically significant difference was found (P=0.05). Conclusion: No clear benefit was identified in the administration of subsequent sequential CA subcutaneous injections after the first administration of CA by CRI for the treatment of dogs diagnosed with MUO

Clinical features, treatment and outcome of discospondylitis in cats

ObjectivesThere is a paucity of information on feline discospondylitis. This study aimed to describe the signalment, clinical and laboratory findings, aetiological agents, treatment and outcome in cats affected by discospondylitis.MethodsThis was a retrospective review of the medical records of cats diagnosed with discospondylitis at four referral institutions.ResultsA total of 17 cats were identified. Most were domestic shorthair cats (76.5%) and male (58.8%), with a median age of 9 years (range 0.9–14) and a median duration of clinical signs of 3 weeks (range 0.3–16). All cats presented with spinal hyperaesthesia; 3/17 had pyrexia. Neurological dysfunction was found in 64.7% of cats, which was indicative of a T3–L3 or L4–S2 spinal segment, associated nerve root or associated nerve neurolocalisation. Haematology, serum biochemistry and urinalysis revealed occasional inconsistent non-specific changes. All cats underwent urine culture; 9/17 cats also had a distinct tissue cultured. Positive bacterial cultures were obtained in two cats (11.8%) for Staphylococcus species (urine, blood and intradiscal fine-needle aspirate) and Escherichia coli (urine); both presented with multifocal discospondylitis. Treatment was non-surgical in all cats, with sustained antibiotic therapy for a median of 3 months (range 1–9). Analgesia provided included non-steroidal anti-inflammatory drugs, alone or in combination with gabapentin. Restricted exercise was advised for a minimum of 4 weeks. Outcome information available in 12 cats was excellent in terms of pain control and neurological function in 10 cats (83.3%) at the time of stopping antibiotics. Recurrence occurred in one case, which had received a single antibiotic for 6 weeks, and relapsed 4 months after presentation. One other case failed to improve and was euthanased during the course of hospitalisation.Conclusions and relevanceFeline discospondylitis is uncommon and no obvious signalment predisposition was found in this study. Spinal hyperaesthesia was universally present, with neurological dysfunction also highly prevalent. Bacterial culture was unrewarding in most cases. Amoxicillin–clavulanic acid or cephalosporins are reasonable choices for first-line antibiotics. Prognosis was favourable, with no long-term evidence of recurrence in cats on sustained antibiotic therapy, for a mean duration of 3 months

COVID-19 Athlete question and answer translations

Aspetar provides evidence-based information and guidance on the Covid-19 pandemic to athletes and those involved in athlete (health) care. We asked (and continue to ask) athletes and coaches what they want to know about the covid-19 disease and pandemic. We catalogue these questions, rephrase them where necessary and synthesise the best evidence. Based on that evidence we formulate accessible answers, with bottom line short answers for infographics. Clinicians and non-clinicians review the questions and answers before we translate them into different languages