Acute hydrated nucleus pulposus extrusion in dogs with severe neurologic status: comparison between conservative and surgical treatment.

BACKGROUND

Hydrated nucleus pulposus extrusion (HNPE) is associated with favorable outcome after conservative or surgical treatment. However, optimal management for dogs with severe neurologic deficits remains unclear.

HYPOTHESIS/

OBJECTIVES

Compare conservative vs surgical treatment in nonambulatory paretic or plegic dogs with HNPE, focusing on recovery of unassisted ambulation and voluntary urination, and identify prognostic factors.

ANIMALS: Eighty-six dogs with severe neurologic impairment and a presumptive magnetic resonance imaging (MRI) diagnosis of HNPE.

METHODS

Retrospective multicenter study. Signalment, neurologic grade, neurolocalization, MRI findings, and treatment were recorded. Outcome was assessed at 1 week, 4 weeks, and 6 months. Satisfactory outcome was defined as recovery of voluntary urination and independent ambulation. Recovery time was defined as days to regain unassisted ambulation.

RESULTS

Sixty dogs were treated conservatively and 26 surgically. Hydrated nucleus pulposus extrusion was cervical in 71/86 (83%) dogs and thoracolumbar in 15/86 (17%). At presentation, 62/86 (72%) dogs were nonambulatory paretic, 22/86 (26%) were plegic with intact nociception, and 2/86 (2%) were plegic without nociception. At 1 week, neurologic status was better in the conservative group than in the surgical group, whereas no differences were observed at later follow-up. Satisfactory outcome was achieved in 85% of conservatively treated and 100% of surgically treated dogs. Median recovery time was 7 days with conservative treatment and 9 days with surgery. Non-chondrodystrophic breed, MRI intramedullary T2-weighted hyperintensity, and physical therapy were associated with longer recovery.

CONCLUSIONS AND CLINICAL

IMPORTANCE

Conservative treatment represents a valid option for nonambulatory dogs with HNPE. Signalment and MRI features should guide treatment selection.