Department of Small Animal Clinical Sciences, University of Tennessee Veterinary Teaching Hospital, College of Veterinary Medicine, Knoxville, TN, 37966-4544, USA.
Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC, 27607, USA.
BMC Vet Res. 2019 Dec 3;15(1):433. doi: 10.1186/s12917-019-2186-0.
Progressive myelomalacia (PMM) is a usually fatal complication of acute intervertebral disc extrusion (IVDE) in dogs but its risk factors are poorly understood. The objective of this retrospective case-control study was to identify risk factors for PMM by comparing dogs with complete sensorimotor loss following IVDE that did and did not develop the disease after surgery. We also investigated whether any risk factors for PMM influenced return of ambulation. Medical records of client-owned dogs with paraplegia and loss of pain perception that underwent surgery for IVDE from 1998 to 2016, were reviewed. Dogs were categorized as PMM yes or no based on clinical progression or histopathology. Walking outcome at 6 months was established. Signalment, onset and duration of signs (categorized), steroids, non-steroidal anti-inflammatory drugs (yes or no), site of IVDE (lumbar intumescence or thoracolumbar) and longitudinal extent of IVDE were retrieved and their associations with PMM and walking outcome were examined using logistic regression.
One hundred and ninety seven dogs were included, 45 with and 152 without PMM. A 6-month-outcome was available in 178 dogs (all 45 PMM dogs and 133 control dogs); 86 recovered walking (all in the control group). Disc extrusions at the lumbar intumescence were associated with PMM (p = 0.01, OR: 3.02, CI: 1.3-7.2). Surgery performed more than 12 h after loss of ambulation was associated with PMM (OR = 3.4; CI = 1.1-10.5, p = 0.03 for 12-24 h and OR = 4.6; CI = 1.3-16.6, p = 0.02 for the > 24 h categories when compared with the ≤12 h category). Treatment with corticosteroids was negatively associated with PMM (OR: 3.1; CI: 1.3-7.6, p = 0.01). The only variable to affect walking outcome was longitudinal extent of IVDE (OR = 2.6; CI = 1.3-5.3, p = 0.006).
Dogs with lumbar intumescence IVDE are at increased risk of PMM. Timing of surgery and corticosteroid use warrant further investigations. PMM and recovery of walking are influenced by different factors.
进行性脊髓软化症（PMM）是犬急性椎间盘突出（IVDE）的一种通常致命的并发症，但人们对其危险因素知之甚少。本回顾性病例对照研究的目的是通过比较 IVDE 后完全丧失感觉运动功能但手术后是否发生该病的犬，来确定 PMM 的危险因素。我们还研究了 PMM 的任何危险因素是否会影响行走能力的恢复。我们回顾了 1998 年至 2016 年间因 IVDE 接受手术治疗的伴有截瘫和疼痛感觉丧失的患犬的病历。根据临床进展或组织病理学，将犬分为 PMM 阳性或 PMM 阴性。在 6 个月时建立行走结果。检索了犬的品种、发病和症状持续时间（分类）、类固醇、非甾体抗炎药（是或否）、IVDE 部位（腰椎膨隆或胸腰椎）和 IVDE 的纵向范围，并使用逻辑回归检查了这些因素与 PMM 和行走结果的关系。
共纳入 197 只犬，45 只为 PMM 阳性，152 只为 PMM 阴性。178 只犬（45 只 PMM 犬和 133 只对照犬）可获得 6 个月的结果；86 只犬恢复行走（均在对照组）。腰椎膨隆处的椎间盘突出与 PMM 相关（p=0.01，OR：3.02，CI：1.3-7.2）。发病后超过 12 小时进行手术与 PMM 相关（OR=3.4；CI：1.1-10.5，p=0.03，12-24 小时；OR=4.6；CI：1.3-16.6，p=0.02，>24 小时，与≤12 小时相比）。皮质类固醇治疗与 PMM 呈负相关（OR：3.1；CI：1.3-7.6，p=0.01）。唯一影响行走结果的变量是 IVDE 的纵向范围（OR=2.6；CI：1.3-5.3，p=0.006）。
腰椎膨隆处 IVDE 的犬发生 PMM 的风险增加。手术时机和皮质类固醇的使用值得进一步研究。PMM 和行走恢复受不同因素影响。
