Lewis Melissa J, Granger Nicolas, Jeffery Nick D
Department of Veterinary Clinical Sciences, Purdue University College of Veterinary Medicine, West Lafayette, IN, United States.
The Royal Veterinary College, University of London, Hertfordshire, United Kingdom.
Front Vet Sci. 2020 Oct 15;7:579933. doi: 10.3389/fvets.2020.579933. eCollection 2020.
Some dogs do not make a full recovery following medical or surgical management of acute canine intervertebral disc herniation (IVDH), highlighting the limits of currently available treatment options. The multitude of difficulties in treating severe spinal cord injury are well-recognized, and they have spurred intense laboratory research, resulting in a broad range of strategies that might have value in treating spinal cord-injured dogs. These include interventions that aim to directly repair the spinal cord lesion, promote axonal sparing or regeneration, mitigate secondary injury through neuroprotective mechanisms, or facilitate functional compensation. Despite initial promise in experimental models, many of these techniques have failed or shown mild efficacy in clinical trials in humans and dogs, although high quality evidence is lacking for many of these interventions. However, the continued introduction of new options to the veterinary clinic remains important for expanding our understanding of the mechanisms of injury and repair and for development of novel and combined strategies for severely affected dogs. This review outlines adjunctive or emerging therapies that have been proposed as treatment options for dogs with acute IVDH, including discussion of local or lesion-based approaches as well as systemically applied treatments in both acute and subacute-to-chronic settings. These interventions include low-level laser therapy, electromagnetic fields or oscillating electrical fields, adjunctive surgical techniques (myelotomy or durotomy), systemically or locally-applied hypothermia, neuroprotective chemicals, physical rehabilitation, hyperbaric oxygen therapy, electroacupuncture, electrical stimulation of the spinal cord or specific peripheral nerves, nerve grafting strategies, 4-aminopyridine, chondroitinase ABC, and cell transplantation.
一些犬只在接受急性犬椎间盘突出症（IVDH）的药物或手术治疗后未能完全康复，这凸显了当前可用治疗方案的局限性。严重脊髓损伤治疗中的诸多困难已得到充分认识，这些困难推动了深入的实验室研究，产生了一系列可能对脊髓损伤犬有治疗价值的策略。这些策略包括旨在直接修复脊髓损伤、促进轴突保留或再生、通过神经保护机制减轻继发性损伤或促进功能代偿的干预措施。尽管在实验模型中最初显示出前景，但这些技术中的许多在人类和犬类的临床试验中失败或显示出轻微疗效，尽管其中许多干预措施缺乏高质量证据。然而，持续向兽医临床引入新的治疗选择对于扩展我们对损伤和修复机制的理解以及为重症犬开发新的联合治疗策略仍然很重要。本综述概述了已被提议作为急性IVDH犬治疗选择的辅助或新兴疗法，包括对局部或基于损伤的方法以及急性和亚急性至慢性情况下全身应用治疗的讨论。这些干预措施包括低强度激光治疗、电磁场或振荡电场、辅助手术技术（脊髓切开术或硬脊膜切开术）、全身或局部应用低温、神经保护化学物质、物理康复、高压氧治疗、电针、脊髓或特定周围神经的电刺激、神经移植策略、4-氨基吡啶、软骨素酶ABC和细胞移植。
