Neurology & Neurosurgery Service, Pride Veterinary Referrals, Derby, UK.
Clinical Science and Services, Royal Veterinary College, Hatfield, UK.
Vet Rec. 2023 Sep 9;193(5):e2992. doi: 10.1002/vetr.2992. Epub 2023 May 29.
Recurrence of neurological signs following surgery for intervertebral disc herniation (IVDH) is reported, yet many cases lack MRI-confirmed diagnosis. This study describes the MRI and clinical findings in dogs presenting with recurrence of neurological signs following surgical treatment of IVDH.
Medical records of dogs that underwent decompressive surgery for IVDH followed by a subsequent MRI within 12 months were retrospectively reviewed.
One hundred and thirty-three dogs were identified, all of which initially presented with intervertebral disc extrusion (IVDE). Of these, 109 (81.9%) had a recurrent IVDE, and 24 (18.1%) had an alternative diagnosis that included haemorrhage (n = 10), infection (n = 4), soft tissue encroachment (n = 3), myelomalacia (n = 3) or other (n = 4). Same-site IVDE recurrence or alternative diagnoses were significantly more likely to present within 10 days postoperatively. Thirty-nine percent of dogs presenting with 'early recurrence' had an alternative diagnosis. Type of surgery, fenestration, neurological grade or IVDE site was not significantly associated with the subsequent MRI diagnosis.
Limitations include the retrospective study design, the exclusion of conservatively managed recurrences, the variable length of follow-up and differences in the clinicians' surgical experience.
The most common cause for the recurrence of neurological signs following decompressive spinal surgery was IVDE. Just over one-third of dogs presenting with early recurrence had an alternative diagnosis.
椎间盘突出症(IVDH)手术后出现神经体征复发的情况时有报道,但许多病例缺乏 MRI 确诊。本研究描述了在接受 IVDH 减压手术后出现神经体征复发的犬只的 MRI 和临床发现。
回顾性分析了 133 只接受 IVDH 减压手术并在 12 个月内进行后续 MRI 的犬的病历。
共发现 133 只犬,均最初表现为椎间盘突出(IVDE)。其中,109 只(81.9%)出现了复发性 IVDE,24 只(18.1%)出现了替代诊断,包括出血(n=10)、感染(n=4)、软组织侵犯(n=3)、脊髓软化(n=3)或其他(n=4)。同一部位的 IVDE 复发或替代诊断更可能在术后 10 天内出现。39%的“早期复发”犬有替代诊断。手术类型、开窗术、神经学分级或 IVDE 部位与随后的 MRI 诊断无显著相关性。
本研究的局限性包括回顾性研究设计、排除保守治疗的复发、随访时间的差异以及临床医生手术经验的差异。
减压脊柱手术后神经体征复发的最常见原因是 IVDE。超过三分之一的早期复发犬有替代诊断。