Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom.
Department of Small Animal Clinical Studies, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA.
J Vet Intern Med. 2024 Sep-Oct;38(5):2603-2611. doi: 10.1111/jvim.17149. Epub 2024 Jul 25.
Currently, low-level evidence suggests loss of ambulation associated with acute thoracolumbar disk extrusion is best treated by decompressive spinal surgery. Conservative management can be successful, but the proportion of dogs that recover and the fate of herniated material are uncertain.
Determine the proportion of nonambulatory dogs with conservatively treated acute thoracolumbar disk extrusion that recover ambulation and measure the change in spinal cord compression during the first 12 weeks after presentation.
Seventy-two client-owned nonambulatory dogs with acute thoracolumbar intervertebral disk extrusion.
This is a prospective cohort study. Enrolled dogs underwent magnetic resonance imaging at presentation and owners were provided with conservative management recommendations. Imaging was repeated after 12 weeks. Recovery of ambulation was defined as 10 consecutive steps without falling. Spinal cord compression was determined from the cross-sectional area of the vertebral canal and extradural compressive material at the lesion epicenter. The association between recovery and change in compression over the 12-week observational period was examined.
Forty-nine of fifty-one (96%; 95% confidence interval [CI], 87%-99%) of deep pain-positive and 10/21 (48%; 95% CI, 28%-68%) of deep pain-negative dogs recovered ambulation within the 12-week period. The median time to ambulation was 11 and 25 days for deep pain-positive and -negative dogs, respectively. Reduction in spinal cord compression varied among individuals from minimal to complete and apparently was unrelated to the recovery of ambulation.
A high proportion of conservatively treated dogs recovered ambulation after conservative management of acute thoracolumbar disk herniation. Recovery was not dependent on the resolution of compression.
目前，低水平证据表明，与急性胸腰椎间盘突出症相关的活动丧失最好通过减压脊柱手术治疗。保守治疗可能有效，但康复的犬比例和突出物的命运不确定。
确定保守治疗急性胸腰椎间盘突出症的非活动性犬中，有多少比例能够恢复活动能力，并测量在出现后最初 12 周内脊髓受压的变化。
72 只患有急性胸腰椎间盘突出症的非活动性犬。
这是一项前瞻性队列研究。纳入的犬在就诊时接受磁共振成像检查，并且为其提供了保守治疗建议。在 12 周后进行了重复成像。恢复活动能力定义为连续 10 步而不跌倒。脊髓压迫通过椎管的横截面积和病变中心的硬膜外压迫材料来确定。检查了在 12 周观察期内恢复和压迫变化之间的关联。
51 只深痛阳性犬中的 49 只（96%；95%置信区间[CI]，87%-99%）和 21 只深痛阴性犬中的 10 只（48%；95%CI，28%-68%）在 12 周内恢复了活动能力。深痛阳性和阴性犬的平均恢复时间分别为 11 天和 25 天。脊髓压迫的减少在个体之间从最小到完全不等，似乎与活动能力的恢复无关。
在对急性胸腰椎间盘突出症进行保守治疗后，很大一部分保守治疗犬恢复了活动能力。恢复与压迫的缓解无关。
