Gomes Sérgio A, Alvites Rui Damásio, Lopes Bruna, Coelho André, Targett Mike, Ribeiro Jorge, Gouveia Débora, Martins Ângela, Varejão Artur S P, Maurício Ana Colette, Luís Ana Lúcia
Dovecote Veterinary Hospital, Castle Donington, United Kingdom.
Departamento de Clínicas Veterinárias, Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto (UP), Porto, Portugal.
Front Vet Sci. 2024 Dec 4;11:1487105. doi: 10.3389/fvets.2024.1487105. eCollection 2024.
Current literature warrants surgical decompression in paraplegic dogs with absent pain perception (APP), but the rate of ambulatory dogs with APP following thoracolumbar (TL) IVDE surgery in a clinical setting remains unknown. Furthermore, the outcome of paraplegic APP French Bulldogs (FBs) is anecdotally considered poor. The aims of this study were threefold within a large population of TL-IVDE paraplegic dogs with APP undergoing decompressive surgery: (1) to characterize early spontaneous pelvic limb movement and ambulation following surgery; (2) to identify risk factors for the recovery of ambulation; and (3) to compare the outcome of FBs and Dachshunds presenting with APP.
A single-center, retrospective case series of dogs with paraplegia and APP diagnosed with TL-IVDE based on CT or MRI, all undergoing surgical decompression (hemilaminectomy ± durotomy). Two main groups were defined: ambulatory and non-ambulatory. These were further characterized depending on the presence of pain perception and spontaneous movement. The outcome was obtained at 4-8 weeks postoperatively. Statistical analysis was performed comparing ambulatory and non-ambulatory dogs and comparing rates of ambulation on FBs vs. Dachshunds.
A total of 127 cases were included, with 77 out of 127 (60.6%) being ambulatory at recheck and 9 out of 127 (7.1%) being ambulatory despite APP. The remaining case distribution of non-ambulatory cases was: with APP (32 out of 127; 25.2%), with pain perception (5 out of 127; 3.9%), and with spontaneous movement (5 out of 127; 3.9%). Multivariate analysis revealed two negative factors for the recovery of ambulation: dogs undergoing hemilaminectomy alongside durotomy ( = 0.003) and dogs presenting with spinal shock (lower motor neuron signs with a lesion higher than the L3-L4 intervertebral disk) characterized by reduced/absent withdrawal reflex ( = 0.008). No difference was found between Dachshunds ( = 41, 73.2% ambulatory) and FBs ( = 33, 63.6% ambulatory) in terms of recovery of ambulation, with only 2 out of 33 (6.1%) FBs developing myelomalacia.
Early recovery of ambulation alone (60.6%) and ambulation alongside pain perception (53.5%) occurred in the majority of surgically managed TL-IVDE-affected dogs with APP. Negative prognostic factors for recovery of ambulation were durotomy performed alongside hemilaminectomy, and dogs presenting with spinal shock with reduced/absent withdrawal reflexes, the latter translating to a reduced/absent withdrawal reflexes with a lesion higher than L3-L4 intervertebral disk. Finally, no indications of a worse prognosis for recovery of ambulation or a higher rate of development of myelomalacia in FBs when compared to Dachshunds were found.
当前文献支持对无痛觉的截瘫犬进行手术减压，但在临床环境中，胸腰椎（TL）椎间盘突出症（IVDE）手术后仍有痛觉的犬的行走恢复率尚不清楚。此外，据传闻，截瘫且无痛觉的法国斗牛犬（FB）预后较差。本研究的目的有三个，针对大量接受减压手术的TL-IVDE截瘫且无痛觉的犬：（1）描述术后早期自发的骨盆肢体运动和行走情况；（2）确定行走恢复的风险因素；（3）比较出现无痛觉的FB和腊肠犬的预后。
一项单中心回顾性病例系列研究，纳入基于CT或MRI诊断为TL-IVDE的截瘫且无痛觉的犬，均接受手术减压（半椎板切除术±硬脊膜切开术）。定义了两个主要组：能行走和不能行走。根据痛觉和自发运动的存在情况进一步对这些组进行特征描述。术后4-8周获得结果。进行统计分析，比较能行走和不能行走的犬，并比较FB与腊肠犬的行走恢复率。
共纳入127例病例，127例中有77例（60.6%）在复查时能行走，127例中有9例（7.1%）尽管无痛觉但仍能行走。其余不能行走病例的分布情况为：无痛觉（127例中的32例；25.2%）、有痛觉（127例中的5例；3.9%）和有自发运动（127例中的5例；3.9%）。多因素分析显示行走恢复的两个负性因素：同时进行半椎板切除术和硬脊膜切开术的犬（P = 0.003）以及表现为脊髓休克（下运动神经元体征，病变高于L3-L4椎间盘）且以退缩反射减弱/消失为特征的犬（P = 0.008）。在行走恢复方面，腊肠犬（n = 41，73.2%能行走）和FB（n = 33，63.6%能行走）之间未发现差异，33例FB中只有2例（6.1%）发生脊髓软化。
大多数接受手术治疗的TL-IVDE且无痛觉的犬出现了单独的早期行走恢复（60.6%）和伴有痛觉的行走恢复（53.5%）。行走恢复的负性预后因素是与半椎板切除术同时进行硬脊膜切开术，以及表现为脊髓休克且退缩反射减弱/消失的犬，后者意味着病变高于L3-L4椎间盘时退缩反射减弱/消失。最后，未发现与腊肠犬相比，FB在行走恢复预后更差或脊髓软化发生率更高的迹象。
