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Neurology & Neurosurgery

..."is it neurological"?

One of the most frequently asked questions by colleagues and friends every day!

 

The first question that comes to us in a clinical case, and the primary purpose of the neurological examination, is precisely to define whether our patient is affected by a problem affecting the nervous or neuromuscular system. We, therefore, aim for a precise neuroanatomical localisation that, together with the patient's clinical history, allows us to draw up a list of differential diagnoses and thus set up a correct and logical diagnostic workup.

 

VetCrew specialists, thanks to veterinary teleconsultation, can assist you in clinical reasoning by pointing to the solution of the diagnostic puzzle!

 

Highlights: 
Intervertebral Disc Disease

Classification of intervertebral disc disease

The first report of disc extrusion in dogs dates back to 1800. So much has been said and written about it since then.  Dogs have many types of disc herniation, most of which benefit from surgical correction. Only at times, however, surgery is the answer. At times, conservative treatment is the appropriate clinical choice.

The therapeutic choice is based on the type of disc disease and the patient's clinical condition.

 

A recent consensus on the classification of disc disease divides them into eight subtypes:

1.  Acute Intervertebral Disc Extrusion (Hansen type I) 

2. Acute Intervertebral Disc Extrusion associated with           extensive epidural bleeding

3. Intervertebral Disc Protrusions (Hansen type II) 

4. Acute Non-Compressive Nucleus Pulposus Extrusion       (ANNPE) 

5. Hydrated Nucleus Pulposus Extrusion (HNPE) 

6. Intradural/ Intramedullary Intervertebral Disc                     Extrusion (IIVDE) 

7. Traumatic Disc Extrusion 

8. Fibrocartilaginous Embolic Myelopathy (FCEM)

 

The authors include in the HNPE subtype those previously described as "intraspinal cyst" and "canine discal cyst". Foraminal disc extrusions are not mentioned in this classification; however, it is reasonable to classify them among acute disc extrusion considering the clinical history, typically hyperacute, and their biological behaviour.

MRI Sag T2 cervical disc.png
Fig 1. T2W Sag image of the caudal fossa and C-spine of a dog showing an acute intervertebral disc extrusion at C4-C5 causing sc compression and dorsal displacement
MRI T1-T2 tra cervical disc.png
Fig 2.  T2W e T1W tra images at the intervertebral disc space C4-C5 showing the compressive material causing sc compression and displacement 

Fenn J, Olby NJ; Canine Spinal Cord Injury Consortium (CANSORT-SCI). Classification of Intervertebral Disc Disease. Front Vet Sci. 2020 Oct 6;7:579025. doi: 0.3389/fvets.2020.579025. PMID: 33134360; PMCID: PMC7572860.
 

Bersan E, McConnell F, Trevail R, Behr S, De Decker S, Volk HA, Smith PM, Gonçalves R. Cervical intervertebral foraminal disc extrusion in dogs Vet Rec. 2015 Jun 6;176(23):597. doi: 10.1136/vr.102851. Epub 2015 Mar 5. PMID: 25745084.

VetCrew Neurology  

Erika Bersan

DMV, MRCVS, DipECVN, FHEA

EBVS & RCVS Recognised Specialist in Veterinary Neurology

 

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