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Comparison of surgical and conservative treatment of hydrated nucleus pulposus extrusion in dogs

Nessler, Jasmin, Flieshardt, Cornelia, Tünsmeyer, Julia, Dening, Ricarda, Tipold, Andrea
Journal of veterinary internal medicine 2018 v.32 no.6 pp. 1989-1995
cages, dogs, extrusion, intervertebral disks, magnetic resonance imaging, physical therapy, prognosis, retrospective studies, surgery
BACKGROUND: Whether compressive cervical myelopathy caused by hydrated nucleus pulposus extrusion (HNPE) in dogs should be treated surgically or conservatively has been debated. Only 1 recent study has contradicted the former predominant reports of surgical treatment for HNPE. HYPOTHESIS AND METHOD: Single center retrospective study to compare the outcome of client‐owned dogs with HNPE after decompressive surgery or conservative treatment. ANIMALS: Thirty‐six dogs diagnosed with HNPE confirmed by magnetic resonance imaging (MRI). RESULTS: Eighteen of 36 dogs underwent surgery whereas 18 dogs were managed conservatively including cage rest and physiotherapy. The most common affected intervertebral disc space was C4‐5. In 3 dogs, HNPE was diagnosed at the level of T13‐L1. Median time to regain ambulation was 6.6 days (range, 0‐28 days) after surgery and 5.9 days (range, 0‐15 days) with conservative management (P = .37). Only the length of a potential intramedullary lesion in cervical HNPE detected by MRI had an influence on the prognosis to gain ambulatory status in a time period of ≤9 days (P = .0035) and on short‐term survival (P = .0011). CONCLUSIONS AND CLINICAL IMPORTANCE: Conservative management of HNPE in the cervical as well as in the thoracolumbar region represents a reasonable alternative to surgery, showing similar favorable outcome.