This time, I figured, I’d put the punch line right in the title!
Here’s the story. A university classmate of mine reached out to me about her friends dog and wondered if I could help or point her in the right direction. I said, “Sure, tell her to email me with a full detail of the history.”
Reader’s Digest Case History: Small older dog. Owner concerned about the dog having ‘pain’ with being picked up and a front leg lameness – subsequent to being ‘babysat’ by friends two months ago. He has progressed to weakness in the rear. Metacam and gabapentin have helped a bit. Jumping off of furniture makes him worse. X-rays taken of his back. Referral to specialist, who can’t get him in for another 6 weeks!
Now, I hope that everyone reading this blog can SEE a very important piece of information here. That is, there is Lameness in the Front Leg. And what was my punch line? Thoraco-lumbar or lumbar disc herniations do not cause front leg lameness. There is no mechanism that could allow for this. Yes, there could be two lesion. I’ll concede that point, however, the full picture, and full history, (and back x-rays that don’t look too bad to me) support my thinking that this dog’s disc issue is in the cervical spine.
I thought, I wonder if Pubmed could back me up on this (I mean, it’s basic anatomy… but I do love me some Pubmed time!)
Kerwin SC, Taylor AR. Neurologic Causes of Thoracic Limb Lameness. Vet Clin North Am Small Anim Pract. 2021 Mar;51(2):357-364.
“Neurologic diseases cause lameness due to disease of the nerves, nerve roots, spinal cord, or muscles. Common differentials include lateralized intervertebral disc extrusions, caudal cervical spondylomyelopathy (wobbler disease), brachial plexus avulsion, neuritis, and peripheral nerve sheath tumors. Many of these diseases compress or destroy the nerve roots of the cervical intumescence, resulting in non-weight-bearing lameness, or root signature.”
Within this list, we can rule out Wobbler’s (wrong size of dog), brachial plexus avulsion (is lame, not non-weight bearing, no history of trauma, & has back end issues as well), nerve sheath tumour (again, has back end weakness). That leaves disc extrusion and/or neuritis.
Wolf JK, Early PJ, Pozzi A, Vigani A. Ultrasound-guided paravertebral perineural glucocorticoid injection for signs of refractory cervical pain associated with foraminal intervertebral disk protrusion in four dogs. J Am Vet Med Assoc. 2021 May 1;258(9):999-1006.
This was a case series of 4 dogs with signs of chronic cervical pain and forelimb lameness secondary to cervical foraminal intervertebral disk protrusion. They were confirmed by MRI, and treated with ultrasound-guided paravertebral perineural injections steroids. Three of the four dogs had long-lasting improvement.
So, would I recommend this as a first line of treatment? No, because I’m a physio, and there’s so much we can do with rehab! AND, because this is a great paper as well…
Steffen F, Kircher PR, Dennler M. Spontaneous regression of lumbar Hansen type 1 disk extrusion detected with magnetic resonance imaging in a dog. J Am Vet Med Assoc. 2014 Mar 15;244(6):715-8.
This was a case presentation of a 3-year old French Bulldog with a Hansen type 1 disc extrusion somewhere between T3-L3 that was treated conservatively with cage rest, restricted exercise on a leash, and NSAIDs. Five weeks later there was complete resolution of clinical signs, and results of repeated MRI indicated a 69% reduction in the volume of the herniated disk material.
We see this in people too. Refer back to the blog I wrote on Sept 25th, 2021. It reported on a human paper / case series of 75 human patients with spontaneous regressions of discs. Check it out here: https://www.fourleg.com/Blog?b=532
What about the case that started this commentary?
Well, this correspondence just occurred this week. I’ve given the owner some things to try. I’ve provided the names and contact info for rehab practitioners local to her. I’ve given her the ‘insiders scoop’ on how to see a neurologist sooner if she needs to by going to the emergency department where the neurologist works, should things deteriorate. And, she has my email in order to follow up!
So, with that, I wish you some Happy Deductive Reasoning with your cases for the week ahead!