Case Study

CT- Degenerative lumbosacral stenosis with disc protrusion and intervertebral space degeneration in a 10 year old MN Dalmation dog

This 10 year old MN Dalmation dog presented non ambulatory. Patient was adopted 5 days ago and was unable to walk at that time. According to shelter, patient could walk 1 week ago. Radiographs at shelter revealed spondylosis in the thoracolumbar region; have been treating with tramadol and steroids.

Physical exam-Mentation: Normal; Gait: non-ambulatory; Posture: no head tilt/decerebrate or decerebellate rigidity, no opisthotonus, possible Schiff-sherrington; CN: no muscle atrophy, no nystagmus, lateral/medial blink reflex present, menace present, tongue symmetrical, gag reflex present, PLR present, no anisocoria; Postural reactions: Proprioceptive placing absent all legs; Muscle size/tone: no muscle atrophy/swelling/enlargement; Spinal reflexes: thoracic limb and LPL withdrawal present, no withdrawal on RPL, patellar present, sciatic present, panniculus/perineal present; Sensory: No neck/spinal pain, no hyperesthesia

Image Interpretation

CT of the spine-
Level with C7/T1, T12/13 and T13/L1 moderate chronic disc protrusions are noted
which both cause a mild compressive effect on the spinal cord. The ventral epidural
space is occupied by the herniated annulus fibrosus, the spinal cord reveals mild
dorsoventral flattening, and the dorsal epidural space is narrowed.
Moreover, wedge shaped narrow disc spaces, which may be an indirect sign of disc
herniation, are noted at C6/7 and C7/T1.
The neighbouring vertebral endplates of T10/11 and T13/L1 reveal moderate signs of
spondylosis deformans.
Moderate signs of degenerative lumbosacral stenosis with narrow disc spaces,
spondylosis deformans and degenerative spondylarthropathy are noted at L5/6, L6/7 and L7/S1. The lumbosacral disc reveals a degeneration related vacuum phenomenon,
moderate protrusion with dorsal displacement of the dural tube and cauda equina
nerves. The epidural space dorsal to the dural tube and nerve fibres is maintained. The
disc protrusion and lateralized spondylotic new bone formation extends into the
entrance and exit zones of both lumbosacral neurforamina and causes a moderate
bilateral neuroforaminal stenosis.
Multifocal age related dural calcification is noted throughout the spine and most
pronounced within the cervical spine.
Multifocal disc mineralization is seen throughout the spine as an expression of
generalized fibrotic disc degeneration.
The urinary bladder is severely distended.

DX

Degenerative lumbosacral stenosis with moderate disc protrusion causing moderate vertebral canal stenosis as well as bilateral mild to moderate neuroforaminal stenosis. • Moreover multifocal moderate chronic disc protrusions at C7/T1, T12/13, T13/L1, L5/6 and L6/7. • Signs of multifocal age related degeneration of the intervertebral spaces throughout the spine. • Impeded micturition.

Outcome

Even though there are multifocal signs of mild to moderate chronic compressive
myelopathies or neuropathies of the Cauda equina the computed tomographic findings
do not seem to fully explain the clinical presentation. The findings are most
pronounced in the lumbosacral area but the history does not report lumbosacral pain
syndrome and the degree of changes does usually not correlate with a non-ambulatory
state of the patient.
Differential diagnoses such as spinal cord infarction, traumatic type 3 disc extrusion
(low volume, high velocity), degenerative myelopathy, ascending myelomalacia,
degenerative myelopathy, spinal cysts, intradural & intramedullary neoplasia, or other
may be present concurrently and cannot be ruled out based on the plain study.
There is no evidence of discospondylitis or extradural neoplasia.
MRI or CT-myelography would be ideal to better evaluate the suspected lesions.CT-