A 13-year-old, spayed female mix breed dog was presented for evaluation of cervical and left forelimb pain beginning 2 weeks prior. She was receiving methocarbamol, gabapentin, and tramadol. On presentation, the patient was stiff in the forelimbs with lameness in the forelimb. Guarding was noted on cervical manipulation, and orthopedic evaluation was normal. Radiographs taken previously by the referring veterinarian revealed collapse of the intervertebral disk spaces at C4–C5 and C5–C6.\nMagnetic resonance imaging showed a small amount of contrast enhancing material within the extradural space on the left ventral aspect of the vertebral canal at C5–C6. This material minimally displaced the left portion of the spinal cord dorsally and caused compression of the left fifth spinal nerve root within the C5–C6 intervertebral foramen. The intervertebral disk nuclei at C2–C3, C3–C4, C4–C5, C5–C6, and C6–C7 were hypointense on all sequences, consistent with in situ degeneration. Narrowing of the ventral subarachnoid space was present at C2–C3, C3–C4, C4–C5, and C6–C7, suggesting mild non-compressive intervertebral disk protrusions.\nTreatment options were discussed and the owner elected to proceed with cervical perineural injection of the left C5 nerve root. Methylprednisolone (1 mg/kg) was injected into the perineural space. The patient was sent home on methocarbamol (25 mg/kg) q24 h, gabapentin (10 mg/kg) q8–12 h, and tramadol (5 mg/kg) q12 h as previously prescribed by the referring veterinarian for continued pain management.\nMild improvement in the patient’s clinical status was observed during hospitalization, most notable a decrease in cervical pain. The patient returned for follow-up 1 week later and the owner reported marked improvement in cervical and forelimb pain; findings were confirmed on physical exam. Six-month telephone follow-up revealed continued improvement in both cervical and forelimb pain. Gabapentin had been continued as needed for pain after prolonged activity, but all other medication had been discontinued.
A 6-year-old, neutered male Dachshund was presented for severe cervical pain. Medical management, including tramadol, methocarbamol, and prednisone, was attempted for 2 weeks prior to presentation. Physical and neurological examinations identified lameness in the left forelimb and cervical pain. Mild postural reaction deficits and decreased spinal reflexes were noted in the left forelimb. Orthopedic examination was normal.\nMagnetic resonance imaging of the cervical spine was performed. At C6–C7, there was an aggregation of material in the left ventral aspect of the vertebral canal and interverterbral foramen that was hypointense on T2W and STIR sequences with mild contrast enhancement on T1W sequence (Figure ). This material resulted in mild left sixth spinal nerve root compression and minimal extradural spinal cord compression. Additionally, there was mild broad-based dorsal protrusion of the annulus fibrosis throughout the remainder of the cervical vertebral column, without spinal cord or nerve root compression.\nTreatment options were discussed and the client elected fluoroscopically guided perineural injection of 5 mg methylprednisolone (1 mg/kg) at the C6–C7 foramen. Anesthetic recovery was uneventful.\nOnly mild improvement in pain was noted during hospitalization. The patient was discharged with gabapentin 50 mg (10 mg/kg) q8–12 h, tramadol 12.5 mg (2.5 mg/kg) q8–12 h, and prednisone 2.5 mg (1 mg/kg) q12 h the following day. The owner reported that over the next couple of months the patient continued to improve at home and both the tramadol and prednisone were discontinued by the owner and family veterinarian. Six months later, the clients were contacted by phone and reported that they administered gabapentin only as needed after intense exercise.