A 10-year-old, neutered male Dachshund was presented for evaluation of severe neck pain that began 1 month earlier. Treatment prior to referral included deracoxib, tramadol, and cage rest. On presentation, physical and neurological examinations identified cervical pain and lameness of the left forelimb. Orthopedic examination was normal.\nComputed tomography of the cervical spine was performed. At C3–C4, the intervertebral disk space was collapsed and a large amount of mineral-attenuating material was present in the left intervertebral foramen, displacing the perineural fat (Figure ). Incidentally, in situ mineralization of the intervertebral disks was noted throughout the remainder of the cervical vertebral column.\nThe lateralized material at C3–C4 was thought to contribute to clinical signs due to compression of the left third spinal nerve, and its location suggested that it would not be accessible through a ventral slot approach. Interventional options included cervical hemilaminectomy or fluoroscopically guided perineural injection of local anesthetic (bupivacaine) and methylprednisolone. The client elected the latter.\nTwenty milligrams of methylprednisolone (2.1 mg/kg) and 9.4 mg of bupivacaine (1 mg/kg) were injected into the left C3–C4 foramen. The patient was moved to the ICU after the procedure for recovery. Although the patient became increasingly alert, he initially failed to regain voluntary respiration. Mechanical ventilatory support was required for 30 min; later, the patient began breathing on his own, was weaned off the ventilator, and was extubated.\nImmediate improvement in lameness was apparent while in the hospital. The patient was discharged with tramadol PO (1.4 mg/kg q8 h) and gabapentin PO (5.5 mg/kg q12 h) to be combined with cage rest and physical therapy. Fourteen days later at follow-up, the patient was doing well and was pain free. Tramadol was discontinued at that time, and the dose of gabapentin was reduced by half. By 3 months after surgery, all medications had been discontinued. Follow-up was obtained 4 years later when the patient was presented to the teaching hospital ophthalmology service for cataract evaluation. No recurrence of neck pain was reported by the client, and none was found on neurological examination.
An 11-year-old, neutered male mixed breed dog was presented for evaluation of an acute onset of severe neck pain and left forelimb lameness that worsened the week prior to presentation. He had received no treatment prior to presentation. Physical and neurological examinations identified mild tetraparesis and ataxia with left thoracic root-signature signs. Left forelimb lameness was noted with mild proprioceptive deficits in the left thoracic and pelvic limbs. The right forelimb was normal. Pain was apparent on cervical but not thoracolumbar manipulation. Orthopedic examination was normal. Findings were consistent with a lesion affecting the C6–T2 spinal nerves or spinal cord segments and T3–L3 spinal cord segments.\nMagnetic resonance imaging of the cervical spine revealed that the nucleus of the intervertebral disk at C6–C7 was hypointense on all sequences, and there was mild broad-based dorsolateral protrusion of the C6–C7 intervertebral disk toward the left intervertebral foramen, compressing the left sixth nerve root. No spinal cord compression was noted.\nTreatment options were discussed with the client. The client elected fluoroscopically guided perineural injection of methylprednisolone (1 mg/kg) into the area of the intervertebral foramen of C6–C7. Anesthetic recovery was uneventful.\nIncreased willingness to ambulate and improved voluntary range of motion of the head and neck were noted on exam the following morning; lameness was still present. The patient was subsequently discharged with gabapentin (5.9–11.8 mg/kg PO BID), prednisone on a tapering dose beginning at 1.2 mg/kg q12 h and tramadol (3–4.4 mg/kg PO q8 h). At the 2-week follow-up evaluation, the patient showed only mild pain during range of motion. Forelimb weakness and lameness were no longer evident. Prioprioception was improved in the left forelimb. T3–L3 signs were unchanged. Prednisone and tramadol were discontinued at this visit. Further telephone follow-up with the owner revealed that gabapentin was continued as needed for pain for 2–3 months then discontinued. The patient remained free from clinical signs of radicular pain but had succumbed to lymphoma 18 months later.