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 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.