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.
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.