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.
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.