A 10-year-old, intact male Lhasa apso was presented for evaluation of acute severe neck pain and left forelimb lameness that was unsuccessfully treated with medical management, including meloxicam and diazepam, for 7 days prior to presentation. On presentation, physical and neurological examinations identified left forelimb lameness, cervical pain, and mild lumbosacral pain. Orthopedic evaluation was normal.\nComputed tomography of the cervical spine was performed, using the aforementioned protocol. The findings included intervertebral disk space narrowing at C3–C4 with an aggregation of mineral-attenuating material in the left intervertebral foramen and in situ mineralization of the intervertebral disk. Incidentally, there was also in situ mineralization of the intervertebral disk at C7–T1. Since no overt compressive spinal cord lesion was noted, cervical MR was performed to avoid administration of intrathecal contrast and provide a complete study. This revealed lateral disk extrusion into the left intervertebral foramen at C3–C4. The left third spinal nerve was not distinctly visualized in the foramen. There was also mild flattening of the ventral aspect of the cervical spinal cord at C2–C3 and C3–C4 secondary to hypertrophy of the dorsal longitudinal ligament and/or dorsal protrusion of the annulus fibrosis.\nTreatment options were discussed and the client elected to have fluoroscopically guided perineural injection of 16 mg methylprednisolone (2.1 mg/kg) of the C3 left nerve root. Oral medications (gabapentin 6.4 mg/kg q12 h and tramadol 3.2 mg/kg q8–12 h) were continued.\nImmediate improvement was apparent while in the hospital. The patient was discharged on the next day. The owner reported no pain at home following the procedure. All medications were discontinued 1 month after the procedure. Three years later, the patient had no recurrence of clinical signs reported by the owner via telephone follow-up.
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.