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.
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.