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 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.