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.
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.