Compressive hydrated nucleus pulposus extrusion: is surgery necessary?

Myelo‐CT imaging findings in 15 dogs with surgically‐treated cervical acute compressive hydrated nucleus pulposus extrusion

“…Furthermore, the fact that all but two of the included dogs had exactly the same distinctive imaging characteristics, similar to what has been previously described for MRI, 1,6–10,12–14 makes a strong case for the diagnosis of compressive cervical HNPE when MRI is not available. The observation of this characteristic imaging pattern may become important when considering the most appropriate treatment for a particular case, especially for clients with financial restraints or concerns about surgery 16 . Contrary to Hansen type I intervertebral disc herniation, medical management should be considered a viable treatment option in dogs with cervical compressive HNPE based on previous literature 2,6,8,13,14,16 regardless of the severity of clinical signs since spinal cord contusion is thought to play an important role in these dogs, 16 and also the herniated material has been demonstrated to reabsorb with time 2,13 …”

“…The observation of this characteristic imaging pattern may become important when considering the most appropriate treatment for a particular case, especially for clients with financial restraints or concerns about surgery. 16 Contrary to Hansen type I intervertebral disc herniation, medical management should be considered a viable treatment option in dogs with cervical compressive HNPE based on previous literature 2,6,8,13,14,16 regardless of the severity of clinical signs since spinal cord contusion is thought to play an important role in these dogs, 16 and also the herniated material has been demonstrated to reabsorb with time. 2,13 In conclusion, our results suggest that myelo-CT might be a useful diagnostic tool for cervical compressive HNPE when MRI is not available and might influence surgical decision-making, although a greater number of cases is required to strengthen our findings.…”

“…Unfortunately, MRI may not be available, and an alternative diagnostic modality might be useful to diagnose this particular type of intervertebral disc extrusion. Considering that conservative treatment of HNPE has been associated with a good prognosis, even with severe neurological deficits, the identification of characteristic features with imaging modalities other than MRI might influence decision‐making 2,6,8,13,14,16 …”

“…Considering that conservative treatment of HNPE has been associated with a good prognosis, even with severe neurological deficits, the iden-tification of characteristic features with imaging modalities other than MRI might influence decision-making. 2,6,8,13,14,16 The appearance of compressive HNPE during contrast-enhanced CT has already been described, 15 but the myelo-CT characteristics of this specific type of intervertebral disc herniation have never been published.…”