• DVM360_Conference_Charlotte,NC_banner
  • ACVCACVC
  • DVM 360
  • Fetch DVM 360Fetch DVM 360
DVM 360
dvm360 | Veterinary News, Veterinarian Insights, Medicine, Pet Care
dvm360 | Veterinary News, Veterinarian Insights, Medicine, Pet Care
By Role
AssociatesOwnersPractice ManagerStudentsTechnicians
Subscriptions
dvm360 Newsletterdvm360 Magazine
News
All News
Association
Breaking News
Education
Equine
FDA
Law & Ethics
Market Trends
Medical
Politics
Products
Recalls
Regulatory
Media
dvm360 LIVE!™
Expert Interviews
The Vet Blast Podcast
Medical World News
Pet Connections
The Dilemma Live
Vet Perspectives™
Weekly Newscast
dvm360 Insights™
Publications
All Publications
dvm360
Firstline
Supplements
Vetted
Clinical
All Clinical
Anesthesia
Animal Welfare
Behavior
Cardiology
CBD in Pets
Dentistry
Dermatology
Diabetes
Emergency & Critical Care
Endocrinology
Equine Medicine
Exotic Animal Medicine
Feline Medicine
Gastroenterology
Imaging
Infectious Diseases
Integrative Medicine
Nutrition
Oncology
Ophthalmology
Orthopedics
Pain Management
Parasitology
Surgery
Toxicology
Urology & Nephrology
Virtual Care
Business
All Business
Business & Personal Finance
Hospital Design
Personnel Management
Practice Finances
Practice Operations
Wellbeing & Lifestyle
Continuing Education
Conferences
Conference Listing
Conference Proceedings
Upcoming dvm360 Conferences
Resources
CBD in Pets
CE Requirements by State
Contests
Partners
Spotlight Series
Team Meeting in a Box
Toolkit
Top Recommended Veterinary Products
Vet to Vet
Veterinary Heroes
  • Contact Us
  • Fetch DVM360 Conference
  • Terms and Conditions
  • Privacy
  • Do Not Sell My Information
  • About Us

© 2023 MJH Life Sciences and dvm360 | Veterinary News, Veterinarian Insights, Medicine, Pet Care. All rights reserved.

Advertisement
By Role
  • Associates
  • Owners
  • Practice Manager
  • Students
  • Technicians
Subscriptions
  • dvm360 Newsletter
  • dvm360 Magazine
  • Contact Us
  • Fetch DVM360 Conference
  • Terms and Conditions
  • Privacy
  • Do Not Sell My Information
  • About Us
  • MJHLS Brand Logo

© 2023 MJH Life Sciences™ and dvm360 | Veterinary News, Veterinarian Insights, Medicine, Pet Care. All rights reserved.

Treating Hydrated Nucleus Pulposus Extrusion in Dogs

November 1, 2018
Natalie Stilwell, DVM, MS, PhD

Which treatment method has higher success rates and shorter recovery times: surgical or conservative management?

Hydrated nucleus pulposus extrusion (HNPE) is a recently described pattern of intervertebral disk herniation in dogs. HNPE differs from other forms of compressive myelopathy, as the extruded disk material is gelatinous or liquid rather than solid or calcified.

Most HNPE studies emphasize surgical rather than conservative management. However, researchers in Germany recently found evidence that conservatively managed cases of HNPE offered a success rate similar to that of decompressive surgery.

Evaluation of 36 HNPE Cases

Thirty-six dogs were diagnosed with HNPE at the University of Veterinary Medicine in Hanover between 2006 and 2017. Magnetic resonance imaging (MRI) indicated extradural spinal cord compression caused by well-delineated T2-weighted hyperintense and T1-weighted isointense or hypointense material originating from the intervertebral disk space in a “seagull” shape.

Mobility at presentation was as follows:

  • 1 ambulatory and 2 nonambulatory paraparetic dogs
  • 4 ambulatory and 22 nonambulatory tetraparetic dogs
Advertisement
  • 7 tetraplegic dogs with intact nociception

Ten dogs had spinal hyperesthesia, and urinary retention was noted in 5 dogs. Lesions were localized to the cervical region in 33 dogs and to the thoracolumbar junction in 3 dogs, and maximal cross-sectional spinal cord compression ranged from 0% to 62%. Seventeen pure breeds and several mixed breeds were represented.

Half of the dogs underwent surgery, which consisted of a ventral slot for cervical HNPE or a hemilaminectomy for thoracolumbar HNPE. Surgery was most frequently chosen for those dogs with heterogeneous-appearing extruded disk material on MRI. Postoperative care or conservative management for nonsurgical cases consisted of cage rest, physiotherapy, and multimodal analgesic therapy including metamizole, either gabapentin or pregabalin, constant-rate infusion of fentanyl-lidocaine-ketamine, and bethanechol and phenoxybenzamine as needed for urinary retention.

Treatment and Outcome

Sixteen of 18 surgically managed dogs and 17 of 18 conservatively managed dogs achieved functional recovery, while 3 dogs died due to either cardiopulmonary arrest or ascending-descending myelomalacia. Functional recovery was achieved within a median of 6 to 7 days for both treatment groups, and only 1 dog took more than 15 days to recover. Those dogs that either died or required a longer recovery time had significantly larger lesions compared with dogs that recovered quickly, regardless of the treatment chosen.

Outcome was not significantly affected by any of the following factors:

  • Age, sex, or weight
  • Severity or duration of neurologic signs or spinal hyperesthesia
  • HNPE localization
  • Severity of spinal cord compression
  • Signal intensity of extruded disk material

Summary

This study, the first to compare surgical and conservative management of HNPE, revealed that both treatments had similar success rates. The authors hypothesized that the gelatinous or liquid consistency of extruded disk material in HNPE allows it to disperse within the vertebral canal, alleviating spinal compression even without surgical intervention. They did note that surgery was chosen most frequently when MRI indicated the presence of heterogeneous (relatively firm) disk material, implying that long-term spinal cord compression was likely without surgical removal.

Dr. Stilwell received her DVM from Auburn University, followed by a MS in fisheries and aquatic sciences and a PhD in veterinary medical sciences from the University of Florida. She provides freelance medical writing and aquatic veterinary consulting services through her business, Seastar Communications and Consulting.


Advertisement

Latest News

Partners for Health Pets and VHMA collaboration publish white paper

Vetstoria releases its Fill Rate platform

What's new with the "Dentistry Lane" across the veterinary profession?

Meet the BlackDVM Network

View More Latest News
Advertisement