DISKOSPONDYLITIS IN A 3-YEAR-OLD, MALE CASTRATED

DOBERMAN PINSCHER

February 12, 2014

Nicholas ShermanClinical Advisor: Dr. EsteyBasic Science Advisor: Dr.

Scrivani

Our patient

Signalment 3 yo MC Doberman Pinscher

Presenting complaint 3 month hx of:

Weight loss/ muscle atrophy Inappetance Painful when moving

History Diskospondylitis diagnosed July 2013 Born in Utah then owned by two different families

in NY Gastric foreign body removed in 2011

Image. 1

Initial presentation

PE abnormalities Quiet, alert and responsive Moderately dehydrated Diffuse muscle atrophy

~14 kg lost in 3 months Fleas present

Image. 2

Neurologic exam

Mental status: Depressed

Attitude/Posture: Normal Conformation/Muscularity:

Diffuse muscle atrophy Gait: Normal Cranial nerves: Normal Proprioception: Normal Spinal Reflexes: Normal withdrawals and patellar reflexes Nociception:

Pain noted bilaterally on flexion of the hock and stifle Pain on palpation of his lumbar and cervical vertebrae

Neurolocalization: Cervical (C1-C5) and Lumbosacral

Image. 3

Spinal pain with decreased range of motion

Degenerative IVDD Cervical

spondylomyelopathy (Wobbler’s) 

Anomalous Metabolic Neoplastic

Spinal cord neoplasia Vertebral body tumor

Infectious/inflammatory Diskospondylitis,

vertebral osteomyelitis, physitis

Infectious or non-infectious myelitis

Polyarthritis or polymyositis

Traumatic Traumatic disk herniation

Vascular Extramedullary spinal

hemorrhage

Radiographic rule in/out

Degenerative IVDD Cervical spondylomyelopathy (Wobbler’s) 

Neoplastic Spinal cord neoplasia Vertebral body tumor

Infectious/inflammatory Diskospondylitis, vertebral osteomyelitis, physitis Infectious or non-infectious myelitis Polyarthritis or polymyositis

Traumatic Traumatic disk herniation

Vascular Extramedullary spinal hemorrhage

Initial diagnostic results

Diagnostics CBC – unremarkable Chemistry – unremarkable Urinalysis – cocci present Urine culture and sensitivity Blood culture and sensitivity Canine Brucella Slide AGGL/ AGID II

Zoonotic potential Fungal Serology Panel

Image. 4

Imaging

Abdominal Ultrasound L2-L3 vertebral bodies have irregular bone

contour Non-diagnostic for the cause of

inappetance Lateral spinal radiographs

Progressive diskospondylitis Worst at L2-L3

Severe degenerative changesand spondylosis deformans – thoracolumbar vertebrae Image. 5

Vertebral endplate circulation

1. IVD

2. Dorsal longitudinal ligament

3. Spinal nerve root

4.Vertebral body

5. Segmental artery

6. Interosseous artery

10. Aorta

Image. 7

Normal vertebrae

Image. 8

L1L2

L3

Comparing vertebral lesions

A. Diskospondylitis

B. Lumbar osteomyelitis

C. Spondylosis deformans

D. Vertebral neoplasia

Image. 9

July spinal radiographs

August spinal radiographs

December spinal radiographs

January spinal radiographs

Radiographic healing Absence of the lytic

focus Loss of sclerotic

margins Smoothing of

margins around the lytic focus

Replacement by bridging of the involved vertebrae

Most frequent disk spaces involved

Image. 10

Most common organisms

Bacteria Staphylococcus spp (26 samples) Brucella spp (13) Streptococcus spp (12) Escherichia coli (11)

Fungal Aspergillus Fusarium Paecilomyces

Image. 11

Common clinical picture

Larger breed dogs Great Dane, Boxer etc

Older males seem to be predisposed ~50% of the time a microbial agent is detected

UTI positive culture 25-50% Blood positive culture 45-75%

Neurologic findings Primarily non-specific signs Progressive over several weeks (can be acute)

Spinal pain General proprioceptive deficits Hind limb paresis Tetraparesis

Image. 12

Complete diagnostic story

Urinalysis – cocci present Urine culture and sensitivity

Staphylococcus pseudintermedius Blood culture and sensitivity

Staphylococcus pseudintermedius Canine Brucella Slide AGGL/ AGID II

Negative Fungal Serology Panel

Blastomycoces, Coccidioides, Histoplasma, Aspergillus, Cryptococcus

Negative

Treatment

In hospital IV fluids

P-Lyte IV antibiotics

Enrofloxacin and Cefazolin Pain management

Gabapentin and Meloxicam Fleas treatment

Nitenpyram

BAR, euhydrated with a much improved mentation and appetite at discharge

Image. 13

Treatment

At home Drug therapy – staggered withdrawal

Staphylococcus pseudintermedius susceptible to:

Enrofloxacin – 4 mos course Cephalexin – 6 mos

Pain Gabapentin Meloxicam (d/c 3 days post discharge)

Prognosis

Resolution of c/s expected in 5-10 days Radiographic healing can be prolonged

Shorter in younger dogs (<1y/o) Up to 9-14 mos in older dogs (average

13mos) Prognosis is fair-good with bacterial

diskospondylitis

Take home message

General practitioner diagnosis and treatment 50% of cases a causative agent is not found

Effective communication is paramount Treatment is long term

Visit Costs

Initial Exam

Hospitalization + Exam $ 638

Diagnostics $ 460

Imaging (Radiographs + Abdominal Ultrasound)

$ 634

Medication $ 84

Total $ 1,817

Three month recheck

Exam + Radiographs $ 389

Total Cost $ 2,206

References

Burkert, B. Signalment and clinical features of diskospondylitis in dogs: 513 cases (198-2001). JAVMA. 2005 Jul. 227(2), pp 268-275.

Dewey, C. A Practical Guide to Canine & Feline Neurology. 2nd ed. pp 399-401. Wiley-Blackwell publishing; 2008. Ames, Iowa.

Greene, C. Infectious Disease of the Dog and Cat. 4th ed. pp340-348 and 899-902. Elsevier Saunders publishing; 2012. St. Louis, Missouri.

Lorenz, M. Handbook of Veterinary Neurology. 5th ed. Pp124-126. Elsevier Saunders publishing; 2011. St. Louis, Missouri.

Plumb, D. Plumb’s Veterinary Drug Handbook. 6Th ed. Pp188-190 and 375-379. Blackwell publishing; 2011. Ames, Iowa.

Shankar, H. Anatomy and pathophysiology of intervertebral disc disease. Techniques in Regional Anesthesia and Pain Management. 2009. 13(1), pp 67-75.

Slatter, D. Textbook of Small Animal Surgery. 3rd ed. Pp1214-1215. Elsevier Saunders publishin; 2003. Philadelphia, Pennsylvania.

Thrall,D. Textbook of Veterinary Diagnostic Radiology. 6th ed. Pp 185-187. Elsevier Saunders publishing; 2013. St. Louis, Missouri.

Thank you

Advisors Dr. Estey Dr. Scrivani

Dr. Cardwell My patient and

his owners Family Friends Cornell

community Image. 14

Image References Image 1, 4, 5, 12, 13 and 14

http://www.animalplanet.com/breed-selector/dog-breeds/working/doberman-pinscher.html (1/31/14)

Image 2 http://www.bizjournals.com/sacramento/news/2012/09/26/cna-nurses-sutter-mills-peninsula-he

alth.html. (2/5/14)

Image 3 Dewey, C. A Practical Guide to Canine & Feline Neurology. 2nd ed. Pp59&73. Wiley-Blackwell

publishing; 2008. Ames, Iowa. Image 6

http://www.eorthopod.com/content/cervical-spinal-stenosis. MMG 2000. (2/6/14) Image 7

Shankar, H. Anatomy and pathophysiology of intervertebral disc disease. Techniques in Regional Anesthesia and Pain Management. 2009. 13(1), pp70.

Image 8 http://www.slideshare.net/blankita2010/canine-radiographs. Slide 427. Royal Veterinary

College 2009. (2/3/14). Image 9

Greene, C. Infectious Disease of the Dog and Cat. 4th ed. Pp 901. Elsevier Saunders publishing; 2012. St. Louis, Missouri.

Image 10 Lorenz, M. Handbook of Veterinary Neurology. 5th ed. Pp125. Elsevier Saunders publishing;

2011. St. Louis, Missouri. Image 11

http://www.vetbact.org/vetbact//popup/image.php?imgtable=vetbact_images&imgid=287. (2/4/14). Karl-Erik Johansson (BVF, SLU & SVA) & Lise-Lotte Fernström (BVF, SLU)