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Compendium June 2008 (Vol 30, No 6)

Abstract Thoughts — Electroacupuncture for Thoracolumbar Disk Disease

    Electroacupuncture Treatment for Thoracolumbar Interverterbral Disk Disease in Dogs

    Hayashi AM, Matera JM, Pinto AC. Evaluation of electroacupuncture treatment for thoracolumbar intervertebral disk disease in dogs. JAVMA 2007;231:913-918.

    Abstract: In this prospective controlled clinical study from a university teaching hospital in Brazil, 50 dogs with thoracolumbar disk disease were treated with either electroacupuncture stimulation and traditional Western medical treatment (prednisolone, ranitidine, tramadol; group 1) or standard Western medical treatment alone (group 2). The dogs were classified into five neurologic grades ranging from pain only (grade 1) to complete paralysis with or without urinary dysfunction (grade 5). A functional numeric scale was used to evaluate all dogs on days 0, 7, 14, and 21; some dogs were evaluated further. Percutaneous electroacupuncture was performed once or twice a week for at least three applications and for up to 4 weeks for dogs with no deep pain perception.

    Dachshunds were most commonly affected (37 animals). The duration of clinical signs was significantly greater for dogs with milder neurologic signs. For dogs with all grades of dysfunction, overall success rate for recovery was higher (88.5%) in group 1 dogs than in group 2 (58.3%). Time to recovery of ambulation in dogs with grade 3 or 4 neurologic dysfunction was significantly shorter in group 1 (10 ± 6.5 days) than in group 2 (20.8 ± 12 days). Dogs without deep pain perception did not have a significant difference in recovery. The authors concluded that electroacupuncture combined with Western medical treatment was more efficacious than Western medical treatment alone for dogs with various signs of thoracolumbar disk disease.

    Commentary: Intervertebral disk disease (IVDD) is the most common neurologic condition seen in small animal practice. The clinical signs are variable and often recurrent; treatment options have traditionally involved medical (corticosteroids, muscle relaxants, analgesics) and/or surgical (hemilaminectomy, ventral cervical slot) protocols. Although, as noted by the authors, the exact mechanism for acupuncture-associated recovery in IVDD patients is not known, speculation centers on enhancement of electrical activity for axonal healing and regrowth, as well as release of health-associated neuropeptides. The results of this study will certainly provoke debate between advocates of traditional Western therapies, including decompressive surgery for chronically painful or nonambulatory IVDD patients, and clinicians seeking alternative therapies. It would be crucial to know if other studies could confirm or deny the results of this article. The broad nature of the condition and the use of numerous treatment options may always limit definitive or absolute recommendations until large, multicenter, controlled prospective veterinary studies can be conducted.

    Recurrence Rate of Thoracolumbar Disk Disease in Dogs with Spinal Hyperpathia Treated with NSAIDs

    Mann FA, Wagner-Mann CC, Dunphy ED, et al. Recurrence rate of presumed thoracolumbar intervertebral disc disease in ambulatory dogs with spinal hyperpathia treated with anti-inflammatory drugs: 78 cases (1997"2000). J Vet Emerg Crit Care 2007;17:53-60.

    Medical records were reviewed to identify 78 dogs with a first episode of presumptive Hansen type 1 thoracolumbar intervertebral disk disease that were given antiinflammatory treatment. Recurrence rates were compared for treatment with corticosteroids versus NSAIDs. Ambulatory dogs with spinal hyperpathia and no neurologic deficits, spinal hyperpathia and conscious proprioceptive deficits, or ataxia were assigned severity scores of 1, 2, and 3, respectively. Comparison groups included chondrodystrophoid versus nonchondrodystrophoid breeds; corticosteroid versus NSAID treatment; severity score 1 versus 2 versus 3; and treatment within or after 8 hours of the onset of clinical signs. The corticosteroid treatment group was further divided into dogs that received high-dose methylprednisolone sodium succinate (MPSS) and those that received other corticosteroids. Owners supplied recurrence information.

    All the dogs recovered; half had recurrence. No significant relationships were found for recurrence rate and sex, severity score, age, time of MPSS treatment, or MPSS versus NSAIDs. Dogs given MPSS had fewer recurrences than those given other corticosteroids.

    A 50% recurrence rate may be expected in dogs with the characteristics described in this study that are treated with NSAIDs or corticosteroids. This rate supports a recommendation for prophylactic nucleus pulposus ablation. Dogs given NSAIDs or MPSS were less likely to experience recurrence; NSAIDs may be an appropriate alternative to MPSS and other corticosteroids.

    Intraluminal Tracheal Stenting to Treat Tracheal Narrowing in Cats

    Culp WTN, Weisse C, Cole SG, Solomon JA. Intraluminal tracheal stenting for treatment of tracheal narrowing in three cats. Vet Surg 2007;36:107-113.

    This retrospective study evaluated a nitinol mesh self-expanding metallic stent (SEMS) to treat tracheal obstruction caused by benign disease (strictures) in two cats and neoplasia in one cat. Medical records of cats with tracheal obstruction were reviewed for data on physical examination, diagnostic tests, treatment, outcome, and follow-up. Two males and one female met the inclusion criteria. One tracheal stricture resulted from a previous tracheotomy for Cuterebra larva removal, and the other resulted from traumatic endotracheal intubation; the neoplastic mass was a tracheal carcinoma. Each SEMS was placed according to standard procedures. SEMS sizes varied from 8 to 10 mm in diameter and from 50 to 80 mm in length. Clinical improvement was immediate in all cats. No procedure-related or post-SEMS placement complications occurred during follow-up periods of 32 weeks and 44 months (in the cats with strictures) and 6 weeks (the cat with carcinoma was later euthanized).

    Initial results with intraluminal tracheal stent placement seem encouraging, but additional experience is needed to determine the most effective use of stents in cats. Placement of a SEMS should be considered for similar cases in different species (e.g., dogs) when other surgical methods are unavailable or not recommended.

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