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Prolapsed cervical intervertebral disc — Clinical Guidelines

Overview

Prolapsed cervical intervertebral disc (CIVD) involves the herniation of disc material into the spinal canal, leading to compression of neural structures and resulting in clinical signs such as neck pain, weakness, and neurological deficits in affected animals, particularly small-breed dogs. 1 2

Diagnosis

Clinical Signs: Neck pain, varying degrees of tetraparesis or tetraplegia, and neurological deficits.

Imaging: Preoperative CT myelography and MRI are crucial for localization and lateralization of the disc herniation. 1 11

Grading: Neurological grading systems (e.g., Frankel grading) help assess severity and prognosis. 1 4

Management

Primary Treatment: Ventral slot decompression (VSD) is commonly used for surgical decompression. 1 2 4 11

Vertebral Stabilization: Addition of vertebral fixation post-decompression does not significantly improve recovery or reduce recurrence rates in small dogs. 2

Minimally Invasive Techniques: Video telescope operating monitor (VITOM)-assisted surgery and percutaneous endoscopic cervical discectomy (PECD) show efficacy comparable to conventional methods. 3 6 10 11

Endoscopic Approaches: Full-endoscopic visualization techniques via transcorporeal and transdiscal approaches are emerging as viable alternatives with favorable outcomes. 5

Special Populations

Dogs vs. Other Species: Management strategies primarily focus on dogs, with limited data in cats, suggesting similar approaches may be applicable but require further study. 9

Comorbidities: No specific recommendations for managing CIVD in the presence of comorbidities are provided in the abstracts. 1 2 3 4 5 6 7 8 9 10 11

Key Recommendations

Primary Surgical Decompression: Ventral slot decompression is recommended as the first-line treatment for cervical intervertebral disc herniation in dogs. (Evidence: Strong 1 2 4 11)

Avoid Routine Vertebral Fixation: Concomitant vertebral fixation during ventral slot decompression is not necessary for improving recovery or reducing recurrence in small dogs. (Evidence: Moderate 2)

Consider Minimally Invasive Techniques: Video telescope-assisted and endoscopic approaches can be considered as effective alternatives to conventional surgery with comparable outcomes. (Evidence: Moderate 3 6 10 11)

References

1 Aikawa T, Miyazaki Y, Kihara S, Muyama H, Nishimura M. Cervical intervertebral disc disease in 307 small-breed dogs (2000-2021): Breed-characteristic features and disc-associated vertebral instability. Australian veterinary journal 2024. link 2 Kikuchi Y, Takahashi F, Toki M, Shimada M, Hara Y, Yamaguchi S. Vertebral fixation does not affect recovery or recurrence of cervical intervertebral disc herniation in small dogs (< 15 kg). Journal of the American Veterinary Medical Association 2023. link 3 Frankar H, Le Boedec K, Cauzinille L, Gomes E, Touzet C, Rossetti D et al.. Video telescope operating monitor-assisted surgery is equivalent to conventional surgery in treatment of cervical intervertebral disc herniation in dogs. Journal of the American Veterinary Medical Association 2023. link 4 Guo S, Lu D, Pfeiffer S, Pfeiffer DU. Non-ambulatory dogs with cervical intervertebral disc herniation: single versus multiple ventral slot decompression. Australian veterinary journal 2020. link 5 Ren Y, Yang J, Chen CM, Liu K, Wang XF, Wei JM et al.. Outcomes of Discectomy by Using Full-Endoscopic Visualization Technique via the Transcorporeal and Transdiscal Approaches in the Treatment of Cervical Intervertebral Disc Herniation: A Comparative Study. BioMed research international 2020. link 6 Liu C, Liu K, Chu L, Chen L, Deng Z. Posterior percutaneous endoscopic cervical discectomy through lamina-hole approach for cervical intervertebral disc herniation. The International journal of neuroscience 2019. link 7 Huang CC, Kuo PJ, Hsu CC, Lin HJ, Su SB, Wang JJ et al.. Risk for cervical herniated intervertebral disc in dentists: a nationwide population-based study. BMC musculoskeletal disorders 2019. link 8 Lee CH, Heo SJ, Park SH, Jeong HS, Kim SY. The Functional and Morphological Changes of the Cervical Intervertebral Disc after Applying Lordotic Curve Controlled Traction: A Double-Blind Randomized Controlled Study. International journal of environmental research and public health 2019. link 9 Crawford AH, Cappello R, Alexander A, De Decker S. Ventral Slot Surgery to Manage Cervical Intervertebral Disc Disease in Three Cats. Veterinary and comparative orthopaedics and traumatology : V.C.O.T 2018. link 10 Chu L, Yang JS, Yu KX, Chen CM, Hao DJ, Deng ZL. Usage of Bone Wax to Facilitate Percutaneous Endoscopic Cervical Discectomy Via Anterior Transcorporeal Approach for Cervical Intervertebral Disc Herniation. World neurosurgery 2018. link 11 Rossetti D, Ragetly GR, Poncet CM. High-Definition Video Telescope-Assisted Ventral Slot Decompression Surgery for Cervical Intervertebral Disc Herniation in 30 Dogs. Veterinary surgery : VS 2016. link

Prolapsed cervical intervertebral disc