Associations between cerebrospinal fluid biomarkers and long-term neurologic outcome in dogs with acute intervertebral disk herniation

Abstract

Objective—To examine associations between CSF biomarkers, initial neurologic dysfunction, and long-term ambulatory outcome in dogs with acute intervertebral disk herniation (IVDH). Design—Prospective clinical study. Animals—54 dogs with acute thoracolumbar IVDH and 16 clinically normal dogs. Procedures—For each dog, variables, including CSF myelin basic protein (MBP), lactate, calcium, glucose, and total protein concentrations; nucleated cell count; and creatine kinase (CK) and aspartate aminotransferase activities, were measured. For dogs with thoracolumbar IVDH, initial neurologic function was characterized by use of a modified Frankel score (MFS; determined on a scale of 0 to 5, where 0 represented paraplegia with no deep nociception and 5 represented paraspinal hyperesthesia only). Long-term follow-up was assessed. Results—Among dogs with thoracolumbar IVDH, those with CSF CK activity ≤ 38 U/L had a 35-fold increase in the odds of long-term ambulation, compared with the odds in dogs with CSF CK activity > 38 U/L, adjusting for neurologic functioning at the evaluation. The CSF lactate, calcium, and glucose concentrations and aspartate aminotransferase activity were not predictive of long-term ambulatory outcome. Data analysis revealed that long-term functional recovery was > 98% for affected dogs, regardless of their initial MFS, when CSF CK activity was ≤ 38 U/L and MBP concentration was ≤ 3 ng/mL. Conclusions and Clinical Relevance—In dogs with acute thoracolumbar IVDH, CSF CK activity and MBP concentration appeared to be prognostic indicators and, along with initial MFS, can be used to predict long-term ambulatory outcome.

Clinical presentation and outcome of dogs treated medically or surgically for thoracolumbar intervertebral disc protrusion

“…Although an accepted neurological grading system was used, the majority of dogs were ambulatory at presentation and were therefore assigned a similar neurological grade, which likely limited recognition of more subtle differences in severity of clinical signs. The majority of validated grading systems for dogs with spinal disease are designed for dogs with acute thoracolumbar spinal disorders, such as IVDE (Witsberger and others 2012, Van Wie and others 2013, Radcliff and others 2014), with few studies focusing on grading dogs with chronic spinal disease (Lee and others 2015). Inherent to the study design, dogs could not be randomised to treatment modality, which is a major limitation of this study.…”

Use of Autologous Mesenchymal Stem Cells Derived from Bone Marrow for the Treatment of Naturally Injured Spinal Cord in Dogs

“…The neurological gain of both aspects was classified as “no,” “partial,” and “total” considering conscious movements of the tail and bladder continence. Neurologic function was characterized by use of a modified Frankel score (MFS; determined on a scale of 0 to 5, where 0 represented paraplegia with no deep nociception and 5 represented paraspinal hyperesthesia only) [32]. Long-term follow-up evaluations were later assessed.…”

Acute Spinal Cord Injury

“…In large case series of IVDH dogs, between 60% and 80% recover ambulation following loss of detectable pain sensation, 57,136-138 compared with 86% to 96% of cases recovering function if detectable pain sensation is evident on presentation. 2,3,139 These figures show that a significant proportion of animals given a poor prognosis on examination will still go on to regain the ability to walk. In all situations, when recovery occurs the improvement begins within the first 3 weeks (usually 10 days) after injury in 92% of cases.…”

“…Reported cerebrospinal fluid biomarkers include aspartate aminotransferase, calcium, glucose, nucleated cell count, protein, creatine kinase, lactate, myelin basic protein, matrix metalloproteinase 9, and tau protein. 139,[142][143][144][145][146][147][148][149] Witsberger and colleagues 139 published a screening method for clinical cases of acute SCI. In this study, combined elevation of myelin basic protein and creatine kinase in dogs with no detectable pain sensation following IVDH led to the probability of a successful outcome of 10%.…”