Abstract:Objective -To compare the incidence of seizures in dogs with intervertebral disk disease after iopamidol or iomeprol myelography, and to assess whether the incidence of seizures differed between the 2 agents when severity of neurological deficits, location of cord compression, duration of anesthesia, site of myelogram, volume of contrast, and concentration of contrast were evaluated. Design -Retrospective study. Setting -Veterinary teaching hospital. Animals -One hundred and sixty-one client-owned dogs with in… Show more
“…Diagnostic sensitivity of myelography or CT‐myelography is 53% to 97%, and myelography is less accurate than other modalities for determining correct lateralization of extrusion for surgical planning 6,7,29,40,42,46‐52 . Myelography also carries a risk of seizures, especially in large dogs or those receiving larger intrathecal contrast volumes 53‐55 . Extensive 56,57 spinal cord swelling and infiltration of contrast medium within the spinal cord 58 are poor prognostic factors on myelographic studies.Magnetic resonance imaging, CT, CT‐myelography or myelography are reasonable modalities for diagnosing TL‐IVDE.…”
Background
Thoracolumbar intervertebral disc extrusion (TL‐IVDE) is the most common cause of acute paraparesis and paraplegia in dogs; however, guidelines on management of the condition are lacking.
Objectives
To summarize the current literature as it relates to diagnosis and management of acute TL‐IVDE in dogs, and to formulate clinically relevant evidence‐based recommendations.
Animals
None.
Methods
A panel of 8 experts was convened to assess and summarize evidence from the peer‐reviewed literature in order to develop consensus clinical recommendations. Level of evidence available to support each recommendation was assessed and reported.
Results
The majority of available literature described observational studies. Most recommendations made by the panel were supported by a low or moderate level of evidence, and several areas of high need for further study were identified. These include better understanding of the ideal timing for surgical decompression, expected surgical vs medical outcomes for more mildly affected dogs, impact of durotomy on locomotor outcome and development of progressive myelomalacia, and refining of postoperative care, and genetic and preventative care studies.
Conclusions and Clinical Importance
Future efforts should build on current recommendations by conducting prospective studies and randomized controlled trials, where possible, to address identified gaps in knowledge and to develop cost effectiveness and number needed to treat studies supporting various aspects of diagnosis and treatment of TL‐IVDE.
“…Diagnostic sensitivity of myelography or CT‐myelography is 53% to 97%, and myelography is less accurate than other modalities for determining correct lateralization of extrusion for surgical planning 6,7,29,40,42,46‐52 . Myelography also carries a risk of seizures, especially in large dogs or those receiving larger intrathecal contrast volumes 53‐55 . Extensive 56,57 spinal cord swelling and infiltration of contrast medium within the spinal cord 58 are poor prognostic factors on myelographic studies.Magnetic resonance imaging, CT, CT‐myelography or myelography are reasonable modalities for diagnosing TL‐IVDE.…”
Background
Thoracolumbar intervertebral disc extrusion (TL‐IVDE) is the most common cause of acute paraparesis and paraplegia in dogs; however, guidelines on management of the condition are lacking.
Objectives
To summarize the current literature as it relates to diagnosis and management of acute TL‐IVDE in dogs, and to formulate clinically relevant evidence‐based recommendations.
Animals
None.
Methods
A panel of 8 experts was convened to assess and summarize evidence from the peer‐reviewed literature in order to develop consensus clinical recommendations. Level of evidence available to support each recommendation was assessed and reported.
Results
The majority of available literature described observational studies. Most recommendations made by the panel were supported by a low or moderate level of evidence, and several areas of high need for further study were identified. These include better understanding of the ideal timing for surgical decompression, expected surgical vs medical outcomes for more mildly affected dogs, impact of durotomy on locomotor outcome and development of progressive myelomalacia, and refining of postoperative care, and genetic and preventative care studies.
Conclusions and Clinical Importance
Future efforts should build on current recommendations by conducting prospective studies and randomized controlled trials, where possible, to address identified gaps in knowledge and to develop cost effectiveness and number needed to treat studies supporting various aspects of diagnosis and treatment of TL‐IVDE.
“…11,12 Because of the high risk of postmyelographic seizures with the use of metrizamide, second-generation nonionic contrast agents such as iopamidol and iohexol were introduced, followed more recently by newer contrast agents such as iotrolan and iomeprol. 5,[13][14][15] Among all contrast media for myelography in dogs, iohexol appears to be the most commonly used. As for its predecessor, metrizamide, the use of iohexol for myelography is associated with seizures.…”
Large-breed dogs with cervical lesions and large volumes of iohexol injected into the cerebellomedullary cistern had the highest risk of seizures. The use of contrast medium volumes > 8 mL in large dogs should be avoided, with preference given to injections into the lumbar cistern.
“…Various adverse reactions to IVIC administration in human beings have been reported [ 35 , 36 , 37 ]. On the contrary, there is a paucity of literature on alterations of serum biochemical and urinary parameters in dogs and adverse effects of contrast agents, in particular CI-AKI [ 20 , 28 , 30 , 38 , 39 , 40 , 41 ]. Partial decreases in glomerular filtration rate and AKI were described in some dogs following the injection of first-generation contrast agents, or higher doses of second-generation contrast agents [ 30 , 42 , 43 ].…”
Intravenous iodinated contrast (IVIC) medium is routinely administered to dogs. Scattered information exists regarding the serum biochemical or urinary profiles associated with the administration of IVIC in dogs. The aim of the study was to describe, compare, and discuss from the perspective of previous studies the alterations in serum biochemical and urinary parameters before (T0) and within one week (T1) of the IVIC administration during routine computed tomography (CT) scan evaluation of 22 dogs. Mature dogs presenting for CT scan evaluation for preoperative oncology staging/surgical planning were included. T1 evaluation was performed within one week of IVIC administration. Statistically significant differences in serum total protein, albumin, chloride, calcium, and phosphorus concentrations, urine protein to creatinine ratio, and urine specific gravity were found between T1 and T0. At T1, the serum creatinine concentration was within reference ranges in all dogs but one. An increase in the urine protein to creatinine ratio was observed in four samples, one of which was non-proteinuric at T0. Changes in biochemistry and urine parameters between T0 and T1 were not considered clinically significant.
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