TY - JOUR

T1 - Proportion recovery and times to ambulation for non-ambulatory dogs with thoracolumbar disc extrusions treated with hemilaminectomy or conservative treatment

T2 - A systematic review and meta-analysis of case-series studies

AU - Langerhuus, L.

AU - Miles, J.

PY - 2017

Y1 - 2017

N2 - Thoracolumbar intervertebral disc extrusion is a common cause of spinal cord dysfunction in dogs. Peer-reviewed studies reporting treatment of predominantly chondrodystrophic dogs with disc extrusion with loss of ambulation with either hemilaminectomy or conservative treatment (rest, analgesics and anti-inflammatories) were evaluated in a systematic review of the literature. Generally, the level of evidence available was low with no controlled studies and only case series available. In the meta-analysis, there was a clear trend to a greater proportion of dogs recovering and returning faster to ambulation for dogs treated with hemilaminectomy than for conservatively treated dogs. The mean proportions that recovered for neurological grades 3, 4 and 5 were 93, 93 and 61% for those treated with hemilaminectomy, and 79, 62 and 10% for those treated conservatively (Grade 3 – non-ambulatory paraparetic dogs; grade 4 – paraplegic dogs with intact deep pain perception; grade 5 – paraplegic dogs without intact deep pain perception). Due to the use of case series, these results represent between-study comparisons, thereby increasing the risk of selection bias and other biases. Data presented in this review support the current recommendations for surgical management of non-ambulatory dogs with disc-extrusion, but controlled clinical studies comparing outcomes are necessary to confirm these findings.

AB - Thoracolumbar intervertebral disc extrusion is a common cause of spinal cord dysfunction in dogs. Peer-reviewed studies reporting treatment of predominantly chondrodystrophic dogs with disc extrusion with loss of ambulation with either hemilaminectomy or conservative treatment (rest, analgesics and anti-inflammatories) were evaluated in a systematic review of the literature. Generally, the level of evidence available was low with no controlled studies and only case series available. In the meta-analysis, there was a clear trend to a greater proportion of dogs recovering and returning faster to ambulation for dogs treated with hemilaminectomy than for conservatively treated dogs. The mean proportions that recovered for neurological grades 3, 4 and 5 were 93, 93 and 61% for those treated with hemilaminectomy, and 79, 62 and 10% for those treated conservatively (Grade 3 – non-ambulatory paraparetic dogs; grade 4 – paraplegic dogs with intact deep pain perception; grade 5 – paraplegic dogs without intact deep pain perception). Due to the use of case series, these results represent between-study comparisons, thereby increasing the risk of selection bias and other biases. Data presented in this review support the current recommendations for surgical management of non-ambulatory dogs with disc-extrusion, but controlled clinical studies comparing outcomes are necessary to confirm these findings.

KW - Intervertebral disc disease

KW - Neurological

KW - Spinal

U2 - 10.1016/j.tvjl.2016.12.008

DO - 10.1016/j.tvjl.2016.12.008

M3 - Journal article

C2 - 28190499

AN - SCOPUS:85012065275

VL - 220

SP - 7

EP - 16

JO - The Veterinary Journal

JF - The Veterinary Journal

SN - 1090-0233

ER -