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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. [ABSTRACT FROM AUTHOR]

Background: Antemortem diagnosis of degenerative myelopathy (DM) in dogs is presumptive and there are no accepted guidelines for the management of this condition. Hypothesis/Objectives: Describe current practices of neurology clinicians and physical rehabilitation professionals in the diagnosis and management of DM. Animals: None. Methods: Online surveys examining diagnosis and management of DM were constructed and distributed via neurology and rehabilitation listservs. Results: One hundred ninety neurology and 79 rehabilitation professionals from 20 countries participated. Most neurology (142/189) and rehabilitation (23/39) respondents required genetic testing for the superoxide dismutase 1 (SOD1) mutation and 82/189 neurologists also required spinal magnetic resonance imaging (MRI) for presumptive DM diagnosis. Most neurology respondents recommended exercise (187/190) and physical rehabilitation (184/190). Over 50% (102/190) of neurology respondents perform rechecks on dogs diagnosed with DM. Rehabilitation respondents reported preservation or improvement of strength (78/79) and coordination (77/79) as therapeutic goals. At‐home exercises (75/79), underwater treadmill (64/79), gait training (55/79), and strength building exercises (65/79) were used to maintain strength (58/79), coordination (56/79), muscle mass (56/79), and improve overall wellbeing (54/79). Neurology respondents reported that owners elect euthanasia when dogs become nonambulatory paraparetic whereas rehabilitation respondents report euthanasia when paraplegia and incontinence develop. Conclusion and Clinical Importance: The majority of dogs diagnosed with DM have not undergone advanced imaging, the combination of history, neurological findings, and genetic testing is heavily relied upon. Whereas the diagnosis of DM is frequently made by veterinary neurologists, continued care is often performed by rehabilitation professionals or primary veterinarians. [ABSTRACT FROM AUTHOR]

Background: Reduced pelvic limb reflexes in dogs with spinal cord injury typically suggests a lesion of the L4‐S3 spinal cord segments. However, pelvic limb reflexes might also be reduced in dogs with a T3‐L3 myelopathy and concurrent spinal shock. Hypothesis/Objectives: We hypothesized that statistical models could be used to identify clinical variables associated with spinal shock in dogs with spinal cord injuries. Animals: Cohort of 59 dogs with T3‐L3 myelopathies and spinal shock and 13 dogs with L4‐S3 myelopathies. Methods: Data used for this study were prospectively entered by partner institutions into the International Canine Spinal Cord Injury observational registry between October 2016 and July 2019. Univariable logistic regression analyses were performed to assess the association between independent variables and the presence of spinal shock. Independent variables were selected for inclusion in a multivariable logistic regression model if they had a significant effect (P ≤.1) on the odds of spinal shock in univariable logistic regression. Results: The final multivariable model included the natural log of weight (kg), the natural log of duration of clinical signs (hours), severity (paresis vs paraplegia), and pelvic limb tone (normal vs decreased/absent). The odds of spinal shock decreased with increasing weight (odds ratio [OR] = 0.28, P =.09; confidence interval [CI] 0.07‐1.2), increasing duration (OR = 0.44, P =.02; CI 0.21‐0.9), decreased pelvic limb tone (OR = 0.04, P =.003; CI 0.01‐0.36), and increased in the presence of paraplegia (OR = 7.87, P =.04; CI 1.1‐56.62). Conclusions and Clinical Importance: A formula, as developed by the present study and after external validation, could be useful for assisting clinicians in determining the likelihood of spinal shock in various clinical scenarios and aid in diagnostic planning. [ABSTRACT FROM AUTHOR]

Background: Osseous‐associated cervical spondylomyelopathy (OA‐CSM) is a complex disorder with limited long‐term survival. The longitudinal progression is currently unknown. Objective: To describe changes on magnetic resonance imaging (MRI) over a 2‐year minimum period. We hypothesized that spinal lesions would progress in the majority of dogs. Animals Eleven dogs previously diagnosed with OA‐CSM were prospectively studied. Nine dogs were treated medically, whereas 2 were treated surgically. Methods: Clinical and MRI follow‐up were performed with a median time between MRI studies of 30 months (range, 24‐54). Morphologic assessment evaluated vertebral canal stenosis, spinal cord compression, foraminal stenosis, and articular processes, among other variables. Morphometric assessment included vertebral canal area, spinal cord area, area of the articular processes, and foraminal height. Results: On follow‐up MRI, the most affected site at the initial examination in medically treated dogs had progressed in 4 of 9 dogs, improved in 4, and was unchanged in 3. Clinically, all dogs except 2 medically treated dogs were unchanged to improve at follow‐up. Initially, 50 of 60 (83.3%) intervertebral spaces had vertebral canal stenosis, whereas in the follow‐up MRI 82.3% did. Of the sites with stenosis, 45.7% were unchanged, 18.6% improved, and 38.9% worsened. Morphometry identified significant decreases in vertebral canal and spinal cord areas at C4‐C5 through C6‐C7, and significant progression of articular process irregularities at C3‐C4 and C6‐C7. Conclusions and Clinical Importance: This long‐term follow‐up study of dogs with OA‐CSM did not identify clinical or MRI progression of lesions in the majority of dogs. [ABSTRACT FROM AUTHOR]

Background: Retrospective research recently identified a possible relationship between duration of surgery and outcome in severely affected dogs treated surgically for acute thoracolumbar intervertebral disk herniation (TL‐IVDH). Hypothesis: That increased duration of surgery is associated with poorer outcome in dogs with absent pain perception treated surgically for TL‐IVDH. Animals Two hundred ninety‐seven paraplegic dogs with absent pain perception surgically treated for acute TL‐IVDH. Methods: Retrospective cohort study. Medical records of 5 institutions were reviewed. Inclusion criteria were paraplegia with absence of pain perception, surgical treatment of TL‐IVDH, and 1‐year postoperative outcome (ambulatory: yes or no). Canine data, outcome, and surgery and total anesthesia duration were retrieved. Results: In this study, 183/297 (61.6%) dogs were ambulatory within 1 year, 114 (38.4%) dogs failed to recover, including 74 dogs (24.9%) euthanized because of progressive myelomalacia. Median anesthesia duration in dogs that regained ambulation within 1 year of surgery (4.0 hours, interquartile range [IQR] 3.2‐5.1) was significantly shorter than those that did not (4.5 hours, IQR 3.7‐5.6, P =.01). Multivariable logistic regression demonstrated a significant negative association between both duration of surgery and total anesthesia time and ambulation at 1 year when controlling for body weight and number of disk spaces operated on. Conclusions and Clinical Importance: Findings support a negative association between increased duration of anesthesia and outcome in this group of dogs. However, the retrospective nature of the data does not imply a causal relationship. [ABSTRACT FROM AUTHOR]

Background: "Readability" of consent forms is vital to the informed consent process. The average human hospital consent form is written at a 10th grade reading level, whereas the average American adult reads at an 8th grade level. Limited information currently exists regarding the readability of veterinary general medical or clinical research consent forms. Hypothesis/Objectives: The goal of this study was to assess the readability of veterinary clinical trial consent forms from a group of veterinary referral centers recently involved in a working group focused on veterinary clinical trial review and consent. We hypothesized that consent forms would not be optimized for client comprehension and would be written above the National Institutes of Health‐recommended 6th grade reading level. Animals: None. Methods: This was a prospective study assessing a convenience sample of veterinary clinical trial consent forms. Readability was assessed using 3 methods: the Flesch‐Kincaid (F‐K) Grade Level, Flesch Reading Ease Score (FRES), and the Readability Test Tool (RTT). Results were reported as mean (±SD) and compared across specialties. Results: Fifty‐three consent forms were evaluated. Mean FRES was 37.5 ± 6.0 (target 60 or higher). Mean F‐K Grade Level was 13.0 ± 1.2 and mean RTT grade level was 12.75 ± 1.1 (target 6.0 or lower). There was substantial agreement between F‐K and RTT grade level scores (intraclass correlation coefficient 0.8). Conclusions and Clinical Importance: No form evaluated met current health literacy recommendations for readability. A simple and readily available F‐K Microsoft‐based approach for evaluating grade level was in substantial agreement with other methods, suggesting that this approach might be sufficient for use by clinicians and administrators drafting forms for future studies. [ABSTRACT FROM AUTHOR]

Thank you for the opportunity to address the points made by Dr Cummings on our recent paper reporting the development of a clinical predictive model for spinal shock. Dr Cummings suggests that provision of a simple tool such as a spinal shock calculator would allow others to quickly perform model calculations for their own patients. [Extracted from the article]