Recent study shows that most cases of acute canine thoracolumbar myelopathy can be managed with clinical reasoning alone, without the need for imaging.
Acute thoracolumbar myelopathy is a common neurological presentation in dogs. It encompasses various spinal conditions, such as intervertebral disc extrusion (IVDE), ischaemic myelopathy (IM), and acute non-compressive nucleus pulposus extrusion (ANNPE). While certain spinal conditions may present with characteristic clinical signs, the management of such cases with clinical reasoning alone, without the aid of cross-sectional imaging, has not been extensively explored.
A recent study aimed to define the outcomes of dogs with suspected IVDE, IM, or ANNPE that were managed solely with clinical reasoning, without initially undergoing imaging. The study utilized the database of the Queens Veterinary School Hospital (Cambridge) to collect data on paraparetic or paraplegic dogs with suspected spinal conditions. Clinical presentation and outcomes were recorded, and if cross-sectional imaging was subsequently performed, information about the final diagnosis was collected and compared with the initially suspected diagnosis.
Outcomes Demonstrated Efficacy of Clinical Reasoning
The study collected data on 123 IVDE cases, revealing that 81% had successful outcomes without the need for imaging. Of the remaining cases, 16% had IVDE confirmed with imaging and achieved successful outcomes with surgery or medical management, while just 3% were found to have alternative diagnoses or were euthanized without imaging.
Data on 16 IM/ANNPE cases were also collected, with 94% achieving successful outcomes and only one dog being euthanized.
These findings indicate that successful outcomes can be obtained in the majority of dogs with suspected IVDE or IM/ANNPE using clinical reasoning alone.
Significant Implications for Veterinary Practice
The study’s findings highlight the efficacy of clinical reasoning in managing acute thoracolumbar myelopathy cases. The authors recommend the use of clinical reasoning while considering the patient’s overall condition and circumstances in order to avoid unnecessary tests and procedures.
By employing a systematic approach and considering the patient’s clinical presentation, veterinarians can achieve successful outcomes in the majority of cases without the need for immediate cross-sectional imaging. This approach not only optimizes patient care but also considers practical and financial constraints that may affect treatment decisions.
