Can we trust surgeons impression?

Agreement of surgeon's perception of the effectiveness of spinal cord decompression with findings on postoperative magnetic resonance imaging for dogs surgically treated for intervertebral disk extrusion

Federica Tirrito, Francesca Cozzi, Martina Bonaldi, Sara Conti, Rocco Lombardo

Background
Intervertebral disk extrusion (IVDE) is a leading cause of spinal cord dysfunction in dogs, especially in small and chondrodystrophic breeds. Surgical decompression is the standard treatment, yet it is often unclear how accurately surgeons can assess decompression success intraoperatively. This study aimed to evaluate the agreement between surgeons’ perception and postoperative MRI findings regarding spinal cord decompression (SCD) and to assess whether postoperative MRI findings were more strongly associated with clinical outcomes.

Methods
This prospective study included 68 dogs surgically treated for cervical or thoracolumbar IVDE. All dogs underwent standardized pre- and postoperative MRI, and decompressive surgery. Postoperative SCD was classified as satisfactory if residual spinal cord compression (SCC) was ≤15% and unsatisfactory if >15%. MRI-based assessments were compared to surgeons’ intraoperative evaluations. Associations with neurologic outcomes and recovery times (up to 6 months post-op) were statistically analyzed using kappa statistics, rank-sum tests, and Kaplan-Meier analysis.

Results
MRI-based assessment found satisfactory decompression in 78% of dogs, while surgeons perceived satisfactory decompression in 91%. Agreement between surgeon perception and MRI findings was only fair (kappa = 0.40). Unsatisfactory decompression on MRI was associated with thoracolumbar IVDE, higher preoperative neurologic grade, greater preoperative SCC, and ventral circumferential distribution of extruded material. Dogs with satisfactory decompression on MRI had better neurologic recovery and shorter mean recovery times (18.2 days vs. 33.1 days; P = 0.009). MRI detected intramedullary signal changes postoperatively in more dogs than preoperatively, but these changes were not significantly associated with long-term outcome or recovery time.

Limitations
The study’s limitations include a relatively small sample size and the use of low-field MRI, which may reduce sensitivity for detecting spinal cord signal changes. Measurements were conducted by a single observer, and surgical assessments were subjective. Variability in timing of postoperative MRI may also have influenced detection of residual SCC.

Conclusions
Postoperative MRI provides a more reliable assessment of spinal cord decompression than surgeon perception, particularly in dogs with severe neurologic deficits or thoracolumbar IVDE. Residual compression is associated with worse short-term outcomes and delayed recovery, supporting the routine use of postoperative imaging to guide further treatment decisions.

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