Could be something else then IVDE...

MRI and clinical findings in 133 dogs with recurrent deficits following intervertebral disc extrusion surgery

Emma Suiter 1, Nicholas Grapes 2, Lucia Martin-Garcia 3, Steven De Decker 2, Rodrigo Gutierrez-Quintana 3, Annette Wessmann 1

Background:
Recurrent neurological deficits after surgical treatment for intervertebral disc extrusion (IVDE) are a clinical concern, with causes including recurrent disc extrusion (RDE), progressive myelomalacia (PM), and others. Prior studies have limited data on MRI characteristics associated with these recurrences. This study aimed to describe the MRI and clinical features of dogs presenting with recurrent deficits after IVDE surgery to improve diagnostic accuracy and guide treatment.

Methods:
A retrospective study was conducted involving 133 client-owned dogs that underwent MRI evaluation for recurrent neurological deficits following initial IVDE surgery. Cases were categorized based on MRI diagnoses including RDE, PM, new disc extrusion at a different site, and other causes. MRI findings were reviewed by board-certified neurologists or radiologists, and clinical data were extracted from medical records. Statistical analysis compared clinical and imaging features across diagnostic groups.

Results:
Recurrent disc extrusion was the most common finding (63.2%), typically occurring at the original surgical site. Progressive myelomalacia was diagnosed in 11.3% of cases, characterized by diffuse intramedullary T2 hyperintensity and spinal cord swelling. New extrusions at different sites accounted for 10.5%. Dogs with PM had significantly shorter intervals between surgeries and recurrence and were more likely to have non-ambulatory status. Surgical treatment was often pursued in RDE and new extrusion cases, while PM cases typically received conservative management or euthanasia. Imaging revealed that recurrent extrusion often presented with ventral extradural compression and hyperintense signals on T2-weighted sequences.

Limitations:
The retrospective nature of the study and the lack of histopathologic confirmation limit diagnostic certainty, particularly for PM. MRI protocols varied across institutions, and follow-up duration was inconsistent. Outcomes were not uniformly recorded for all cases.

Conclusions:
MRI is essential for identifying the cause of recurrent neurological deficits post-IVDE surgery. RDE is the most frequent finding, often at the original site, while PM presents distinct imaging and clinical features with a more severe prognosis. Recognizing these patterns can aid in clinical decision-making and prognosis estimation for dogs with post-surgical neurological deterioration.

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