Outcomes of surgically and conservatively managed thoracolumbar and lumbosacral intervertebral disc herniations in cats

Jack A. Amey, Theofanis Liatis, Giunio Bruto Cherubini, Steven De Decker, Max H. Foreman

Background: Intervertebral disc herniation (IVDH) is a spinal condition that affects cats, but little information is available on its pathology and treatment. Previous studies have reported different types of IVDH, such as extrusion, protrusion, and intradural-intramedullary extrusion, and different outcomes for surgical and conservative management.

Methods: A retrospective cohort study was conducted using the records of 92 cats with compressive IVDH between T3 and S1 vertebrae, diagnosed by MRI or CT, and treated surgically or conservatively at two referral hospitals between 2012 and 2022. Outcome was assessed using hospital and referring veterinarian records and owner questionnaires, and defined as successful if the cat regained or improved ambulation, urinary and fecal continence, and did not require analgesic medication. Statistical analysis was performed to compare outcomes among treatment modalities, IVDH types, and other factors.

Results: The incidence of IVDH during the study period was 0.44%. Most IVDH occurred caudal to the T11 vertebra, and IVDP were especially common at the L7-S1 space. Surgical treatment resulted in 62% (6 weeks) and 74% success (6 months). Conservative treatment resulted in 54% (6 weeks) and 65% success (6 months). Neurological grade at presentation was higher in cats treated surgically than in those treated conservatively. Regardless of treatment type, cats suffering trauma were more likely to have a successful outcome 6 weeks after treatment. Neurological deficits remained in the majority of cats for both treatment types. Four cases of intradural-intramedullary intervertebral disc extrusions were identified and treated successfully.

Limitations: The study had a low number of cases in some groups, a lack of standardization and follow-up, and a selection bias for surgical treatment. The retrospective nature of the study and the use of owner questionnaires may have introduced errors or inconsistencies in the data. The criteria for success may have been too strict or not comprehensive enough. The study did not evaluate the pathophysiology of IVDH in cats or the effectiveness of conservative treatment before surgery.

Conclusions: The study showed that there may be no difference in outcome between surgical and conservative treatment of thoracolumbar and lumbosacral IVDH in cats, regardless of IVDH type. Intervertebral disc herniation was more common in male neutered, middle-aged cats, and the majority of cats presented with progressive clinical signs and spinal hyperesthesia. The prevalence of compressive IVDH in cats appears higher than previously reported, and neurological deficits are likely to remain after either surgical or conservative treatment, at least in the short-term.

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