8 years old Pointer with neuro issues

last one

Good evening,

Last post for this case.

We have localised the problem to the mid lumbar cord in this case and considering the differential diagnosis I listed earlier on, an MRI is the test that will cover most of the conditions listed. However, a CT scan will detect a bone lesion, discospondylitis and some disc herniations. In a large dog like this one, we would be looking for a disc protrusion (rather than calcification as we see in Dachshunds and French bulldogs for example) and this is less easy to see on CT, MRI is better for this. For parenchymal diseases such as meningo-myelitis, or some cancers such as lymphoma, MRI is superior. Meningiomas can be suspected well on CT because they take up contrast, as they do on MRI too.

X-rays before MRI is not a bad idea, they may well reveal the cause of the problem; the issue is that if the X-rays are normal, then you are no further.

See attached the results of the MRI. This is likely a synoviosarcoma because the mass seems to take it's origin from the facet of L5/L6 on the left but this could be an osterosarcoma. Note the invasion of the musculature, nevertheless, this would be hard to palpate as there is no deformation at the level of the skin. The lesion is extra-dural and invades the spinal canal, compressing the cord significantly and explaining the clinical signs and would cause a degree of pain. The lesion is likely a primary neoplasm, rather than a metastasis, due to it's size and location and unfortunately the prognosis is poor. 

Prognosis: there is a real risk of pathological fracture here. Surgery would be an option followed with radiation. The dog would need stabilisation of the lumbar spine alongside the decompression, for a prognosis of ~6 months potentially 12 months. 

Note that you would have seen with X-rays or CT!

I hope this case was interesting. If you have any comment or questions, please feel free to ask!

I wish you a good week-end.

Bw

Nicolas

PS: we did actually take some biopsies, I have just remembered now, and I have attached the pathologist report which contains some interesting comments: osteosarcoma!