Surgical Experience with Lumbosacral (Myelo)meningoceles with Tethered Cord Syndrome (TCS) in 8 Bulldog Puppies

Abstract: Background – Limited information is reported regarding surgical management of lumbosacral (myelo)meningoceles in puppies, the largest series being 6 dogs from several surgeons.
Hypothesis/Objectives – Surgical management may be associated with neurological improvement. The author reports MRI features (entire neuraxis), personal surgical experience/findings (through VITOM® intra-operative images/videos) and outcome.
Animals – 8 bulldog puppies diagnosed with (myelo)meningocele on MRI
Methods – All the dogs examined by the author and diagnosed with (myelo)meningocele were offered surgical management. All dogs operated on are included in this cohort. The surgical intervention and findings will be reviewed through step-by-step intra-operative images/videos.
Results – All dogs showed urinary/fecal incontinence, pelvic limbs deficits (most commonly sciatic nerve), and imaging +/- clinical features of TCS. One dog (lipomyelomeningocele) died of a pulmonary fatty embolism within 72hrs of surgery, preventing follow-up (necropsy findings presented). Adhesions between the dural sac and laminae of adjacent vertebrae, or within the meningocele between nervous structures and meninges, are frequent and should be addressed surgically. Three dogs recovered urinary/fecal continence with improvement of pelvic limbs deficits; 4 showed only mild/no improvement of urinary/fecal incontinence (3 with moderate improvement of pelvic limbs deficits, 1 unchanged). One dogs is only 2months post-operative at this time, all others >1 year follow-up.
Conclusions and clinical importance – Surgery for congenital lumbosacral (myelo)meningoceles can be associated with neurological improvement. Review of the cases of this series and cases reported in the literature did not allow identification of prognostic factors (imaging, clinical nor surgical) for urinary/fecal continence.