As a veterinary neurologist and neurosurgeon in Charleston, SC I see many patients with paralysis and spinal disease. Obviously, the most common questions are, “What’s causing this?” and “What can we do to fix it?”. There are many ways to image the spine, including a plain x-ray, a myelogram, a CT scan, and MRI. Which imaging technique to choose is a discussion I have daily and is made on a case by case basis. These techniques have an increasing degree of diagnostic benefit, but unfortunately, the ability to get a more accurate and complete diagnosis also comes with a greater cost. When evaluating these cases it is important to choose testing that allows us to come to an accurate diagnosis but at the same time minimizing anesthetic risk and cost. Although MRI requires anesthesia and costs more than a plain x-ray, it is vastly more sensitive and helpful in achieving a diagnosis than a plain x-ray is. Last week I saw a case that demonstrated the importance of MRI as a diagnostic test.
Lola is a 1 ½ year old Miniature Schnauzer. Four or five days prior to my evaluation here she was at the dog park and was standing next to her owner when she suddenly developed a very rapidly progressive inability to walk in all four limbs. Plain x-rays were taken of her neck and demonstrated a condition called atlantoaxial subluxation (a dislocation/instability of the first two neck bones). An x-ray of this is provided:
Based upon the exam findings and the history, this diagnosis was a little unusual and I was concerned another condition may be responsible for the signs. The treatment of the atlantoaxial instability is a surgery to fuse the two neck bones together. Since I was suspicious there was something else going on with Lola I did not want to rush in to doing this surgery based upon the x-rays alone and we performed an MRI. The MRI (provided below) demonstrated evidence of a fibrocartilaginous embolism (aka spinal cord stroke) as the primary cause of Lola’s weakness, and the atlantoaxial instability was an incidental finding and she was likely born with this condition.
In this case the MRI may have been more expensive than the plain x-ray, however, without it Lola would have been subjected to an unnecessary surgery and the additional cost associated with that procedure as well. I have seen many cases in which my treatment recommendations have drastically changed after performing an MRI and I feel that it is a very important test that may actually save pet owners money and prevent unnecessary procedures in the long term treatment of our patients.
Lola has been recovering and improving each day without any need for surgery. Below is a link to her video on my Facebook page if you would like to see her getting around without any need for support. https://www.facebook.com/photo.php?v=423915624345755