JOURNALOF
Veterinary
Science
J.Vet.Sci.(2003),4(1),97-101
Abstract
15)
Theaimof this studyistoinvestigatethe effectsof
electroacupuncture,corticosteroid,and combination
of twotreatmentsonambulatoryparesisdueto
spinalcordinjuryin dogsbycomparingtherapeutic
effectsofelectroacupuncture and corticosteroid.
Spinalcordinjurywasinducedintwentyhealthy
dogs(2.5~7kg and 2~4 years)byforeign body
insertionwhichcompressedabout25%ofspinalcord.
There wasnoconsciousproprioception,noextensor
posturalthrust,and ambulatory.Dogswere divided
intofourgroupsaccordingtothetreatment; cor-
ticosteroid(group A),electroacupuncture (group B),
corticosteroidand electroacupuncture (group AB),
and control(group C).Neurologicalexaminationwas
performedeveryday toevaluatethespinalcord
dysfunction until motorfunctionswere returnedto
normal.Somatosensoryevoked potentials(SEPs)
were measuredforobjectiveand accurate evalu-
ations.Thelatencyinmeasured potentialswas
convertedintothevelocityforthe evaluationof
spinalcord dysfunctions.Pain perceptionswere
normalfrompre-operationto 5 weeksafter operation.
Recoverydaysofconsciousproprioceptioningroups
A,B,AB,and C w ere 21.2±8.5days,19.8±4.3days,
8.2±2.6days,and 46.6±3.7days,respectively.
Recoverydaysofextensorposturalthrustingroup A,
group B,group AB,and group C w ere 12.8±6.8days,
13.8±4.8days,5.4±1.8days,and 38.2±4.2days,
respectively.There were nosignificantdifferences
betweengroup Aand group B.However,recovery
daysofgroup ABwas significantlyshorter thanthat
ofother groupsand thatofgroup C was significantly
＊
Corresponding author:Tchi-chou Nam
CollegeofVeterinaryMedicine,SeoulNationalUniversity
San 56-1Shillim9-dong,Kwanak-gu,Seoul151-742,Korea
Tel: +82-2-880-8680;Fax:+82-2-888-5310
E-mail: tcnam@plaza.snu.ac.kr
This study was supported by ResearchInstituteforVeterinaryScience
ofSeoulNationalUniversity.
delayed(p<0.05).Conductionvelocitiesofeachgroup
were significantlydecreasedafter inductionofspinal
cordinjury on SEPs(p<0.05)and theyshowedaten-
dencytoreturntonormalwhenmotorfunctionswere
recovered.Accordingtothese results,itwasconsi-
deredthat the combinationofcorticosteroidand
electroacupuncture wasthemost therapeuticallyef-
fectiveforambulatoryparesisduetospinalcord
injuryin dogs.
Keywords
:spinalcordinjury,electroacupuncture,corti-
costeroid,dog
Introduction
Intervertebraldiscdisease(IVDD)in dogsisa common
clinicalproblemencounteredinsmall animalpractice.
There arevariousclinicalsignsranging from mild back pain
to paralysiswithloss ofdeep pain perception.Several
methodsofmanaging dogswithIVDD havebeenreported.
Conservativetherapy consistsofcage confinementwith
medications,physiotherapy,swimming,ultrasound,massa-
ge,eventualantibiotics,laxativediet,and bladderemptying
[10,12].Anotherconservativetherapy,asanalternative
medicine,acupunctureisuseful in dogswith paresis[15].
Decompressivesurgeryincludesfenestration,dorsal lami-
nectomy,hemilaminectomyand minihemilaminectomy or
pediculectomy[20].
Theproperchoice oftreatmentforintervertebraldisc
diseaseremainscontroversialalthough thereisgeneral
agreement thatseveralformsofdecompressivesurgeryare
mosteffectivefordogswithsevereneurologicaldysfunction
[20].The approachtoanindividualcasewill beinfluenced
by thestageofthedisease[7,8,23].Theduration of
clinicalsignsand economicfactorswill alsoinfluence the
choice oftreatmentmethods[20].
Recoveryrateofmedicationsfordogswithambulatory
paresisisabout90%and recurrence rateisabout28%[9].
Butdecompressivesurgeryisthemosteffectivein dogswith
paraplegia[4,6].Recoveryrateofmedicationsfordogswith
mild paralysisisabout50 ~80%,whichis significantly
lowerthanthatofparesis[7].Comparisonsorevaluations
EffectsofCorticosteroidand Electroacupuncture onExperimentalSpinalCordInjury
inDogs
Jung-whanYang,Seong-mokJeong,Kang-moon Seo and Tchi-chouNam*
CollegeofVeterinaryMedicine,SeoulNationalUniversity,San 56-1 Shillim9-dong,Kwanak-gu,Seoul151-742,Korea
ReceivedDecember16,2002 /AcceptedFebruary 2,2003
98 Jung-whanYang,Seong-mok Jeong Kang-moon Seoand Tchi-chou Nam
on variousdecompressivesurgeriesand medicationsin dogs
withintervertebraldiscdiseasehavebeenreported[15,16,
20]but there arefewreportson the effectsofthe combina-
tion ofmedicationsand electroacupuncture.
Thepurposeofthis study istoinvestigatethe effectsof
electroacupuncture,corticosteroid,and combination oftwo
treatmentson paresisduetospinalcordcompression in dogs.
Materialsand Methods
ExperimentalAnimals
Neurologicallyintact twenty dogs(2.5~7.0 kg and 2 ~
4 years)weredividedintofourgroupsregardless oftheir
sex,body weightand age.Fourgroupswere corticosteroid
(Group A,n=5),electroacupuncture(Group B,n=5),
corticosteroidwithelectroacupuncture(Group AB,n=5),
and control(Group C,n=5).
InductionofSpinalCordCompression
1.Anesthesia
Dogswerepremedicatedwithacepromazinemaleate(0.01
㎎
/
㎏
,IV,Sedaject®,Samwoo,Korea).Ampicillin(20
㎎
/
㎏
,
IM,Penbrex®,Samyang Co., Korea)and enrofloxacin(5
㎎
/
㎏
,SC,Baytril®,BayerKorea Co., Korea)were admini-
stered.Anesthesiawasinducedwiththiopentalsodium(15
㎎
/
㎏
,IV,Penthotalsodium®,Joongwei,Korea).Dogswere
intubated,and thesurgicalplaneofanesthesiawasmain-
tained using isoflurane(1.5MAC,Aerane®,Ilsung Co.,
Korea).LactateRinger's solution with 5%dextrose(10
㎖
/
㎏
/h,IVdrip,DeahanHartmandex®,DeahanPharm.Ltd.
Co., Korea)wasadministered during thesurgicalprocedure.
2.Induction ofspinalcordcompression
Theskinincision wasmade at thedorsalmidlinefrom
the2nd to 5thlumbarvertebra and aperiostealelevator
wasusedtoelevateleftepaxialmusclesfromtheir
attachmentson thelateralaspectofspinousprocesses,
lamina,articular facetand pedicle.Rongeurorpneumatic
burwasusedtoenterthespinalcanaland makethe
windowof7×3 ~15×5
㎜
on theleft lamina according tothe
size ofspinalcanal,cautiously not tocontusethe cord.
Epiduralfataround theduramaterwasremoved by
suction.Spinalcanalsize wasexaminedwith bluntmicro-
dissector.According tothesize ofspinalcanal,15×8×3 ~
8×5×2
㎜
size autogenousbonefragmentwasinsertedthrough
thewindowtocompress spinalcordabout25%.Autogenous
bonefragmentwasmadefromaportion ofL3spinous
process.Subcutaneousfatgraftwasplaced overlaminectomy
site.Epaxialmuscles,subcutaneousand skinwere closed
routinely.After recoveryfromanesthesia,proprioceptive
deficit and loss ofvoluntarymovementwere confirmed.
Treatment
1.Medications
In groupsAand AB,fourty-eighthoursafterinduction of
spinalcordcompression,methylprednisolonesodium
succinate(MPSS) (30
㎎
/
㎏
,Bando methylprednisolone®,
Bando Pharm.Co.Ltd., Korea)wasadministratedin-
travenously 6 times,q6h,then prednisolone acetate(PDS) (2
㎎
/
㎏
,Corusprednisolone®,CorusPharm.Co.Ltd., Korea)
wasgiven orally,bidwithcimetidine(10
㎎
/
㎏
,Cimetidine®,
SungjinPharm.Co., Korea),misoprostol(5
㎍
/
㎏
,Alsoben®,
UnimedCo., Korea),and vit B1(1
㎎
/
㎏
,Vitamedin®,Hanil
Pharm.Co., Korea).ThedosageofPDSwastapered
according toclinicalsignsand complications.Cage con-
finementwasappliedconcurrently.
2.Electroacupuncture
In groupsBand AB,48 hoursafterinduction ofspinal
cordcompression,electroacupuncturetreatmentwasapplied
every otherdayatGV-4(Ming Men),GV-3(Yao Yang
Guan),BL-23 (Shen Shu),and BL-24 (QiHaiShu)aslocal
points,and GB-30 (Huan Tiao),GB-34 (Yang Ling Quan),
ST-36 (Zu San Li),ST-40 (Feng Long),ST-41 (JieXi)as
distalpoints.Outofthem,atGV-4(Ming Men)and ST-36
(Zu San Li)electroacupuncturewasappliedand atother
acupointstraditionalacupuncturewasused.Electrical
stimulationswith 2 V,25 Hzweredonefor20 minby using
ofelectricalstimulator (PulsestimulatorAM3000,Tokyo
ElectronicCo., Japan).Cage confinementwasapplied
concurrently.
Evaluation
1.Neurologicalexamination
Afterinduction ofparesis,all dogswere examined
everyday on motorand sensoryfunctionsby postural
reaction,superficialpainand deep pain.Theseneurological
examinationswere continued until thedogsresponded
normally.
2.SomatosensoryEvokedPotentials(SEPs)
SEPsweremeasuredforprediction ofsensoryfunctions.
According toPonceletsmethod [18],SEPswererepresented
as spinalconduction velocity.Stimulation and measurement
wereperformedwitha‘Neuropack 2,MEM-7102' (Nihon
Kohden,Japan)and subdermal‘Platinumneedle electrodes'
(E2,Grass,U.S.A.)were applied on thetwochannels.The
channel1waslocated on thesubdermalregion betweenthe
5thand 6thlumbarvertebra and the channel2was
positioned betweenthe11thand 12ththoracicvertebra.
3.Radiology
Beforesurgery,plainradiograph wasperformedto know
thesize ofspinalcanal.According totheradiograph,the
size ofbonefragment toinsertwasdetermined.After
surgery,myelogramwascarried out toconfirmthat the
spinalcordwascompressed by inserted bonefragment.
StatisticalAnalysis
One-wayANOVA wasperformedtoinvestigatediffer-
EffectsofCorticosteroidand Electroacupunctureon ExperimentalSpinalCordInjuryinDogs99
encesamong groupsinrecovery daysofconsciouspro-
prioception and extensorpostural thrustby SPSS (SPSS for
windowsRelease8.0StandardVersion,SPSS Ins., USA).
Two-tailedStudent'st-testwasusedtocompare conduction
velocitiesofpre-operation,post-operation and whenmotor
functionswerereturnedto normal.Forstatistical interpre-
tation,significance levelwas setatp
＜
0.05.
Results
MeanRecoveryDaysofConsciousProprioception
In group A,meanrecovery period ofconsciouspro-
prioception was21.2 ± 8.5 days.In group B,19.8 ± 4.3 days,
in group AB,8.2 ± 2.6 days,and in group C,46.6 ± 3.7 days
(Table1).Meanrecovery period ofconsciousproprioception
was significantly decreasedin group AB(p 0.05).How-
ever,therewasno significantdifference between group A
and group B.
Table1.
Recovery daysofconsciousproprioception and
extensorpostural thrust ineach group
Group Recovery days*
Consciousproprioception Extensorpostural thrust
A
B
AB
C
21.2
±
8.5a
19.8
±
4.3a
8.2
±
2.6b
46.6
±
3.7c
12.8
±
6.8a
13.8
±
4.8a
5.4
±
1.8b
38.2
±
4.2c
*Data are expressedasmean ± SD.aNosignificant
difference between groups.bSignificantlyshorterthan other
groups(p<0.05).cSignificantlylongerthan othergroups
(p<0.05).group A,corticosteroid;group B,acupuncture;
group AB,corticosteroid+acupuncture;group C,control.
MeanRecoveryDaysofExtensorPosturalThrust
In group A,meanrecovery period ofextensorpostural
thrustwas12.8 ± 6.8 days,in group B,13.8 ± 4.8 days,in
group AB,5.4 ± 1.8 days,and in group C,38.2 ± 4.2 days
(Table1).In group AB,meanrecovery daysofextensor
postural thrustwas significantlyshorterthanthoseofother
groups(P£¼0.05).Group Aand group Bhad no significant
difference inrecovery days.
Table2.
Changesofconduction velocitiesbetweenchannel1tochannel2ineach group
Group Conduction velocities(m/sec)*
Pre-operation Post0operation After recovery
A
B
AB
C
56.77
±
8.81
60.13
±
1.43
61.88
±
5.72
70.92
±
4.13
49.73
±
7.36a
46.31
±
8.74a
39.34
±
7.97a
52.59
±
6.20a
54.17
±
7.13
53.22
±
9.44
56.99
±
6.34
67.74
±
5.50
*Data are expressedasmean ± SD.aSignificantly differentfrompre-operation ineach group (p<0.05).
SomatosensoryEvokedPotentials(SEPs)
Afterinduction ofspinalcordinjury,conduction velocities
ofeach group (Table2)weresignificantly decreased
comparedwith pre-operativevalueon SEPs(p 0.05).
However,the conduction velocityshowedatendencyto
returnto normalwhenmotor functionswererecovered on
neurologicalexamination.
Radiology
Aftersurgery,myelography wastaken.Onmyelograms,
autogenousbonefragmentscompressing thespinalcord
about25%,whichwere confirmed on theimageof
radiopaque extraduralmass betweenL3and L4.
Discussion
Themanagementofintervertebraldiscdiseaseisbased
on assessmentofthedegree ofneurologicaldysfunction and
localization ofthelesion.It isnowgenerallyacceptedthat
decompressivesurgeryis superiortoeitherconservative
managementor fenestration,especiallyforthosedogsthat
haveparesis[20].However,conservativetherapy waseffec-
tive asmuchasdecompressivesurgeryin dogswitham-
bulatory paresis[8].Inthisexperiment,dogswereinduced
tothelevelofparesistoexaminetherapeutic effectsof
corticosteroidand electroacupuncture.
In 1983,Hoerleinevaluated dexamethasoneuseincats
withspinalcordinjuryand found dexamethasonenot to be
more effectivethanaplacebo inimproving neurological
outcome[10].Increasing thedoseofdexamethasonetoless
than halfofthereportedequipotenthigh-doseprotocolof
MPSS (30 mg/kg)hadresultedin gastrointestinalcomplica-
tionsin dogsand cats[5,9,22].
Thenegative effectsofcorticosteroidtreatment in neu-
rological traumahad been described.Itwas suggestedthat
corticosteroidsnotbeusedmorethan 24 hoursafteronset
ofherniation ormorethan once; theirusemightcause
additionalcomplicationsand aslowercurerate[3,17].
Based on previous study,MPSS was selectedfirst,and then
administeredPDSwithcimetidine,misoprostol tominimize
complication ofcorticosteroids.
Themechanismofacupuncturetreatmentneedsmore
studiesand isnotyetunderstood.However,acupuncture
100 Jung-whanYang,Seong-mok Jeong Kang-moon Seoand Tchi-chou Nam
wasknownto be a potentanalgesic and thusit might
abolish back pain.Acupuncture couldactivate axonal
regrowthand thusregeneration ofdestroyedaxonsinthe
spinalcord.Thefasterthisregrowthtook place,themore
axonsmightgainaccess totheiroriginaldistalaxonal
sheathesbecausetherewasless scartissue at thelesion.
Acupuncturewasapotentantiinflammatorytreatment,
becauseit mightdecreaselocalspinal inflammation,edema,
vasodilation orconstriction and histamineorkininrelease.
Thiswould decreasescartissueformation,cordcompression
orhypoxemia and pain[13].
Inthis study,acupointscould bedividedintolocaland
distalpoints.Localpointsweresegmentalurinary bladder
points.Localpointson thegoverning vesselmeridianin
thesesegmentswere also used.Thelogicofusing local
pointswasthat theymighthavesegmentaleffectsat the
siteoflesion.ThesegmentaleffectswerethatA-betafibers
stimulated,rapidlycarrying nonpainfulsensoryinformation
tothesubstantiagelatinosa,wouldsynapseon inhibitory
interneuronsthatwouldclosethe“gate”toascending pain
transmission beforepainimpulsesarrivedfromslowly
conducting Cfibers.Thiswould preventpainimpulsesfrom
reaching higherbraincentersforconsciousperception [21].
Based on thisprinciple,GV-3,GV-4,BL-23 and BL-24,close
toL3and L4 vertebra,wereusedaslocalpoints.
Distalpointsusedinthis study wereon urinary bladder
(BL),gall bladder (GB)and stomach(ST)meridians.The
logicofdistantpointsusedwaspresumedthat they
stimulatenervefibersthathave anafferent inputon higher
centersand on theinjuredspinalsegment.Theseimpulses
mightcombat inflammation and painand activaterege-
neration.Acupuncturewith onlyfourneedleswasprovedto
be aseffective asaslightlymore extensivetreatment[15].
Inthis study,the choice ofdistalpointswhichwereGB-30,
GB-34,ST-36,ST-40,and ST-41 wasbased on aRogers'
computerized bestpointchoice listing [13].
Stimulation methodscan bedividedintofive categories;
plain puncturing,electrostimulation ofneedles,laserthe-
rapy,injectionsatacupoints,and moxibustion [1].Electro-
stimulation isusedmorefrequentlyintheUnitedStates
thaninEurope and China[13].The electrostimulation is
appliedwithawidevariety ofmachines,awidevariety of
waveforms,wavepatternsand intervals,differentfrequen-
ciesand amplitudes.The amplitudeisaugmented until
muscletwitching and painisobserved.In onereport,
electrostimulation deterioratedthe condition ofthepatient
and no better resultshavebeenreported by using electros-
timulation than by plainacupuncture[14].However,it was
currentlywidely usedinmany humanand veterinary
acupuncturepracticestotreatpainand physicalailments
and toinduce analgesiaforsurgicalprocedures.Several
advantagesofelectroacupuncturethantraditionalacupunc-
tureweresavingsintime,the amountand quality of
stimulation can bemore accurately,uniformly,and objec-
tivelyregulatedand measured,and the electroacupuncture
produce a higherand more continuouslevelofstimulation
thancan beprovidedmanually[1].
In general,weakstimulation withlowcurrentand low
frequencyappliedtoanacupuncturepointwill tonifythat
pointwhich procedureisindicatedforchronicpain pro-
blems.Toaccomplishsedation oranalgesic,high frequency,
greaterthan 15 Hz(usually25~150 Hz),and higher
amplitudeofcurrentareused.Thistechniqueisprimarily
usedforacutepain problems[1].
Therecovery daysofthedog which had negativeres-
ponseson proprioception and hoping were90%withina
three-week period withelectroacupuncture[9].Thiswas
almostaccordedwiththeresult ofgroup Ainthepresent
study.
The availability ofobjective and accuratemethodsfor
spinalcordfunction assessmentcould beofgreathelp[19].
Inthisexperiment,SEPsweremeasuredformoreobjective
and accurate evaluation ofspinalcord dysfunctions.Several
investigatorshavesuggestedthatambulation afterspinal
injurycan bepredicted by SEPs[11].Spinal traumamay
causethereduction ofconduction velocity oramplitudein
spinalcord.Conduction velocitiesweremoreoftenaffected,
butwerenotalwaysreducedin dogswith paralysis.
Conduction velocitymighthavebeenmore affected by
compression,and amplitudemore affected by hypoxia.
However,additionalstudieswereneededtoconfirmthese
hypotheses[2].Inthis study,conduction velocitiesineach
group afterinduction ofspinalcordcompression were
significantly decreasedcomparedtothoseofpre-operation.
Inthepresentstudy,it was suggestedthat the com-
bination ofcorticosteroidwithelectroacupuncturewas
significantlymore effectivethancorticosteroid orelectro-
acupuncture alone.Itwasthought to beduetoasynergistic
action ofanalgesic,antiinflammatory,antiedemic effectof
corticosteroidand acupuncture.
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