12. Cervical Vertebral Compressive Myelopathy Flashcards
What is ECVCM?
Equine cervical vertebral compressive myelopathy
What is cervical vertebral compressive myelopathy?
Ataxia and weakness caused by the narrowing of cervical vertebral canal, compression of spinal cord, malalignment and malformation cervical vertebrae
Stenosis of the vertebral canal most common
What are some other names for Cervical vertebral compressive myelopathy?
Wobblers Syndrome
Cervical vertebral malformation (CVM)
Cervical vertebral instability (CVI)
Cervical vertebral stenotic myelopathy
What is the difference between type 1 and 2 CVCM?
Type 1: Young horse, thoroughbred, multifactorial, malformation vertebrae or spinal cord
-Malformation (OCD, angulation, phases enlarged) - malformation doesnt mean disease
Type 2: OIder horse (>5), all breed, degenerative, osteoarthritic change articular processes
-Degeneration - DJD, wedge, proliferation, cyst, fracture
What does the typical CVCM case look like?
Most common non-infectious spinal ataxia
-Thoroughbred, quarter horse, warm blood
-Males
-Type 1 <2yr
What is the pathogenesis of type 1?
Genetic - DOD
-Trauma, exercise, nutrition (fed too much to young, too much P, not enough CU?)
What is a common history for CVCM?
Type 1: rapid growth or weight gain, big foal
Acute ataxia/gait abnormality following trauma
Gradual Neuro signs
Older - chronic poor performance
What may you see on PE of an CVCM horse?
Worn hooves, DOD, pain and focal muscle atrophy, bony abnormalities palpable
What would you find on a neurologic exam?
Ataxia and paresis of cervical spinal cord
-Symmetric
-Damage white matter - more severe pelvic limb, tract more superficial
What are some differential diagnosis for CVCM?
EPM, Trauma, Equine Degenerative myeloencephalopahty, herpes
How can you diagnose CVCM?
Rads - cervical - look for bony malformations and flare, ossification, malalignment, DJD
Where should you look on a rad to determine if a horse has CVCM?
-Dorsal laminae should end before intervertebral space
-Articular process/articular facet joints
-Caudal vertebral epiphysis should be flat
-Adjacent vertebrae should line up
-Intervertebral foramina should be open and radiolucent
If you look at the x-ray of a horse and it looks normal does that rule out CVCM?
No
If you look at a rad and see a sight of compression does that rule the disease in?
No
What is a measurement that can help in IDing CVCM?
Sagittal ratios - compare canal width to height of Vertebral body
What is an objective measurement that can confirm spinal cord compression, IDs the location and number of lesions, required GA and contrast injected into the AO space?
Myelography
Where are the most common sites of static vs dynamic compression?
Static: C5/6 and C6/7
Dynamic: C3/4 and C4/5
How do you know there is compression with a myelogram?
-reduction of Colum less than 2mm
-attenuation dorsal and ventral >50%
-Only see dorsoventral compression not lateral
What are some other objective measurements beside a myelogram?
CT and MRI
How can you treat CVCM horses medically?
Type 1:
<1yr may benefit
Restrict exercise
Restrict diet - protien and carbs 66-75% NRC, vitamin and mineral balance, VA and VE increased, SE
Type 2:
Facet injections - more effected no neuro sign
How can you surgically treat CVCM?
Stop repetitive trauma to spine
-ventral stabalization
-Consider - quality candidate (young with 1-2 lesion), expectations improvement (6 months and only 1-2 grades), cost, safety and liability
What should you tell the owner about post-op care?
1 month stall rest
1 month stall rest with hand walk
small paddock turn out 3rd month
1 month unlimited turn out before work
-Ground work
-Saddle 6 months
What is the prognosis for CVCM?
Depend on age, severity, duration signs, expected performance level
No treatment = poor
With medical 30-83%
Surgical 45-60 to use, 80% improve
