Acute myelopathies

Question 1

Pathophysiology of fibrocartilagenous embolic myelopathy

Answer 1

• Obstruction of arterial or venous supply to the spinal cord
• Obstructive material is fibrocartilage, likely from the nucleus pulposus

Question 2

Signalment and history for FCE

Answer 2

• Disease of non-chondrodystrophic, large/giant breed dogs
• Any age, typically 1-7 years (Irish WOlfhounds at 8-13 weeks of age; Miniature Schnauzeres)
• Cats (DSH, older)
• Peracute onset, usually during physical activity

Question 3

Neuro exam with FCE

Answer 3

• may be non-ambulatory para/tetra paretic/plegic
• Most commonly non-painful
• Can lose pain sensation if lesion is severe enough
• Signs can be asymmetrical

Question 4

Most common locations for FCE in dogs

Answer 4

• L4-S1, T3-L3

Question 5

Most common locations for FCE in cats

Answer 5

• C6-T2

Question 6

Diagnosis of FCe

Answer 6

• Tentative diagnosis based on hx, signalment, neuro exam findings
• Radiographs help rule out fractures
• MRI +/- CSF to visualize cord
• If focal, often centered over vertebral body
• Gold standard = histopathology

Question 7

What’s a dfdx for FCE based on MRI findings?

Answer 7

• GME
• IVDD too
• Acute non-compressive nucleus pulposus extrusion

Question 8

Treatment for FCE

Answer 8

• Time - improvement typically begins within days
• Supportive care
• Nothing you can do otherwise
• Might get worse initially and then better
• REhabilitation

Question 9

What is the advantage of MRI for FCe suspects?

Answer 9

• More aggressive rehabilitation

- Otherwise, you’re still worried about IVDD

Question 10

What determines prognosis for FCE?

Answer 10

• Lesion size (shorter than the length of two vertebral bodies, or cross sectional area <67% = more favorable prognosis for successful outcome)
• Pain sensation

Question 11

What % of animals recover to a functional capacity with FCE if they still have pain sensation?

Answer 11

• 85% will recover

Question 12

Prognosis of FCE in cats

Answer 12

• Favorable

Question 13

Pathophysiology of acute non-compressive nucleus pulposus extrusions

Answer 13

• Result of increased forces on the intervertebral disc - usually vigorous exercise
• Most commonly a concussive injury but can lacerate meninges and cord

Question 14

Signalment and history for ANNPE

Answer 14

• Similar to FCE cases
• Middle aged, large breed dogs, non-chondrodystrophic
• Males appear to be predisposed
• Peracute onset after some form of activity
• Not as much cats

Question 15

Neuro exam findings for ANNPE and most common location

Answer 15

• T3-L3 signs most often
• Signs are often lateralized = asymmetrical
• Pain may be more common with this disease

Question 16

Diagnosis of ANNPE

Answer 16

• Radiographs to rule out fractures/luxations/pathological bone lesions
• MRI +/- CSF analysis

Question 17

What are the two main ischemic myelopathies?

Answer 17

• FCE and ANNPE

Question 18

Treatment for ANNPE?

Answer 18

• Similar to FCE but less aggressive with PT

Question 19

Prognosis for ANNPE?

Answer 19

• Depends on pain sensation

Question 20

Fracture definition

Answer 20

• Cracking or breaking of bone

Question 21

Subluxation definition

Answer 21

• Beginning of a dislocation, but some joint contact still remains

Question 22

Luxation definition

Answer 22

• No joint contact

Question 23

History with suspected spinal fracture?

Answer 23

• Trauma!!
• HBC (most common), playing, animal attack/dog fights, falling from cliff
• Pathologic fracture
• Peracute onset

Question 24

Neuro examination for spinal fracture suspect

Answer 24

• ALWAYS assess systemically first
• CV and respiratory systems
• Exam findings depend on the location of the lesion
• May need to immobilize

Question 25

Diagnosis for suspect spinal fracture

Answer 25

• Initial trauma evaluation
• ECG
• FAST scans
• Initial blood work (PCV/TS/Azo, lactate, electrolytes)
• Blood pressure
• Vertebral radiographs
• Ideally CT AND MRI in this case

Question 26

What do radiographs tell you about possible spinal cord fracture?

Answer 26

• Only assess vertebral integrity, not the spinal cord
• Lateral radiographs easier to obtain than VD, for the latter use the horizontal beam
• CT is best for bone evaluation

Question 27

Best modality for bone evaluation?

Answer 27

• CT

Question 28

Best modality for cord evaluation?

Answer 28

• MRI

- Also can help you determine concussive lesions

Question 29

Advantages of MRI

Answer 29

• Cord and soft tissue visualization

Question 30

Disadvantages of MRI

Answer 30

• Bone
• Longer anesthetic time
• More patient manipulation

Question 31

Treatment for spinal cord fractures

Answer 31

• Medical (cage rest for 6 weeks; external coaptation; pain control)
• Surgical (some form of stabilization if needed)

Question 32

How do you determine if spinal cord stabilization is needed for a fracture?

Answer 32

• Divide it into three parts (ventral compartment, middle compartment, and dorsal compartment)
• If two out of three are damaged, then surgical stabilization is warranted

Question 33

Dorsal compartment

Answer 33

• Looks like it’s from the dorsal aspect of the transverse process to the dorsal aspect of the spinous process

Question 34

Middle compartment

Answer 34

• Looks like it’s the transverse process?

Question 35

Ventral compartment

Answer 35

• Looks like it’s from the ventral aspect of the transverse process to the ventral aspect of the spine

Question 36

Prognosis for spinal fractures

Answer 36

• Good as long as the patient has pain sensation

- Grave if deep pain negative