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PHASE 2 - > Cervical > Flashcards

Cervical Flashcards

1
Q

what is the overall recurrence rate for disc-associated CSM (cervical spondylomyelopathy)?

A

24%

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2
Q

what is success rate for medical management of CSM?

A

38 -54%

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3
Q

what is success rate of IVD fenestration alone?

A

30-33%

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4
Q

where do meningioma of spinal cord most commonly occur?

A

cervical - often cranial to C3

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5
Q

what breed is predisposed to meningioma?

A

boxer
lrg breed dogs

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6
Q

what is prognosis with surgery for meningioma

A

19 mo.

those that survive 3 months and neuro signs improve have good prognosis

recurrence possible

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7
Q

what are advantages of cervical disc arthroplasty? long term success?

A
  • allowing decompression of spinal cord with dorsal annulectomy, assuring direct decompression
  • can be used to treat 2-3 consecutive cases
  • 91% BUT subsidence in all dogs
    AND intravertebral mobility lost or not detectable in 77% of operated sites
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8
Q

what is chemonucleolysis?

A

inject IVD with chondroitirase ABC
- 7 d post injection 92% have some improvement
- 77% have excellent improvement

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9
Q

what is a piezoelectric device? what are the benefits?

A
  • ultrasonic tool for osteotomy/osteoplasty (use low freq 25-50 Hz) to help cut bone for ventral slot
  • benefit - can adjust so only cuts mineralized tissue and not soft tissue
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10
Q

which cervical vertebrae is associated with better prognosis?

A

cranial to C4 (some papers disagree)
- <15kg dog with caudal have poorer prognosis

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11
Q

what is prognosis for cervical IVDD with relation to:
- degree of CNS injury

  • duration of disease
  • type of treatment:
A
  • degree of CNS injury: even tetraplegia can make full recovery
  • duration of disease: dogs that dont walk within 2 week more likely to have residual effects
  • type of treatment:
    1 - recurrence rate >/= 36% with conservative treatment
    2 - V slot = 90% recovery in 1 month; 97% recovery in 12 months; recurrence 5-10%
    3 - dorsal lam - 100% in one study
    4 - hemilam - better smaller breeds 78-90%
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12
Q

what are 3 factors associated with disc associated compression? age of dogs with DACSM?

A

vertebral canal stenosis

pronounced torsion of caudal cervical intervertebral column - IVDD

protrusion of larger IVD in caudal cervical column

Age = middle age large breed

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13
Q

what causes narrowing of osseous associated CSM? age?

A

stenosis - proliferation of lamina, articular process, or pedicles

Age = young giant breeds

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14
Q

what angle between atlas and axis is predictive of instability?

A

<162 degrees

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15
Q

complications of conservative management for AAI?

A

recurrence of disease, corneal ulcers, migration of splint (ineffective), moist dermatitis, decubital ulcers, hyperthermia, respiratory compromise, anorexia, otitis externa, accumulation of food in badnage

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16
Q

what is the main contraindication for dorsal technique for AAI?

A

spinal cord compression from dorsal deviation of dens

17
Q

list dorsal techniques to address AAI

A

atlantoaxial wiring (or w suture)
nuchal ligament technique
dorsal cross-pinning (+PMMA)
kishigami AA tension band

18
Q

what is the toughest (cautious) step of kishigami?

A

insert over dorsal arch of atlast in subarachnoid space

19
Q

what/how is slanted ventral slot created?

A

removes caudal aspect of cranial vertebral body of affected IVD
- window created cranial to IVD few mm from ventral crest of body
- ~20% width (20-25% length) direct toward vertebral endplate

20
Q

what size dog dog we not recommend doing cervical fenestration

A

> 30kg (arbitrary?)

21
Q

list complications of sx to treat cervical IVDD

A

resp compromise:
1- type 1 - ventilatory failure 2ndary to paralysis/paresis
2- type 2 - ventilating normal. pneumothorax or atelactasis with recumbency/anesthesia

cardiac dysrhythmias

hemorrhage: 19% in Ross. study

neuro deterioration: + lar par/Horners

vertebral subluxation: 8% in one 2000 paper

seroma

22
Q

what is overall complication rate of sx cervical IVDD?

A

9.9% (Rossmerzel 2013)

minor - 3.5%
major - 6.4%

hemorrhage 18.9% (only 5 needed transfusion)

23
Q

list ventral techniques of AAI surgery?

A

transarticular screw + pins
pins and PMMA
screws and PMMA
Ventral plating:
1- mini H plate variant
2 - butterfly plate variant

24
Q

what are the 2 patterns for screw placement in body of axis for AAI stabilization?

A

1 - 4 cortical screws in body; 1 in middle of caudal aspect of each cranial articular surface of axis at insertion point of longus colli

2 - 2 cortical screws, 1 screw to facilitate secure realignment. 2nd screw placed in cranial 1/2 of vertebral body of axis (this technique uses transarticular pins)

25
Q

what is typical gait in dog with CSM?

A

general proprioceptive ataxia even with absence of postural reaction deficit (typical PL ataxia, mild changes in TL)

26
Q

what % are non-ambulatory tetraparetic?

A

10%

27
Q

what % normal Dobies have changes on rads similar to dogs with CSM

A

25%

28
Q

what is the % seizure complication rate in performing myelography in dobies?

A

25-27%

29
Q

for disc-associated cervical spondylomyelopathy, what are typical sx tx plans for:
- ventral static compression
- dynamic compressive
- multiple compressive sites

A
  • ventral static - ventral slot or inverted cone
  • dynamic compressive - distraction and stabilization (PMMA plug or pins/screws + PMMA)
  • multiple compressive sites - distract and stabilize (most often PMMA plug)
30
Q

what are 2 additional techniques for multiple ventral compressions?

A

continuous dorsal laminectomy

cervical disc arthroplasty

31
Q

what are alternatives options to repair cervical fracture if concerned about transverse foramen

A

screws in transverse process, joined curve steel bar and encased PMMA

ventrally applied monocortical screw and PMMA fixation (3 screws/vertebra)
- 9.7% monocortical screws penerated vertebral canal

32
Q

cervical IVD - prevalence of those with IVD?

most common breeds? age?

A

14-25% (most extrusion)

small - toy poodles/ beagles (chondrodystrohpic)
large - labs, dalmatians, dobies (24% of all cases)
age - mean age 6-8 years; BUT shih tzu/yorkies (older; around 9-10 years)

33
Q

cervical IVD - which sites are more often affected?

A

chondrodystrophic - 80% are C2-C4
44-59% C2-C3 aloine

yorkies/chihuahua - caudal C5-6 or C6/7

34
Q

what are advantages of paramedian approach to ventral cervical column?

A

protects carotid sheath, exposes caudal vertebrae, decrease risk of hemorrhage from right caudal thyroid artery

35
Q

with lateral approach to brachial plexus, what muscle needs transecting to show ventral branches of 5-8th cervical nerves?

A

scalenus muscle

36
Q

what are indications of lateral approach to cervical region?

A

lateral or foraminal IVD herniation, nerve sheath neoplasms involve spinal nerve or spinal nerve roots and lesions in lateral epidural space

PHASE 2 - (9 decks)

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