Cervical

Question 1

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

Answer 1

24%

Question 2

what is success rate for medical management of CSM?

Answer 2

38 -54%

Question 3

what is success rate of IVD fenestration alone?

Answer 3

30-33%

Question 4

where do meningioma of spinal cord most commonly occur?

Answer 4

cervical - often cranial to C3

Question 5

what breed is predisposed to meningioma?

Answer 5

boxer
lrg breed dogs

Question 6

what is prognosis with surgery for meningioma

Answer 6

19 mo.

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

recurrence possible

Question 7

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

Answer 7

• 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

Question 8

what is chemonucleolysis?

Answer 8

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

Question 9

what is a piezoelectric device? what are the benefits?

Answer 9

• 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

Question 10

which cervical vertebrae is associated with better prognosis?

Answer 10

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

Question 11

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

• duration of disease
• type of treatment:

Answer 11

• 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%

Question 12

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

Answer 12

vertebral canal stenosis

pronounced torsion of caudal cervical intervertebral column - IVDD

protrusion of larger IVD in caudal cervical column

Age = middle age large breed

Question 13

what causes narrowing of osseous associated CSM? age?

Answer 13

stenosis - proliferation of lamina, articular process, or pedicles

Age = young giant breeds

Question 14

what angle between atlas and axis is predictive of instability?

Answer 14

<162 degrees

Question 15

complications of conservative management for AAI?

Answer 15

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

Question 16

what is the main contraindication for dorsal technique for AAI?

Answer 16

spinal cord compression from dorsal deviation of dens

Question 17

list dorsal techniques to address AAI

Answer 17

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

Question 18

what is the toughest (cautious) step of kishigami?

Answer 18

insert over dorsal arch of atlast in subarachnoid space

Question 19

what/how is slanted ventral slot created?

Answer 19

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

Question 20

what size dog dog we not recommend doing cervical fenestration

Answer 20

> 30kg (arbitrary?)

Question 21

list complications of sx to treat cervical IVDD

Answer 21

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

Question 22

what is overall complication rate of sx cervical IVDD?

Answer 22

9.9% (Rossmerzel 2013)

minor - 3.5%
major - 6.4%

hemorrhage 18.9% (only 5 needed transfusion)

Question 23

list ventral techniques of AAI surgery?

Answer 23

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

Question 24

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

Answer 24

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)

Question 25

what is typical gait in dog with CSM?

Answer 25

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

Question 26

what % are non-ambulatory tetraparetic?

Answer 26

10%

Question 27

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

Answer 27

25%

Question 28

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

Answer 28

25-27%

Question 29

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

Answer 29

- 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)

Question 30

what are 2 additional techniques for multiple ventral compressions?

Answer 30

continuous dorsal laminectomy cervical disc arthroplasty

Question 31

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

Answer 31

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

Question 32

cervical IVD - prevalence of those with IVD? most common breeds? age?

Answer 32

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)

Question 33

cervical IVD - which sites are more often affected?

Answer 33

chondrodystrophic - 80% are C2-C4 44-59% C2-C3 aloine yorkies/chihuahua - caudal C5-6 or C6/7

Question 34

what are advantages of paramedian approach to ventral cervical column?

Answer 34

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

Question 35

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

Answer 35

scalenus muscle

Question 36

what are indications of lateral approach to cervical region?

Answer 36

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