Ch 32 Thoracolumbar Vertebral column Flashcards

Question

medical stratagies (3) ambulatory vs non

Answer 1

-rest allow AF to heal/scar -pain relief and antiinflamm physio to improve muscle mass studies report good outcomes for ambulatory dogs, difficutl to compare outcomes due to different medical tx levine 2007 > 80% ambulatory > 50% recover with no relapse > 15-20% Tx fail > 30% recurrence > nsaid beneficial, CCS equivolcol in general, for non-ambul: - longer reocvery and reduce return to functino when compared to Sx - no DPP, 7% recovery (davies 1983) - no new advancements in SCI mgmt with evidence-based imrpvoment

Answer 2

Creation of a “slot” in the vertebral body, 1/4 the length of the vertebrae 90% successful decompression, deeper slots more successful decompression Risks: Possible instability and risk of fracture/subluxation

Answer 3

18.7% immediate impovement 52.8% improvement at discharge 64.2% improvement 4 weeks 91.4% ambulatory at 6 months, 74.5% having a normal gait

Answer 4

TIMING DPN: current literature does not generally demonstrate improved neurologic outcome in deep pain negative dogs with early surgical intervention, often surgery within 24 h DPN and PMM: one study found (Castel) an association between delay of decompression beyond 12 h and increased risk PMM, but literature overall lacking SURGERY Emerging evidence > focal or extensive hemilaminectomy and durotomy might decrease the risk PMM in dogs DPN and may improve survival in dogs with CS of PMM 2 Japanese retrospective studies reported a 91-100% survival rate with extensive hemi and durotomy, though most remained paralysed, including the FL if affected. Jeffery: 1 prospective study reported a reduced occurrence of PMM following extended durotomy (4 vertebrae) in G5 dogs AVCIM consensus suggests that extensive hemilaminectomy with durotomy can be considered for dogs with suspected PMM however, long-term morbidity (such as spinal instability) and how much surgery require further investigation

Answer 5

retrospective - increased recovery to ambulate with durotomy - no DPP, no dogs with durotomy developed PMM - not prevent progression of PMM - death 12%

Answer 6

the small sample and the lack of a control group preclude definitive conclusions regarding the efficacy of durotomy.

Answer 7

durotomy allow insepction of cord and reduce pressure

Answer 8

-most reliable indiciator of prgnosis - 72-100% recovery (volunrary ambulate and uirnate) - excellent if ambul - increased sevrerity ~ increased recovery time - >90% nonambulatory will reover within 3 months if DPP present (most within 4 weeks) Davies 2022 - mean time to walk 14d

Answer 9

-ensure conscious - 43-69% return to ambulate with Sx (Aikawaw 2012, Ruddle 2006) - if no pain in 2 weeks, prognosis poorer - recovery time 5-10 week - MRI lesion prgnostic (5x >L2 Ito 2005, levine 2009)

Answer 10

contraversial Martin 7% benefit (g4 turn into 5) Upchurch no effect previous studies no bovious diff with duration f CS to decmopression > disparity, this intuituive to perform sooner

Answer 11

no diff in outcome (ruddle 2006)

Answer 12

larger slower to recover l1-l2 common, most type I, > 90% return to function

Answer 13

22% successful outocme with protursion compared to 80% extrusion older lesions gradually compress causing irrevesible damage to cord

Answer 14

reported rate of recurrence 0 – 24.4% with PF 2.7 – 41.7% without PF across multiple studies over the last 50 years definition of recurrence varies in the literature. Some studies include only patients with neurologic deficits and confirmed compressive lesions where as others also include those with any new signs of neck or back pain, so presumed IVDD without proving a disc-based cause 20% within 3 years (mayhew 2004) 40 % medically managed The number of radiographically opacified IVD increases the risk of recurrence 1.4x in non-Dachshund breeds. We know that IVDD is a body-wide condition in many affected animals and those that have symptomatic disease at 1 site are at risk for recurrence at another. Furthermore, multiple studies have shown that almost 90% of thoracolumbar Type I IVDH occur between T11 and L3 So the goal of Prophylactic Fenestration is to creates a window in the anulus fibrosus to partially remove the nucleus pulposus > thereby reducing or preventing future extrusion of disc material

Answer 15

Early recurrences occur within 4 to 6 weeks of surgery and are usually always related to further extrusion at the same site of initial IVDH. Has a 1-5.8% reported incidence. Occur before the complete physiologic healing time of disc tissue Late recurrence is almost always at a new site- 87.5% occur at a disc space adjacent to or one disc away from the initial lesion

Answer 16

Risk factors identified: > The presence of degenerate discs on imaging at the time of initial extrusion significantly increases the chances of a late recurrence > Mayhew: dachshunds at increased risk of recurrence, though this wasn’t supported by a later study by Brisson 2011. > Recently, Kerrs paper on French bulldogs suggested a 51% rate of recurrence in the breed

Answer 17

Some or all discs from T11-L4 can be fenestrated – the no. depends of clinician preference and patient factors L4-5 and L5-6 > due to concern for injury of the nerve roots essential for weight bearing at that location traditional fenestration a #11 blade is used to create a window in the annulus a simple incision into the annulus to allow lateral escape of NP is ineffective long-term because the annulus rapidly heals So, manual fenestration involves removing nuclear material with the use of a dental scraper, curette or similar implements However, often residual NP is left, especially on the contralateral side of the disc (see picture) cadaver studies have been performed in attempt to improve the success. Holmberg study suggested that power fenestration (making a hole in AP larger with burr) improved percentage of disc removed, Forrtere study suggested even further improvement with an ultrasonic aspirator technique While these devices augment removal, none shown to besuperior to manual in clinical outcomes.

Answer 18

Percutaneous Laser Disc Ablation minimally invasive fluoroscopy is used to guide percutaneous placement of needles, fine fiberoptic cable is passed into the center of the disk; the laser is activated low complication rate (<2%) The Dugat study reported recurrence of clinical signs over 3 years as (20%) dogs suspected > procedure may be dangerous to the spinal cord if there is rupture of the annulus, and current recommendations 6 weeks or more after any sx Forterre’s MRI study confirmed that all fenestrated dogs had residual material within the disk > allowing for potential of reherniation The effectiveness of fenestration, therefore would appear to be directly related to the skill and experience of the operator >>> whether removal of more nucleus corresponds to a greater prophylactic benefit has not yet been answered

Answer 19

most common long-term complication after decompressive spinal surgery Good evidence that that a fenestrated disc is less likely to extrude Brisson found that its protective, with only 8% of recurrences occurring at a previously fenestrated site. Multiple studies shown most recurrences occur at a new disk space > 70% in a region that could have been readily fenestrated during the first surgery. Early recurrence is almost solely due to reherniation of the same disk space >>> radiographic evidence of mineralization at the herniated IVD space support fenestration of the affected disc space at the time of decompressive surgery >>> it is intuitive to consider if there was only low volume found during decompressive surgery. The reported complications rates appears very low, of >1,000 cases reported in the studies, complications from fenestration were noted in only 15 cases (0.01%) Avoids morbidity, costs, and potential choice of euthanasia for dogs affected a second or more Perhaps especially pertinent in dachshunds and French bulldogs.

Answer 20

There are lots of studies on outcomes of IVDD, but most have small numbers. These are the more pertinent large scale studies > as you can see, most are retrospective. The Necas + Mayhew are non Fenestration studies as a comparison Brisson 2011: Well- designed prospective trial compared the recurrence rate in dogs that underwent decompressive surgery and were either fenestrated at a single site or multi-disc There was a substantial reduction in risk of recurrence in the multifenestrated group (7% vs 17%) odds of recurrence at a nonfenestrated disk space were approximately 11 times the odds of recurrence at a fenestrated disk space Aikawa study: less that 3% recurrence rate of confirmed cases, and this is the results of ONE surgeon >>> extrusion at non-PF discs was found to be 26.2 times higher than that of PF discs Dugat laser ablation study > 3.6% recurrence, were confirmed by means of CT or MRI and hemilaminectomy

Answer 21

increase anaesthetics and surgical times (prolonged recovery, increased infection risk and increased surgery cost) displacement of disc material into the vertebral (important > where you cant check the vertebral canal– Harris 2020 showed this occurred in of 7/21 cases, >> clinical significance is unknown spinal cord trauma (worsening of neurologic deficits) Haemorrhage (including due to laceration of aorta) soft tissue and nerve root trauma (leading to postoperative pain, scoliosis and abdominal wall weakness) Difficulty identifying disc spaces for fenestration (including suboptimal removal of disc) Pneumothorax + Discospondylitis + vertebral subluxation and instability Fenestration of healthy discs leads to accelerate degeneration within disc and also affects biomechanics, > Hills biomechanical study revealed that fenestration most significant, single destabilizing factor when compared to hemilaminectomies >may result in abnormal biomechanical forces being exerted on the disks adjacent to the treated sites, leading to extrusion (so called ASD)

Answer 22

Several challenges exist in interpreting the existing literature on fenestration No studies have prospectively compared recurrence rates for patients with fenestration to those without fenestration Retrosepctive studies have no controls, no blinding, differences in # + sites of fenestration, the technique, surgeon’s skill level, follow-up time, and sample population While Brisson prospective study shows reduced recurrence with multi-disc PF, it doesn’t compare to not fenestration at all. And as I pointed out earlier, the overall incidence of recurrence may not be a low as suggested in the PF studies Mayhew > the incidence of recurrence without PF combined is 9.1% of 1,184 dogs across several studies , but the true incidence is no known due to these challenges of comparing literature. The large variation in recurrence number for both groups probably suggests there are multiple factors that influence recurrence and that fenestration is not a perfect solution

Answer 23

heamorrhage iatrogenic damage wrong site inadeuate disc removal

Answer 24

PMM 10% (olby, takahashi 2020) inadequte decompression instability infection 0.6% (dyall) reperfusion injury peridural fibrosis recurrence ongoing neuro deficits - 20% high grade urinary incontinence (skytte 2018) - most reocvery micturition before ambulation (90%) - G1-4 2-6 days - G5 14 days if deteriorate > cosndier reimage Post op care - analgesia, recumebency care, pneumonia/regurge - physio (olby 2005) 5 step protocol, possibly reduce post-op probpems and retunr to function quicker

Answer 25

From left to right - Kirby intracapsular lens retractor hook - Angled nerve hook - House curette - Curved dental tartar scraper - Angled ball probe

Answer 26

void via expression (only 50% out) vs indwelling or intermittent ucath q6-8hr: prospective study suggests that duration required to express rather than method associated with UTI Pelvic nerve (S1-S3) - Parasympathetic to detrusor muscle - motor - urine void (contraction) Pudendal nerve (S1-S3) - Somatic innervation - external urethral sphincter, perineal musculature, anal sphincter and skin of perineum - urine store: inc tone external sphincter - urine void: reduce external tone Hypogastric nerve (L1-L2) - Sympathetic innervation - internal urethral sphincter - detrusor muscle. - urine storage (b detrusor relax, a sphinctor increased tone >>Inhibits parasympathetic neurons during urine storage.

Answer 27

large, firm, difficutl to express Tx: aim to reduce internal sphincter tone - prazosin (a1 specific, rapid) - phenoxybenzamine (a1 and a2, may reduce BP) reeduce external tone (diazepam) bethanacol if atony LMN: dt intact hypgastric casuing dtrusir to relax and non-intact pelvic/pudedal reduce sphinctor tone) STUDY: no improvement in urinary continence scores at the time of discharge from the hospital when medications given. development of bacteriuria was significantly associated with administration of medication

Answer 28

Hemivertebrae - Incompletely formed, wedge shaped vertebrae resulting from failure of one or more sclerotomes to form during embryogenesis. - Can prediapose Frenchies to lumbar IVDE and also place at higher risk of myelomalacia Block Vertebrae - Fused vertebrae due to failure of vertebral segmentation Butterfly vertebrae - A sagittal cleft witihin the vertebral body

Answer 29

Spina bifida occulta - no external evidence Spina bifida cystica - concurrent meningocoele, meningomyelocoele or myeloschisis Spina bifida aperta - open dysraphic/myelodysplastic disorders Spina bifida is failure of the lamina to fuse dorsally, often associated with other neural tube malformations

Answer 30

A congenital condition wherein the skin failts to completely seperate from the neural tube. aka Dermoid sinus, Rh. Ridgebacks overrepresented

Answer 31

Incomplete seperation of the neuroectoderm from the ectodermal tissue, trapping viable ectodermal cells within the CNS

Answer 32

A focal accumulation of CSF within the arachnoid membrane or subarachnoid space. Controversy if this causes cord compression and subsequent atrophy or if spinal cord atrophy leave extra space which then fills with CSF Pugs and Rottweilers overrepresented Surgical marsupialisation best outcome

Answer 33

Incomplete or abnormal fusion of the neural tube along the sagittal plant. Aka dysraphism Weimeraners overrepresented. Microscopic - no visible on CT myelogram. All dogs will have a bunny-hopping gait

Answer 34

SSI Rate in hemi without Perioperative Antibiotic. retrospectively review the surgical site the SSI rate was 0.6% (expected SSI rate in clean 2.0 to 4.8% ) the routine use of perioperative antibiotic prophylaxis should be reconsidered

Answer 35

JAVMA study: The prevalence of feline IVDD significantly increases with progressive age, with the thoracic and cervical IVDs showing the highest odds for degeneration. However, extreme stages of IVDD were only occasionally observed

Answer 36

Three cats were treated by surgical decompression plus antimicrobial therapy and one cat was treated medically. All cats showed satisfactory improvement following treatment over a follow-up period of 3 months. Spinal epidural empyema is a rare condition but all cats in this series had favourable outcomes.

Answer 37

Retrospective, single centre study on 273 client Seven of 151 dogs in the early surgery group lost pain perception overnight compared to 15 of 122 in the delayed surgery group - recovery of pain perception (by 3w): 5/7 early sx, 8/14 delayed This study suggests that an overnight delay before spinal decompression increases the risk of clinically meaningful deterioration in dogs unable to walk following thoracolumbar disc extrusion.

Answer 38

Twenty-one dogs that underwent hemilaminectomy and fenestration 7/21 new disc material in the vertebral canal post fenestration (33%) Conclusion This illustrates the importance of checking the vertebral canal after fenestration of an extruded intervertebral disc.

Answer 39

Study design: Prospective study. Animals: Six healthy research dogs. - fluoroscopic positioning (radiation) with operating microscope - vertebral canal successfully accessed → visualisation of ventral aspect of spinal cord - no complications, post-op pain not different to baseline in 5/6 dogs

Answer 40

duration of pre-op clinical signs and rate of onset not correlated with return of pain sensation, urinary continence or ambulation - pre-op neuro grade main variable associated with recovery/outcome - more severe (gr0) → slower time to recovery of urinary continence, less likely to return to ambulation, longer recovery time to ambulation timing of surgery for the dogs in this retrospective study was decided by the clinicians. As a result, there may have been a bias

Answer 41

Retrospective case series with nested cohort study 54 dogs weighing < 20 kg (44 lb) that were surgically treated for Hansen type 1 IVDE 54 dogs weighing < 20 kg (44 lb) that were surgically treated for Hansen type 1 IVDE

Answer 42

surgeon’s perception of adequate spinal cord decompression may be less reliable than postoperative MRI findings.

Answer 43

Ex vivo study. bolus intermittent irrigation maintains lower vertebral canal temperature vs continuous Drilling was performed for 15 s followed by a 10-s pause

Answer 44

Study design: Retrospective clinical study. 28 dogs. EHLD – cranial extension → length of T2W intramedullary hyperintensity (6-13 sites) - PMM diagnosed macroscopically or presumptive in HL group - return to ambulation not discussed - survival rate: HL-alone 11/18 vs ELHD 10/10

Answer 45

presentation: non-painful pelvic limb ataxia, paraparesis - T4-T5 stenosis most common in neurologically affected (10/185) - stenosis more severe in neurologically affected: stenotic ratio 0.56 67% sens/spec - clinical improvement (9/10) or stasis (1/10) with medical or surgical tx - T2-T3 most common in normal dogs (33/175)

Answer 46

Forty-three (51%) dogs that had decompressive surgery for thoracolumbar (n=29) or cervical (n=14) intervertebral disc extrusion suffered recurrence of signs. The median time between decompressive surgery and recurrence of clinical signs was 9 months and 21 days

Answer 47

common findings in screw-tailed brachycephalic breeds and in pugs. cause neurological signs due to spinal cord compression, instability or both. Medicalmanagement of CTVBM has been associatedwith an unfavourable outcome, leading to the progression Most described techniques have used a dorsal approach transthoracic vertebral distraction-stabilization for congenital thoracic vertebral malformations - intercostal thoracotomy → Caspar distractor → screw/PMMA - age at sx 5-43m (majority <10m) - 1/10 cardiac arrest 24hr post-op - Cobb angle improvement (33-83°→10-46°); vertebral canal angle improvement - neurological improvement: 9/10 improved post-op, 7/9 neurologically normal

Answer 48

spinal stabilization with 3D-printed drill guides for TL spinal deformities - 12 pugs, 8 French Bulldogs – 19/20 gr2, 1/20 gr1 - 3D printed drill guide → pedicle screws and PMMA - no post-op complications, optimal screw placement 169/201 - neurological function: 16/20 no change at 24hr post 17/20 static, 2/20 improved short term 6/10 static, 3/10 improved at median 883.5d

Answer 49

Retrospective, Fifty-nine client-owned dogs outcomes and prognostic indicators for medium-large breed with extensive epidural hemorrhage secondary to IVDD - 22/59 DP, 37/59 DPN - return to ambulation: DPP 17/22 (77.3%), DPN 14/37 (37.8%) - PMM in 3/59 (5.1%) - 1/3 DPP, 2/3 DPN -negative: signal interruption on HASTE, DPN - longer decompression → better outcome - pathophysiology: epidural hemorrhage → compression, reduced perfusion > SCI

Answer 50

Study Design Retrospective, single-center study. Results Thirty-six dogs More TL HNPE (11/21) were treated surgically compared with C HNPE (4/15) HNPE – TL vs cervical cases - TL HNPE → spinal hyperaesthesia, disc material more often lateralized - >90% acute onset with vigorous activity; median gr3, 72.2% non-ambulatory - outcomes similar to cervical HNPE – 100% recovery of ambulation (fu 30d), 21.7% full

Answer 51

percutaneous laser disc ablation - applied to T10-L5 to reduce recurrence after previous IVDD - appeared safe – MRI detected endplate lesions and mild diskitis concern was raised in a previous study regarding effectiveness in dehydrated and mineralized disks, documenting recurrence at disk sites that were shown to have complete/ mature mineralization present at the time of PLDA

Answer 52

Urinary continence was recovered in 12 (86%) of 14 affected dogs, faecal continence recovered in nine (90%) of 10 affected dogs and tail function recovered in 13 (87%) of 15 affected dogs. The prognosis for functional recovery following surgical treatment is good.

Answer 53

61 dogs. complications were reported, mainly inadvertent removal (n = 11) and peristomal urine leakage (6). Tube cystostomy facilitates early hospital discharge and allows at-home, extended urinary management in dogs .reported as easy to use by owners positive culture was confirmed in 11 of 13 dogs (85% of dogs tested, 20% of dogs with follow-up data available). U-cath infections common (30-55%) | 4 of the 39 (10.3%) dogs developed a UTI

Answer 54

433 dogs impact of clinical signs, time to surgery and neuro grade for IVDD - poorer outcome: acute onset of clinical signs, worse neuro grade (DPN) at presentation - duration of clinical signs and time of sx not correlated with time to recovery, return of pain sensation, urinary continence or ambulation - return to ambulation: 72.7% overall - 32% full, 40.7% partial, 13.8% incomplete, 7.9% poor - 5.6% progression of disease or PMM Conclusion Dogs presented with severe neurological status and/or rapid onset of clinical signs were operated on more promptly, but their outcomes were also poorer. There was no significant evidence for a better outcome when surgery was not delayed.

Answer 55

The concept of vertebral instability as the cause of the spinal cord injury has been controversial and sparsely investigated in veterinary medicine APs contribute up to 30% of the stability of the vertebral column in normal dogs In a recent report18 on Pug dogs, dynamic myelographic study was used to confirm single or multiple dynamic thoracolumbar spinal cord compressive lesions associated with or without AP anomalies. The decompression and stabilization of these segments resulted in good outcomes.18

Answer 56

total volume of the materials that had extruded into the vertebral canal plus the intervertebral space was greater than the volume of the intervertebral disks without herniation There was a weak positive correlation between the volume of the extruded materials at the herniated site and the neurologic severity Previous studies have found that the maximal transverse spinal cord compression ratio is not correlated with neurologic severity in dogs with type I TL-IVDH on the basis of MRI images.9,10

Answer 57

Fifty percent of included dogs had evidence of gastroesophageal reflux. Brachycephalic dogs did not demonstrate significantly higher rates of reflux compared to non-brachycephalic dogs.

Answer 58

Prospectively. effect of timing of sx on rapidity of recovery for G4 TL IVDD - all dogs operated within 72hr (variation in timing short) - only 14.5% had delay >6.5 hour - 148/151 (98%) return to ambulation – all cases recovered ambulation within 30d (med 5d) - residual neuro deficit: 81/151 gr2 (53.6%), 4/151 gr1 (2.6%) 63/151 (41.7%) gr0

Answer 59

Prospective cohort study series. Materials and methods Forty-nine French Bulldogs and Pugs vertebral body malformations in French bulldogs and pugs - breed-associated malformations: French bulldogs – butterfly vertebra; Pugs – transitional - new subtype: dorsal wedge described - neurological deficits - not associated with presence, number or subtype of malformation - Pugs – neuro deficits associated with Cobb angle >35° (kyphosis) - French Bulldogs → pathology distant to vertebral malformation – IVDD most common

Answer 60

presence of IVD calcification was higher in dogs with 2 copies of FGF4L2 (84.8%) compared to 0 copies (18.5%).1 However, data from a prospective, controlled study lacking.

Answer 61

high degree of kyphosis may not be the only risk factor for development of clinical disease, as is suggested by previously reported findings of high Cobb angles exceeding 35° in French Bulldogs without neurologic deficits.18 Indeed, Cobb angle measurements may not represent all clinically important characteristics of spinal curvature abnormalities.

Answer 62

Conclusions and Clinical Importance: Short-term, prophylactic omeprazole treatment did not decrease clinically detectable GI complications in dogs with acute TL-IVDE. Consistent with this conclusion, previous studies have shown that prophylactic omeprazole, cimetidine, sucralfate, or misoprostol treatment does not decrease clinical GI complications or mucosal evidence or progression of GI lesions in dogs

Answer 63

abnormality in the reflex arc that allows the urethral sphincter to relax at the initiation of detrusor contraction and urination. The lesion is thought to be in the reticulospinal tract, Onuf nucleus, or the caudal mesenteric ganglion, and it is possible that the lesion involves the loss of inhibitory signals to the pudendal and hypogastric nerves Clinical signs are similar to those of mechanical obstruction. The animal often postures to urinate and is able to produce a urine stream that quickly becomes attenuated or stops completely. Ultrasonography is recommended to assess the ureters and renal pelves. Additional diagnostics, including contrast urethrography, urethroscopy, or urodynamic evaluation, may be necessary to verify the diagnosis treatment: prazosin, an alpha1adrenergic-specific antagonist with demonstrated effects on both the internal and external urethral sphincters. Tamsulosin, which is specific for the alpha1A subtype found in the internal urethral sphincter, has alsobeen successful in these dogs. Some dogs require additional therapy if the striated muscle is more significantly affected. Benzodiazepines, severe and refractory cases, intermittent sterile catheterization by the owner at home may be necessary Prognosis for recovery of normal voiding is good, but most dogs require lifelong therapy for DUD.

Answer 64

- extent of surgery: laminectomy → 2 vert body lengths cranial and caudal durotomy – not standardised – based on CSF signal (min 4 vert body) - recovery to ambulation: 16/26 (61.5%); 1/16 PMM → euthanasia - appeared to improve outcome – calculated recovery rate 71% - herniation of softened/liquid cord → non-rcovery - no adverse effects of durotomy

Answer 65

Takahashi 2020 – effect of durotomy in DPN TL-IVDD - return to ambulation: durotomy → higher rate 56.9% vs hemilaminectomy alone 38.5% - associated with: durotomy, breed, surgical site, T2W hyperintensity length:L2 body - French Bulldog → less likely to have good recovery - Mini-Dachshunds → more likely to have good recovery - thoracic/TL site → poorer recovery vs lumbar - T2W:L2 ratio >6 → 22.6% return to ambulation vs 2-4 75% - incidence of PMM: 14/65 hemilaminectomy alone died of suspected PMM, vs 0 durotomy

Answer 66

retrospective. investigate if weekend surgery is associated with poorer outcomes 401 weekday and 59 dogs weekend Cohort Weekend had a higher risk of not recovering ambulation compared to Cohort WD 79.2% vs. 91.6% recovery

Answer 67

retrospective intramedullary oval-shaped space-occupying lesions that appeared hyperintense on T2-weighted images rare primary neural tumours that originate from the ependymal lining of the ventricles and central canal of the spinal cord Surgery offered a dual benefit by facilitating intra-vitam diagnosis and, in some cases, extending survival time All surgically treated (5 dogs) except one (case 8) showed a mild post-operative neurological deterioration; none of the paretic dog became paralysed and, moreover, they all showed improvement within the first week after surgery symptoms relapsed, owners opted for euthanasia.

Answer 68

thoracic or lumbar partial lateral corpectomy (PLC) in cats with spinal cord compression due to intervertebral disc herniation (IVH). Outcomes: 5 cats with an excellent result, 3 with significant improvement, 1 mild improvement and 3 cats that died haemorrhage > 25% mortality rate.

Answer 69

The most common change was IVDD, followed by SD and intervertebral disk protrusion (IVDP), while intervertebral disk extrusion (IVDE) were uncommon to rare. Primary complaint was attributed to a degenerative condition in 22% of cats, including 100% with IVDE, 9% with IVDP, and 43% with degenerative lumbosacral stenosis DLSS for signs of myelopathy, IVDE was always responsible for the clinical presentation IVDP and DLSS might not be associated with the reason for consultation in cats presenting with signs of myelopathy