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Tobias ECVS Exam Prep > Ch 32 - Thoracolumbar Vertebral Column > Flashcards

Ch 32 - Thoracolumbar Vertebral Column Flashcards

1
Q

What attaches to the accessory processes?

A

Tendon of longissimus lumborum musculature

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2
Q

Which is the anticlinal thoracic vertebra?

A

T11

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3
Q

Where is the intervertebral foramen in relation to the zygapophyseal joint?

A

Ventral and slightly cranial

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4
Q

What are the three components of the IVD?

A
  • Annulus fibrosis
  • Nucleus pulposus
  • Cartilaginous end plate
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5
Q

What is each component of the IVD made of?

A

Annulus fibrosis
- concentric lamellae of collagen
Nucleus pulposus
- originates from remnant notochord and chondrocyte-like cells
- Chondroitin sulphate
- keratan sulphate
- type IV collage

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6
Q

What ligaments help to provide stability to the vertebral column?

A

Three long ligaments:
- Dorsal and ventral longitudinal ligaments
- Supraspinous ligament

Three short ligaments:
- interspinous
- intertransverse
- yellow ligaments

Intercapital ligaments (T2-T11)

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7
Q

What volume of methylene blue injection is recommended to aid in localisation?

A

0.05-0.1ml

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8
Q

What muscles are encountered in a dorsal approach to the cranial thoracic spine (T1-T5) which are not encountered more caudally?

A
  • Trapezius
  • Rhomboideus
  • Splenius (cranially)
  • Serratus dorsalis (caudally)
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9
Q

Where does the nuchal ligament attach?

A

Spinous processes of T1 and T2

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10
Q

What is sub-draping?

A

Use of Backhaus towel clamps, michel skin clamps ot suture to complete cover and attach the drapes to the edge of the skin incision

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11
Q

What are the main epaxial muscles encounted on a dorsal approach to the TL spine?

A
  • Multifidus
  • Longissimus lumborum
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12
Q

What epaxial muscles are encountered on a lateral approach to the TL spine?

A
  • Serratus dorsalis caudalis
  • Longissimus lumborum
  • iliocostalis lumborum
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13
Q

Which muscles are seperated to allow a dorsolateral approach to the TL spine?

A

Multifidus and longissimus lumborum

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14
Q

Stabilisation may be required when 2 of 3 of which structures are compromised?

A
  • Vertebral body
  • Intervertebral disc
  • Articular processes
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15
Q

What is the more appropriate term for a hemilaminectomy?

A

hemiarchectomy

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16
Q

What are the anatomic landmarks of a hemilam window?
What parts of the vertebral canal does it allow access to?

A

Landmarks:
- Ventral accessory process
- Base of spinous process
- Base of articular processes cranially and caudally

Access to ventral, dorsal and lateral canal

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17
Q

What is a pediculectomy and mini-hemilam?

A

Pediculectomy - Removes the pedicle over the body of 1 vertebra, leaving the zygapophyseal joint intact

Mini-hemilam - combined pediculectomy over contingous vertebrae

Faster and pediculectomy avoids the spinal nerve, artery and vein. Decreased exposure

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18
Q

What are the three forms for dorsal laminectomy?

A
  • Funkquist A - Removal of spinous process, laminae, articular processes and approx half of the dorsal portion of the pedicles
  • Funkquist B - Leaves the articular processes and pedicles intact
  • Modified dorsal laminectomy - Removal of spinous process, laminae and caudal articular rpocesses are removed. Medial aspect of pedicles can be undercut to enhance exposure
19
Q

What is the accuracy of radigraphs to determine the site of the primary IVDH?

A

51 - 61%

20
Q

What is the sensitivity of myelography in determining the primary site and lateralisation of IVDH?

A
  • Site: 74 - 98%
  • Lateralisation: 55-100%
21
Q

What prognostic factors can be determined from a myelogram?

A

Length of intramedullary pattern / length L2 vert ratio on a lateral view:
- Over 5 = 26% chance of recovery
- Less than 5 = 66% chance recovery

Intraparenchymal spinal cord contrast medium - seen in 6/7 dogs with myelomalacia in one study…

22
Q

What is the reported rate of post-myelographic seizures? What are some risk factors?

A
  • 10-21.4%
  • Risk factors include cisternal myelogram and large body size
23
Q

What is the sensitivty of non-contrast CT for detecting the site and side of IVDH?

A
  • Site: 84-100%
  • Side: 79-94%

MRI has significantly higher sensitivity for site (87% vs79%

24
Q

What is the typical intensity of degenerative IVD material on MRI?

A
  • Hypointense on T1W and T2W

Non-degenerative disc can be isointense on T1W and hyperintense on T2W and blend in with epidural fat and CSF fluid

25
Q

What sequences can be used on MRI to help identify an inconspicuous IVDH?

A
  • T2* can help to identify haemorrhage
  • STIR and FLAIR helpful to identify low volume disc extrusion
  • ultrafast, heavily T2W sequence has appearance of a myelogram
  • Disc material may enhance with gadolinium contrast
26
Q

List some CSF biomarkers with potential prognostic potential in dogs with IVDH

A
  • MMP-9
  • CK
  • Protein tau
  • Glutamate
  • Haptoglobin
  • NCC and protein concentration

Associated with severe spinal cord injury

Increased CK activity and increased protein tau, myelin basic protein and monocyte chemotactic protein 1 conc have been assoc with failure to regain ability to ambulate

27
Q

What is the reported success rate of conservative management with IVDH?

A
  • 82 - 88% ambulatory
  • 43 - 51% non-ambulatory
28
Q

What is a lateral corpectomy?
Success of decompression?
Risks?

A
  • 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
29
Q

What are the improvement rates after corpectomy?

A
  • 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
30
Q

What is the success rate after spinal surgery for dogs with intact nociception?

A

72 - 100%

Inverse relationship between time of onset of nonambulatory status to time of regaining ambulation post-op

31
Q

What is the reported rate of returning to ambulation in dogs with no nociception?

What are the prognostic indicators?

A

43 - 62%

Prognostic Indicators:
- Progressing to nonambulation within 1 hour, poorer prognosis
- Those that do not recover nociception in 2 weeks, unlikely to recovery
- Subdural haemorrhage at surgery may be a negative prognostic indicator
- T2W cord hyperintensity 5 x length of L2 negative prognostic indicator
- Odds of recovery decrease as lenght of T2W cord hyperintensity increase

32
Q

List 2 biomarkers which may be increased in the serum of dogs with spinal cord injury

A
  • Phosphorylated neurofilament
  • MMP
33
Q

Name the following instruments

A

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

34
Q

What is the maximal recommeneded thickness of an autologous free fat graft?

A

3mm

35
Q

What is the reported recurrence rate of surgically treated IVDH? (At either the same site or different site)?
Any known risk factors?

A

15 - 20%

The number of radiographically opacified IVD increases the risk of recurrence 1.4x in non-Dachshund breeds.

36
Q

List some potential alternatives to fenestration for prophylactic treatment

A

Laser disc ablation
-Ho:YAG laser

Chemoneucleolysis
- chymopapain
- collagenase
- chondroitenase ABC

37
Q

List the three main nerves supplying the bladder, their associated spinal cord segments and their main functions

A

Pelvic nerve (S1-S3)
- Parasympathetic supply to the detrusor muscle

Pudendal nerve (S1-S3)
- Somatic innervation to external urethral sphincter, perineal musculature, anal sphincter and skin of perineum

Hypogastric nerve (L1-L2)
- Sympathetic innervation to the internal urethral sphincter, pelvic (parasympathetic) ganglia and detrusor muscle. Inhibits parasympathetic neurons during urine storage.

38
Q

What are hemivertebrae?
Block vertebrae?
Butterfly vertebrae?

A

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

39
Q

What are the three forms of spina bifida?

A
  • 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

40
Q

What is a pilonidal sinus?

A

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

41
Q

What is an epidermoid cyst?

A

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

42
Q

What is a subarachnoid diverticula?

A

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

43
Q

What is myelodysplasia?

A

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

Tobias ECVS Exam Prep (110 decks)

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