Disorders of the Cervical Spine Flashcards
How do cervical spinal cord lesions affect the limbs? What are 4 other general clinical features?
thoracic limb lameness and paresis —> hemiparesis/plegia, tetraparesis/plegia
- neck pain
- Horner’s syndrome
- respiratory difficulty
- UMN bladder dysfunction
How should patients be palpated for neck pain?
- palpate ventrally with a flat palm facing dorsally
- move trachea laterally with fingers falling into bony midline proturberances
What is characteristic of C1-C5 lesions?
intractable pain
What is motion-sensitive pain indicative of?
spinal nerve impingement
What are 4 characteristics of C6-T2 lesions?
- poor withdrawal reflex
- cutaneous trunci deficit
- two engine gait - short, choppy gait with long, sweeping gait
- rotational abnormalities
What is a root signature?
thoracic limb lameness + holding up the thoracic limb due to nerve root irritation
What is the Schiff-Sherrington phenomenon? What causes it?
extensor rigidity of the thoracic limb most notable when in lateral recumbency —> otherwise normal neurologically
interruption of ascending influence from lumbar border cells to C6-T2 neruons
What is central cord syndrome? What causes it? What limbs are most commonly affected?
LMNs in cervical intumescence damaged, but tracts to the pelvic limbs are largely untouched
lesion starting centrally in the gray matter and moves outward —> syringomyelia or neoplasia
LMN disfunction of thoracic limbs, pelvic limbs normal or mildly impaired
What are the 4 most common cervical cases?
- Type I disk disease - acute, Frenchies
- OA-CSM - giant breed Wobblers
- AA, syringomyelia - congenital
- Type II or chronic Type I disk disease - older dogs
What typically dictates whether clients pursue surgery for cervical myelopathy? What treatment can be recommended when in doubt? What type of treatment should be done carefully?
(lack of) response to medical therapy
exercise restriction
rehabilitation —> can be dangerous with absence of diagnosis
What are 3 aspects to conventional medical treatments for cervical myelopathy?
- pain management with Gabapentin, Pregablin, Amantadine, and acupuncture/laser
- anti-inflammatories - NSAIDs or prednisone (not both!)
- Methocarbamol - reduce muscle spasms
What additional treatment strategies can be added to medical management of cervical myelopathy?
- exercise restriction/modification
- controlled exercises, like PROM
- neck wraps/splints
What are 5 traditional Chinese veterinary medicine options for patients with cervical myelopathy?
- acupuncture
- herbal therapy
- food therapy
- Tui-Na massage
- exercise therapy
What are the 3 main medical approaches to cervical disk disease?
- strict confinement about 2 weeks
- pain management - Gabapentin, Pregablin, Amantadine, and acupuncture/laser
- muscle relaxants - Methocarbamol
What is the difference between Type I and II disk disease?
I = characterized by the extrusion of the disc, common in dogs that have a long back and short legs; good to excellent prognosis with strong response to therapy and rare surgical procedures
II = protrusion of the disc, more common in larger breeds of dogs
What are the 4 major indications for surgery in cases of cervical myelopathy?
- intractable pain
- repeat episodes
- non-ambulatory status
- neurologic worsening with medical therapy
What is Wobbler syndrome? What are the 2 distinct etiologies?
cervical spondylomyelopathy (CSM), which causes spinal cord compression in large to giant breed dogs
- disk associated (DA-CSM)
- osseous associated (OA-CSM)
What causes disk-associated CSM? What does this result in?
chronic instability from cervical malformation/malarticulation leading to progressive hypertrophy of soft-tissue structures, including the disk
impingement of spinal cord
What is the most common signalment associated with DA-CSM? What type of disk disease is this?
middle-aged to older large breed dogs, like the Doberman Pinscher
Type II disk protrusion with vertebral instability
Where in the spinal cord is most commonly affected by DA-CSM? What clinical feature is most common?
caudal cervical - C5-C6 and C6-C7
two engine gait
What are 3 possible causes of OA-CSM? What do these result in?
- congenital bony stenosis (Jing deficiency)
- bone proliferation of articular processes, peducle, and lamina
- articular process joint proliferation
narrowed vertebral canal with spinal cord compression
What signalment is most commonly associated with OA-CSM? What clinical sign is most common?
young (1-3 y/o) giant breeds - Great Dane, Mastiff
progressive gait abnormality
What sites are most commonly affected by OA-CSM? What is commonly found on MRI?
multiple sites (cranial/caudal) - C1-C5 or C6-T2 type gait abnormalities
lateral and dorsolateral cord compression —> disks are normal
How can thoracic limb proprioceptive deficits be elucidated in possible Wobbler syndrome cases? What diagnostic is commonly avoided?
blindfold or take away vision
myelography - antiquated, often worsens myelopathy, can cause seizure
What are 4 MRI features of DA-CSM?
- often at one site
- intervertebral step
- ventral compression with protruded annulus
- improvement with flexion views = dynamic
What are 4 MRI features of OA-CSM?
- often at multiple sites
- no intervertebral step
- lateral and dorsal compression with no protruded annulus
- minimal to no improvement with dynamic views
What are the 5 approaches to medical management of DA/OA-CSM?
- initial cage confinement
- anti-inflammatories
- other anti-nociceptive drugs
- TCVM therapy
- neck brace
When is surgical recovery especially prolonged in cases of CSM? What 2 additional therapies are added post-op?
dorsal procedures
- pain management
- physical therapy - especially in giant breeds
What is the prognosis for DA-CSM like?
- generally favorable with long-term medical management
- surgical success varies 70-90% improvement
- post-operative recurrence up to 28%, lower with FITS/SOP procedures
What is the prognosis for OA-CSM like?
- generally respond to long-term medical management, but neurological worsening is common - more likely to be euthanized
- surgical success = 80% neurological improvement
How do DA/OA-CSM compare with medical management and surgical outcomes?
DA - often resonds to long-term medical therapy with stable neurologic status, high surgical success rate with moderate relapses - prevalence has decreased
OA - often resonds to long-term medical therapy, but tend to worsen over time, high surgical success rate with low relapses - prevalence has increased
What are some alternative options for managing post-operative pain with Wobbler syndrome procedures?
- electro acupuncture at Jing-jia-ji points
- cold therapy with ice packs in the first 24 hrs
