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Small Animal Medicine > Disorders of the Cervical Spine > Flashcards

Disorders of the Cervical Spine Flashcards

1
Q

How do cervical spinal cord lesions affect the limbs? What are 4 other general clinical features?

A

thoracic limb lameness and paresis —> hemiparesis/plegia, tetraparesis/plegia

  1. neck pain
  2. Horner’s syndrome
  3. respiratory difficulty
  4. UMN bladder dysfunction
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2
Q

How should patients be palpated for neck pain?

A
  • palpate ventrally with a flat palm facing dorsally
  • move trachea laterally with fingers falling into bony midline proturberances
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3
Q

What is characteristic of C1-C5 lesions?

A

intractable pain

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4
Q

What is motion-sensitive pain indicative of?

A

spinal nerve impingement

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5
Q

What are 4 characteristics of C6-T2 lesions?

A
  1. poor withdrawal reflex
  2. cutaneous trunci deficit
  3. two engine gait - short, choppy gait with long, sweeping gait
  4. rotational abnormalities
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6
Q

What is a root signature?

A

thoracic limb lameness + holding up the thoracic limb due to nerve root irritation

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7
Q

What is the Schiff-Sherrington phenomenon? What causes it?

A

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

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8
Q

What is central cord syndrome? What causes it? What limbs are most commonly affected?

A

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

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9
Q

What are the 4 most common cervical cases?

A
  1. Type I disk disease - acute, Frenchies
  2. OA-CSM - giant breed Wobblers
  3. AA, syringomyelia - congenital
  4. Type II or chronic Type I disk disease - older dogs
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10
Q

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?

A

(lack of) response to medical therapy

exercise restriction

rehabilitation —> can be dangerous with absence of diagnosis

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11
Q

What are 3 aspects to conventional medical treatments for cervical myelopathy?

A
  1. pain management with Gabapentin, Pregablin, Amantadine, and acupuncture/laser
  2. anti-inflammatories - NSAIDs or prednisone (not both!)
  3. Methocarbamol - reduce muscle spasms
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12
Q

What additional treatment strategies can be added to medical management of cervical myelopathy?

A
  • exercise restriction/modification
  • controlled exercises, like PROM
  • neck wraps/splints
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13
Q

What are 5 traditional Chinese veterinary medicine options for patients with cervical myelopathy?

A
  1. acupuncture
  2. herbal therapy
  3. food therapy
  4. Tui-Na massage
  5. exercise therapy
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14
Q

What are the 3 main medical approaches to cervical disk disease?

A
  1. strict confinement about 2 weeks
  2. pain management - Gabapentin, Pregablin, Amantadine, and acupuncture/laser
  3. muscle relaxants - Methocarbamol
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15
Q

What is the difference between Type I and II disk disease?

A

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

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16
Q

What are the 4 major indications for surgery in cases of cervical myelopathy?

A
  1. intractable pain
  2. repeat episodes
  3. non-ambulatory status
  4. neurologic worsening with medical therapy
17
Q

What is Wobbler syndrome? What are the 2 distinct etiologies?

A

cervical spondylomyelopathy (CSM), which causes spinal cord compression in large to giant breed dogs

  1. disk associated (DA-CSM)
  2. osseous associated (OA-CSM)
18
Q

What causes disk-associated CSM? What does this result in?

A

chronic instability from cervical malformation/malarticulation leading to progressive hypertrophy of soft-tissue structures, including the disk

impingement of spinal cord

19
Q

What is the most common signalment associated with DA-CSM? What type of disk disease is this?

A

middle-aged to older large breed dogs, like the Doberman Pinscher

Type II disk protrusion with vertebral instability

20
Q

Where in the spinal cord is most commonly affected by DA-CSM? What clinical feature is most common?

A

caudal cervical - C5-C6 and C6-C7

two engine gait

21
Q

What are 3 possible causes of OA-CSM? What do these result in?

A
  1. congenital bony stenosis (Jing deficiency)
  2. bone proliferation of articular processes, peducle, and lamina
  3. articular process joint proliferation

narrowed vertebral canal with spinal cord compression

22
Q

What signalment is most commonly associated with OA-CSM? What clinical sign is most common?

A

young (1-3 y/o) giant breeds - Great Dane, Mastiff

progressive gait abnormality

23
Q

What sites are most commonly affected by OA-CSM? What is commonly found on MRI?

A

multiple sites (cranial/caudal) - C1-C5 or C6-T2 type gait abnormalities

lateral and dorsolateral cord compression —> disks are normal

24
Q

How can thoracic limb proprioceptive deficits be elucidated in possible Wobbler syndrome cases? What diagnostic is commonly avoided?

A

blindfold or take away vision

myelography - antiquated, often worsens myelopathy, can cause seizure

25
Q

What are 4 MRI features of DA-CSM?

A
  1. often at one site
  2. intervertebral step
  3. ventral compression with protruded annulus
  4. improvement with flexion views = dynamic
26
Q

What are 4 MRI features of OA-CSM?

A
  1. often at multiple sites
  2. no intervertebral step
  3. lateral and dorsal compression with no protruded annulus
  4. minimal to no improvement with dynamic views
27
Q

What are the 5 approaches to medical management of DA/OA-CSM?

A
  1. initial cage confinement
  2. anti-inflammatories
  3. other anti-nociceptive drugs
  4. TCVM therapy
  5. neck brace
28
Q

When is surgical recovery especially prolonged in cases of CSM? What 2 additional therapies are added post-op?

A

dorsal procedures

  1. pain management
  2. physical therapy - especially in giant breeds
29
Q

What is the prognosis for DA-CSM like?

A
  • generally favorable with long-term medical management
  • surgical success varies 70-90% improvement
  • post-operative recurrence up to 28%, lower with FITS/SOP procedures
30
Q

What is the prognosis for OA-CSM like?

A
  • generally respond to long-term medical management, but neurological worsening is common - more likely to be euthanized
  • surgical success = 80% neurological improvement
31
Q

How do DA/OA-CSM compare with medical management and surgical outcomes?

A

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

32
Q

What are some alternative options for managing post-operative pain with Wobbler syndrome procedures?

A
  • electro acupuncture at Jing-jia-ji points
  • cold therapy with ice packs in the first 24 hrs

Small Animal Medicine (52 decks)

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