General Knowledge Flashcards
The prognosis in case of a compressive acute thoracolumbar disc extrusion is:
A) always better with surgical management
B) grave in case of Schiff-Sherrington posture
C) very poor in case of loss of nociception for more than 48h
D) very poor in case of loss of the withdrawal reflex
C) very poor in case of loss of nociception for more than 48h
A 3-year-old, male neutered Dachshund was presented with paraplegia. MRI revealed a left sided extradural lesion at the level of T13-L1 consistent with a disc extrusion. Which surgery would you recommend?
Left hemilaminectomy
A dog was presented with a history of spinal trauma and you suspect a vertebral fracture and/or subluxation. The dog has no deep pain. Which of the following options would you initially choose?
A) Laterolateral and horizontal-beam ventrodorsal radiographs
B) Laterolateral and a ventrodorsal radiographs
C) MRI
D) Scintigraphy
A) Laterolateral and horizontal-beam ventrodorsal radiographs
What it the most common clinical sign in cases of mild cervical intervertebral disc disease?
Pain
The Schiff Sherrington posture is:
A) seen in case of cervical injury
B) is associated with a poor prognosis
C) is not a prognosis indicator
D) is only seen in cases of spinal trauma
C) is not a prognosis indicator
Which of the following statements regarding intervertebral disc degeneration is correct?
A) Chondroid degeneration is seen in chondrodystrophoid breeds late in life
B) Chondroid degeneration is seen in non-chondrodystrophoid breeds later in life
C) Chondroid degeneration is seen in chondrodystrophoid breeds early in life
D) Chondroid degeneration is seen in non-chondrodystrophoid breeds early in life
C) Chondroid degeneration is seen in chondrodystrophoid breeds early in life
Define Hansen type 1 disc extrusion?
Rapid extrusion of nuclear disc material through the annulus fibrosus resulting in spinal cord compression.
What is the most significant advantage of locking screws over cortical screws when used with PMMA cement in spinal fracture stabilisation?
Locking screws have a larger core diameter, greatly increasing their strength
describes the pathophysiology of acute non-compressive nucleus pulposus extrusion (ANNPE)?
Changes in the spinal cord secondary to an acute impact of extruded disc material following a traumatic incident
What is the most appropriate duration of antibiotics for medical treatment of spinal empyema?
4 weeks
Which of the following is not a recognised complication of surgery for thoracolumbar disc disease?
A) Respiratory compromise
B) Incomplete decompression of the cord
C) Post-surgical seroma formation
D) Bleeding from a venous sinus
A) Respiratory compromise
In surgery for thoracolumbar disc disease, in which of the following situations are post-operative antibiotics justified?
A) Where the surgeon identifies a breached surgical glove and changes glove(s) during the procedure
B) Where more than one disc space is fenestrated
C) Where monopolar diathermy is used
D) Where the surgery time is overlong
D) Where the surgery time is overlong
In what proportion of dogs has progressive myelomalacia (PMM) been reported following an acute spinal cord injury resulting in neurological grade 5 clinical signs?
10-15%
Which of the following medications is not appropriate for conservative management in cases of thoracolumbar disc disease?
A) Paracetamol
B) Meloxicam
C) Gabapentin
D) Dexamethasone
D) Dexamethasone
Which of the following is a common complication following a lumbosacral dorsal laminectomy?
Venous sinus drainage
Faecal incontinance
Incomplete decompression
Articular facet fracture
Venous sinus drainage
Incomplete decompression
Articular facet fracture
Are you now prepared to decide when and where it would be most appropriate to manage a cervical spinal case and whether this is either surgical or non- surgical? Have a look at the examples below and drag them into the category representing the most appropriate management.
Atlanto-axial subluxation, osseous associated wobbler
Surgical
Are you now prepared to decide when and where it would be most appropriate to manage a cervical spinal case and whether this is either surgical or non- surgical? Have a look at the examples below and drag them into the category representing the most appropriate management.
Disc associated wobbler syndrome, cervical disc herniation
Surgical or conservative
Are you now prepared to decide when and where it would be most appropriate to manage a cervical spinal case and whether this is either surgical or non- surgical? Have a look at the examples below and drag them into the category representing the most appropriate management.
Hydrated nucleus pulposus extrusion
Conservative
Which of the following statements relating to disc associated wobbler syndrome are true?
It is usually seen in Giant breeds
It is usually seen in young < 2-year-old dogs
It is recognised in the Dobermann and Dalmatian
The mean age of onset is around 7-8 years
It is associated with Hansen type II disc protrusion
It is recognised in the Dobermann and Dalmatian
The mean age of onset is around 7-8 years
It is associated with Hansen type II disc protrusion
What is the most common clinical signs associated with cervical disc herniation?
Neck pain
In a post-operative patient experiencing urinary incontinence following lumbosacral surgery, what would be a suitable management option?
Three times daily manual bladder expression
Placement of an indwelling Foley catheter
Which Cervical disc space is most commonly affected by disc herniation?
C2-C3
Which of the following is not a common findings on clinical exam of a patient with lumbosacral stenosis?
Proprioceptive deficits
Low tail carriage
Reduced anal tone
Pelvic limb paresis
Pelvic limb paresis
What is the recommended width of a ventral slot?
30-50% of width of vertebral body
A dorsal cervical approach would be advised for which of the conditions listed below?
Ventral cervical disc extrusion
Osseous associated wobbler
Disc associated wobbler syndrome
Lateralised cervical disc extrusion
Arachnoid cyst
Osseous associated wobbler
Lateralised cervical disc extrusion
Arachnoid cyst
What are the landmarks for cisternal CSF?
Occipital crest and wings of C1.
What dose of contrast medium can you use for myelography and why do you need to inject it slowly?
A non-ionic contrast medium
bradycardia is not uncommon when the contrast is injected too fast.
Extradural lesion ventral to the spinal cord centered above the C2-C3 disc space causing midline spinal cord compression.
What is your diagnosis?
C2-C3 intervertebral disc extrusion.
C2-C3 intervertebral disc extrusion.
How to manage?
Rest, physiotherapy and multimodal pain relief (NSAIDs/Gabapentin/paracetamol)
Surgical management with ventral slot at C2-C3.
Ventral slot; Risks and possible complications? (6)
Venous sinus bleed
Subluxation/instability due to large slot size
Redistribution of disc material
Impaired ventilation
Incomplete decompression
Neurological deterioration.
What anatomic structures are relevant to ventral slot surgery? (4)
Oesophagus
laryngeal recurrent nerve
vagosypamthetic trunk
internal jugular vein and carotid.
How to approach ventral slot of C2-C3?
Midline approach of cervical spine
Why is vicryl used for suture of longus coli muscle following ventral slot?
Reduce risks of trauma to oesophagus
Why is surgical glue used for the skin for ventral slot?
No tension and provide seal over wound where bandage would not stay very easily(i.e., under the neck).
What options are available to you to manage C6-C7 wobblers?
Conservative management with:
- Rest, physiotherapy and anti-inflammatory.
Surgical management with:
- Distraction/stabilisation with screws and bone cement
- Or cervical disc arthroplasty.
C6-C7 distraction/stabilisation with screws and bone cement (polymethyl methacrylate PMMA)
Risks and possible complications (7)
Haemorrhage (venous sinus / vertebral artery)
Implant failure
Infection
Impaired ventilation
Adjacent segment syndrome
Implant subsidence (loss height disc space)
Neurological deterioration.
C6-C7 distraction/stabilisation with screws and bone cement (polymethyl methacrylate PMMA)
Anatomical structures relevant to surgery (7)
Oesophagus
laryngeal recurrent nerve
vagosypamthetic trunk
jugular
carotid a.
vertebral a.
cranial mediastinum.
How to reduce peri op Inaccurate implant placement.
3D printed patient specific drill guides.
What localisation effects the right brachial plexus?
C6-T2
Localise this lesion:
Decreased postural reactions right thoracic limb (reduced hopping)
Reduced withdrawal in right thoracic limb
Hyperaesthesia of right thoracic limb.
Cutaneous trunci reflex absent on right side
Lesion of the right lateral thoracic nerve (efferent part of the reflex affected).
Procidence 3rd eyelid right eye – anisocoria with right sided miosis
Horner syndrome.
C6-T2
The Shiff-Sherrington and cutaneous trunci reflex are suggestive of what lesion?
T3-L3
The reduced withdrawal reflexes in the pelvic limbs of a dog with T3-L3 could be suggestive of LMN signs but in could represent what than can lead to reduced withdrawal despite a T3-L3.
SPINAL SHOCK
Spinal shcok - prognosis?
Poor prognosis indicator
Pathology behind a FCE?
Fibrocartilaginous embolic myelopathy (FCEM) occurs when microscopic pieces of an intervertebral disc lodge in the blood vessels that supply blood to the spinal cord. The end result is spinal cord ischemia or infarction. The cause of FCEM is unknown.
Decreased withdrawal and muscle tone in all limbs is consistent with what localisation?
LMN signs (lower motor neuron signs) which is unlikely explained by a spinal lesion but much more likely by a disease of the neuromuscular system.
What structures does the neuromuscular system includes?
Peripheral nerve (Lower Motor neuron)
Muscle
Neuromuscular junction
Generalised weakness and LMN signs -> neuromuscular disease.
D/Dx? (10)
Myasthenia gravis
Organophosphate toxicity
Myopathy
- Infectious (Neospora/Toxoplasma)
- Inflammatory (idiopathic immune)
- Endocrine/metabolic (hypothyroidism, electrolyte imbalance)
- Hereditary
Neuropathy:
- Infectious (Neospora/Toxoplasma)
- Inflammatory (idiopathic immune)
- Endocrine/metabolic
- Hereditary
What is Edrophonium test (Tensilon test) used for?
short treatment trial for junctionopathy.
What tests to evaluate myopathies and electrolytes?
Haematology Biochemistry including CK
What test for Acquired Myasthenia Gravis?
Serology for Acetylcholine receptors Ab
What is Edrophonium?
A short and rapid acting reversible acetylcholinesterase inhibitor
- It prevents breakdown of the neurotransmitter acetylcholine and acts by competitively inhibiting the enzyme acetylcholinesterase, mainly at the neuromuscular junction.
If there is a positive response to edrophonium; what is this suggestive of?
junctionopathy like Myasthenia Gravis
Repetitive stimulation revealed a gradual reduction in amplitude of the action potential this is compatible with?
Junctionopathy
What are the two possible types of Myasthenia Gravis?
Acquired (immune mediated)
Congenital
How to differentiate acquired vs congenital myasthenia gravis?
ACh receptor antibody only elevated in acquired.
Why tumour can be associated with Myasthenia Gravis in dogs and cats?
Thymoma
Other than neoplasia, what pathology can be identified in the chest in case of Myasthenia gravis? (2)
Megaoesophagus
Aspiration pneumonia
Tx options for myasthenia gravis?
Medical management:
- Anticholinesterasic
- Oral pyridostigmine
- Neostigmine
Immuno-suppressive:
- Prednisolone
- Cyclosporine
The chances of recovery following decompressive spinal surgery to treat an acute thoracolumbar disc extrusion (Hansen type I) with loss of nociception in the pelvic limbs for less than 48h is:
50-60%
Which of the following neurological sign(s) can be seen with a lesion affecting the C6-T2 spinal cord segments?
a) upper motor neuron signs in all four limbs
b) lower motor neuron signs in all four limbs
c) a Horner syndrome
d) increased muscle tone in the front limbs
c) a Horner syndrome
In case of Hansen type I disc herniation treated surgically with hemilaminectomy and fenestration the risk of further disc extrusion at the same site is:
<5%
Which ONE of the following statements about syringomyelia is CORRECT?
a) Syringomyelia is an accumulation of cerebrospinal fluid in the central canal of the spinal cord
b) Syringomyelia is a fluid filled cavitation in the spinal cord which does not have an intact ependymal lining
c) Syringomyelia is always associated with Chiari-like malformation
d) Syringomyelia only occurs in the cervical spinal cord
b) Syringomyelia is a fluid filled cavitation in the spinal cord which does not have an intact ependymal lining
The most common clinical signs in case of early lumbo-sacral disease are:
a) Lumbar pain and reduced withdrawal reflex in the pelvic limb(s)
b) Lumbar pain and reduced perineal reflex
c) Lumbar and pain and tail paralysis
d) Lumbar pain and increased segmental spinal reflexes in the pelvic limb(s)
a) Lumbar pain and reduced withdrawal reflex in the pelvic limb(s)
