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Spinal Surgery II > Lumbo-Sacral Disc Disease > Flashcards

Lumbo-Sacral Disc Disease Flashcards

1
Q

clinical signs most commonly encountered in cases of lumbo-sacral dx. (5)

A
  • Pain with spontaneous yelping/vocalisation usually when jumping or standing up
  • Ipsilateral lameness with possible associated nerve root signature
  • Pain on palpation and mobilisation of the affected limb
  • Paraesthesia with excessive grooming/licking of the affected limb
  • Lower motor neuron signs of the affected limb.
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2
Q

In severe cases of lumbo-sacral dx. What signs may be seen? (2)

A

Paresis/paralysis of the tail
Urinary and/or faecal incontinence

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3
Q

In cases of lumbo-sacral disease the most common abnormalities on neurological examination are (6)

A

1 Proprioceptive deficits

2 Reduced hock flexion

3 Pseudo hyperreflexia patellar reflex

4 Muscle atrophy especially of the tibial cranial muscle can be present.

5 Reduced perineal reflex / anal tone

6 Low tail carriage.

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4
Q

Benefits of advanced imaging for LS dx (4)

A
  • Investigate foraminal stenosis
  • Good visual of vertebral foramen
  • Identify bone proliferations
  • Identify disc calacification extrusion
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4
Q

With lumbo-sacral dx. On the xrays what other dx should be ruled out? (3)

A
  • Discospondylitits
  • Neoplasia
  • Hip dysplasia
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4
Q

What might be seen on survey radiographs of lumbar-sacral dx? (5)

A
  • Foraminal opacification (in cases of lateralised calcified disc extrusion),
  • Sclerosis of the endplates,
  • Reduced disc space size as well
  • Osteoproliferative changes around the articular facets
  • Spondylosis deformans
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5
Q

What is a CT scan poor at identifying with LS dx? (2)

A
  • Soft tissue
  • Nerve root compression
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6
Q

What study is the imaging modality of choice to investigate associated enlargement of the affected spinal nerve proximal to the level of stenosis, especially on STIR sequences?

A

MRI

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7
Q

What can enable confirmation of the neurological lameness and confirmed the suspicion of LS disease over an orthopaedic disease?

A

Electromyography

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8
Q

What neurological deficits would you expect on examination with a LS subluxation (4)

A

Reduced / absent perineal reflex

Reduced / absent perineal nociception

Absent tail nociception

Reduced to absent withdrawal reflex

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9
Q

With a LS luxation; which of the following would you expect to see?

Urinary incontinence

Faecal incontinence

Flaccid tail

Paraplegia

Muscle wastage

A

Urinary incontinence

Faecal incontinence

Flaccid tail

Muscle wastage

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10
Q

Medical management of lumbo-sacral disc herniation encompasses the use of medication and associated extended periods of rest, for how long?

A

4-8 weeks

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11
Q

The lumbosacral region of the dog’s spine is normally approached using which approach?

A

dorsal approach with bilateral elevation of the paraspinal muscles from the dorsal spinous processes and the dorsal lamina of the vertebra

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12
Q

In which position should the patient be placed for dorsal laminectomy surgery?

A

Ventral with the pelvic limbs directed cranially

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13
Q

Dorsal laminectomy; why are the pelvic limbs directed cranially?

A

Opening of L7-S1 disc space.

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14
Q

Dorsal laminectomy at L7-S1;
Skin is incsed with a number 10 blade; where?

A

L5-S3

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15
Q

Dorsal laminectomy at L7-S1
Incise the fascia on both sides of the spinous process with what?

A

Number 11 scalpel

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16
Q

Dorsal laminectomy at L7-S1
Periosteal elevator is used to elevate which muscles?

A

Paraspinal m.

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17
Q

Dorsal laminectomy at L7-S1;
Expose the L7 and S1 spinous processes and dorsal lamina. How?

A

Gelpi retractor

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18
Q

Dorsal laminectomy at L7-S1; what is removed of L7 and S1?

A

Spinous processes

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19
Q

Dorsal laminectomy at L7-S1;
A) What is burred for L7 and S1?
B) What is left in tact?

A

A) Dorsal laminae
B) Articular facets

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20
Q

Dorsal laminectomy at L7-S1;
What is used to remove cortical bone? (3)

A

Rongeurs
Curettes
Kerrison bone punch

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21
Q

Dorsal laminectomy at L7-S1;
Explore vertebral canal and foramen ; why?

A

Remove disc material if present

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22
Q

Dorsal laminectomy at L7-S1;
What is retracted before both the disc cranial and caudal to surgical site is fenestrated?

A

Cauda equina

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23
Q

Dorsal laminectomy at L7-S1;
Before closure; check what? what is performed?

A

Check - haemorrhage
FLUSH

24
Q

Dorsal laminectomy at L7-S1;
A) Suture material for fat and fascia?
B) Material for S/C
C) Material for skin?

A

A) PDS
B) Monocryl
B) Staple/ethilon

25
Q

cases of very lateralised foraminal disc extrusion/protrusion at L7-S1, what can be performed to allow decompression of the nerve root?

A

foraminotomy

26
Q

What are the most common complications following a lumbo-sacral dorsal laminectomy? (5)

A

Venous sinus haemorrhage

Trauma to the cauda equina

Redistribution of disc material

Incomplete decompression

Articular facet fracture or subluxation.

27
Q

What can be applied on the cauda equina before closure to reduce post-operative pain?

A

Morphine splash

28
Q

A high standard of nursing care is essential in order to prevent what (2) in incontinent animals?

A

bladder distension
urinary tract infections

29
Q

How many times a day should the urinary bladder be emptied?

A

3

30
Q

What drugs may be beneficial post op; in terms of assisting urination? (2)

A

bethanechol
prazosin

31
Q

Which patients is placing an indwelling Foley urinary catheter in a recumbent patient particularly important in?

A

No obvious voluntary movement
+/- nociception

32
Q

What should be ecouraged post op to promote limb use and reduce muscle atrophy? (2)

A
  • Physio
  • Hydro
33
Q

What aids should be used in patients that are unable to ambulate? (3)

A

Belly band (sling),
Chest harness
Hoist.

34
Q

When can physio, massage and passive range of motion be started post op?

A

36-48 hours

35
Q

Post op - when should physio be delayed? (Noticed when going to start)

A

Significant restraint be applied

36
Q

Recumbent animals should be turned regularly, why? (2)

A
  • Reduce decubital ulcers
  • Reduce pneumonia
37
Q

Antimicrobial agents, if considered necessary, should be used when?

A

peri-operatively

38
Q

Faeces should be monitored for evidence of melaena; why?

A

Gastrointestinal ulceration can occur in spinal injury patients treated with anti-inflammatory drugs.

39
Q

The risk of complications associated with recumbency can also be reduced by (4)

A

Keep patients clean and dry
Non-retentive, well-padded bedding
Checking regularly for urine or faecal scald
Check for decubital ulcers over pressure points.

40
Q

A multimodal analgesic regimen should ideally be used. Which combinations would you use?

A

opioids,
non-steroidal anti-inflammatory drugs
Paracetamol
Gabapentin

41
Q

Which opioid is V+ common?

A

Morphine

42
Q

If usign methadone or morphine ; what is the effect of a high dose?

A

Dysphoria

43
Q

Why should opioids be avoided (or strongly considered) in pregnant animals?

A

Cross the placenta

44
Q

Receptor of action for morphine?

A

Mu agonist

45
Q

Receptor of action for methadone?

A

Mu agonist
NMDA receptor

46
Q

Effects of methadone if given IV?

A

Panting

47
Q

Buprenorphine:
A) Receptor?
B) What is inhibited? (2)

A

A) Partial mu agonist
B) Reuptake of noradrenaline and serotonin

48
Q

What to change about giving gabapentin if renal dx?

A

Lower dose

49
Q

Where does methocarbamol act?

A

Central acting skeletal muscle relaxant

Not known receptor wise

50
Q

Where does gabapentin act?

A

GABA ergic

Voltage-dependent Calcium channels

51
Q

Meloxicam, robenacoxib and carprofen; COX 1 or 2 preferential?

A

2

52
Q

Meloxicam:
a) Contraindicated when? (4)
B) Not advised when? (2)

A

A) Liver, renal, GI, blood clotting
B) hypovolaemic and dehydrated

53
Q

Paracetamol receptor?

A

COX 3 inhibitor

54
Q

Ketamine receptor.

A

NMDA receptor antagonist

55
Q

Amantidine receptor

A

NMDA receptor antagonist

56
Q

Amantidine; what pain is it good for?

A

OA
Cancer

57
Q

Amitriptyline; contraindications (4)

A

Glaucoma
Seizing
Urinary retention
Severe liver dx

58
Q

What can amitriptyline NOT be used with? (2)

A

cimetidine,
chlorphenamine

Spinal Surgery II (7 decks)

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