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3. Cat & Dog 3 > Myelopathies pt 2 > Flashcards

Myelopathies pt 2 Flashcards

1
Q

types of spinal trauma

A
  1. Endogenous
    e.g. IVD extrusion
    <><>
  2. EXOGENOUS (e.g. hit by car)
    – Spinal cord contusion
    – Vertebral fracture / luxation
    – Traumatic IVDH extrusion
    – Hemorrhage
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2
Q

Spinal trauma: Initial management

A

— Trauma patient: Life-threatening injuries?!
<><>
1. ABC
2.
a) Minimal manipulation, immobilization
b) Physical, orthopedic examinations
c) Brief neurologic examination
– Lateral recumbence
– Localize, severity
– Deep pain

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3
Q

Spinal trauma: Diagnosis

A

— Bloodwork / Thoracic Rx /Abdominal Ux
— Spinal radiographs: Whole spine
— Myelogram, CT, CT-myelogram, MRI

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4
Q

Spinal trauma:Treatment
- for primary vs secondary injuries

A

many techniques, surgeon preference
<><>
Primary injury
◦ Decompression
◦ Stabilization
<><>
Secondary injury
◦ Maintenance spinal cord perfusion (BP, PO2)
> bloodflow reqs of CNS are very high
> at least keep on fluids
◦ Steroids???…controversial

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5
Q

radiographs or myelogram for FCEM diagnosis?

A

useless, basically

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6
Q

common causes of chronic myelopathies

A

— IVDH: protrusion
— Atlantoaxial subluxation
— Degenerative myelopathy
— Caudal cervical spondylomyelopathy
— Degenerative lumbosacral stenosis

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7
Q

IVDH: protrusion
- pathogenesis, progression

A

— Fibroid degeneration of the intact disc
> HANSEN TYPE II DEGENERATION
> Normal aging process
<><>
— Progressive thickening dorsal annulus
— Chronic, slow compressive myelopathy

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8
Q

IVDH protrusion:
- clinical signs?
- who gets this?
- where anatomincally?

A

— Chronic, progressive (weeks-years)
— Non-chondrodystrophic large dogs:
◦ German Shepherd, Retrievers… > most common reason for older german shepherds to have trouble walking
◦ But happens in any canine breed (even cats)
<><>
— Age: > 5 year-old (5-12y)
— Cervical vs thoracolumbar
— Spinal pain: mild/moderate vs none

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9
Q

IVDH protrusion: diagnosis

A
  • Myelogram
  • CT-myelogram
  • MRI
    <><>
  • radiograph alone totally useless, need something beyond that
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10
Q

IVD protrusion: Treatment options, success rate

A

Conservative:
– Restricted activity
– Anti-inflammatory drugs: STEROIDS:
> They actually work for this! totally different pathophysiology
> Useful for chronic spinal cord injury
> Prednisone
– Many controlled long time
<><>
Surgical:
— Lower success than acute IVDH (guarded prognosis)
> can be mulitple sites - which is most significant? where do we cut?
> tend to use conservative treatment more here

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11
Q

Atlantoaxial subluxation - what is this? forms

A

— Instability between C1-C2
— Dorsal displacement C2
◦ Spinal cord compression
<><>
— Forms:
◦ Congenital
◦ Acquired (trauma)

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12
Q

Atlantoaxial subluxation common congenital causes:

A
  • fractured dens
  • aplastic or absent dens
  • deviated dens
    <><>
    > dorsal atlantoaxial ligament will snap. C1 can compress brainstem.
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13
Q

Atlantoaxial subluxation Clinical signs

A

C1-C5 myelopathy
– Chronic vs acute
– Progressive
– Severe neck pain
– Dyspnea

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14
Q

Atlantoaxial subluxation - who gets the congential form? why? what about acquired?

A

Congenital:
– Small-toy canine breeds (Yorkshire terrier, Chihuahua, Miniature Schnauzer…)
– Usually < 1 year-old
– Failure ligament support or C2 dens development (hypoplasia/aplasia, dorsal angulation)
<><>
Acquired:
– Trauma in any dog and cat, acute onset

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15
Q

Atlantoaxial subluxation - diagnosis, considerations

A

Spinal radiographs:
◦ Usually diagnostic
◦ Increased space dorsal lamina atlas – dorsal spinous process axis (C2)
◦ Extreme care manipulation
◦ Better if awake patient
<><>
Myelogram, CT, MRI: if needed

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16
Q

Atlantoaxial subluxation Surgical treatment, risks

A

— Stabilization ± dens removal
— High morbidity / mortality
— Risk respiratory arrest and death

17
Q

Atlantoaxial subluxation conservative treatments, who they are for, complications

A

— Young animals with mild signs
— External splint ≥ 6 weeks
— Risk of recurrences
<><>
we try this before going to surgery - at the end of the day, if it is a congenital issue, chances of a recurrence are quite high

18
Q

Degenerative myelopathy - what is this? pathogenesis?

A

Degeneration spinal cord white matter
– Mainly T3-L3
<><>
Pathogenesis:
– Genetic
* Form of amyotrophic lateral sclerosis (ALS)
* Genetic marker identified

19
Q

Degenerative myelopathy Signalment

A

Mainly large-breed dogs:
– German Shepherd
– Boxer
– Pembrokeshire Welsh Corgi
– Others
<><>
Age:
– > 5 year-old (mean: 9y)
> chronic, slow process

20
Q

Degenerative myelopathy Clinical signs

A

— Chronic, progressive
— T3-L3
◦ Severe PL proprioceptive ataxia
◦ Paraparesis to Paraplegia (6-12m)
◦ Sometimes: decreased patellar reflexes (L4-L6 nerve roots)
— No spinal pain

21
Q

Degenerative myelopathy diagnosis

A

Rule-out other chronic T3-L3 myelopathies
– IVD protrusion, neoplasia…
– Normal spinal imaging
<><>
Genetic marker (DNA test)
<><>
Definitive diagnosis: Histopathology

22
Q

Degenerative myelopathy treatment, prognosis

A

— Supportive
— Physical therapy
— Vitamins, aminocaproic ac, steroids? > Not proved efficacy.
<><><><>
Prognosis:
– Poor
– Euthanasia 6-12m
– Can progress to thoracic limbs if kept alive

23
Q

what is Wobbler’s syndrome?

A

Caudal cervical spondylomyelopathy (CCSM)
- cervical stenotic myelopathy, cervical malformation/malarticulation…
<><><><>
- Vertebral malformations / malarticulation affecting caudal cervical vertebrae and associated structures (ligaments, articular facets, intervertebral discs):
> Progressive vertebral canal stenosis and compressive cervical myelopathy

24
Q

CCSM: Forms
- who gets them? pathogenesis?

A
  1. Disc-associated CCSM:
    – Large-breed dogs: Doberman
    – Middle aged-older (3-9 year-old)
    – IVD protrusion
    <><><><>
  2. Osseous-associated CCSM:
    – Giant-breed dogs: Great Dane
    – < 3 year-old
    – Articular facets DJD/hypertrophy, synovial cysts, vertebral canal stenosis
    > bone is enlarged, and is compressing the spinal cord (articular facets)
25
Q

CCSM: Clinical signs

A

— Chronic, progressive
— C6-T2 > C1-C5
— Tetraparesis
◦ Pelvic limbs much worse
◦ Pelvic limbs: Severe ataxia and paresis
◦ Thoracic limbs: Short, stilted, choppy gait (hypometria)
— Neck pain (50% cases)

26
Q

CCSM: Diagnosis

A

— Spinal radiographs
— Myelogram
— CT-myelogram
— MRI > Identifies intramedullary lesions

27
Q

CCSM: Treatment options

A

Conservative therapy:
◦ Restricted exercise, physical therapy, anti-inflammatory (steroids)
<><><><>
Surgical therapy:
* Ventral approach
> Ventral slot ± stabilization
> Disc-associated form
* Dorsal approach
> Dorsal laminectomy
> Osseous-associated form

28
Q

CCSM: Prognosis

A

— Long recovery period
— Surgical treatment:
> Good prognosis on short-term but high recurrence rate on long-term
— “Domino effect” (surgical stabilization)
> stabilize one area and its gets better, but gradually other areas may get worse

29
Q

Degenerative lumbosacral stenosis (DLSS)
- what is this?

A

— Compression cauda equina nerve roots due to degenerative changes at L7-S1
— Cauda equina syndrome, lumbosacral malarticulation / malformation, lumbosacral instability, lumbosacral spondylopathy…
<><><><>
- nerve roots as opposed to spinal cord - nreve roots can tolerate compression much better
- this compression will not result in the same clinical signs and consequences that we will see in other areas

30
Q

DLSS: Pathogenesis

A

— Chronic instability?
— IVD protusion L7-S1
— Hypertrophy:
> Ligaments (interarcuate-flavum)
> Articular facets (DJD, synovial cysts)
— Subluxation L7-S1

31
Q

DLSS: Signalment

A
  • Large-breed dogs > German Shepherd
  • Age: Middle-aged to older
  • Males > females?
32
Q

DLSS: Clinical signs, presentation

A

LUMBOSACRAL PAIN
– Reluctance to rise, sit, jump…
– Lameness
– PLs tucked under abdomen
– Low tail carriage
<><>
— Other clinical signs often not present
<><>
— Detection LS pain:
> Dorsal palpation LS joint, hyperextension PLs, raising up tail, rectal palpation LS joint
<><><><>
LMN lesion caudal to L7 (sciatic, pudendal, coccygeal)
– Paraparesis (short-stride gait, not ataxia or mild)
– Mild proprioceptive deficits PLs
– Tail paralysis (low tail carriage)
– PLs muscle atrophy (sciatic innervated)
– Decreased withdrawal reflexes (hock)
– Urinary / fecal incontinence
– Paraesthesias (tail, feet, rump biting)

33
Q

DLSS: Diagnosis

A

— Spinal radiographs, myelogram (but spinal cord ends at L6 in large dogs), CT, epidurography, discography
— MRI

34
Q

DLSS:Treatment options, success rate

A

Conservative
◦ First episode / intermittent pain
◦ Restricted exercise
◦ Anti-inflammatory
◦ Success: ≈ 55%
<><><><>
Surgical
◦ Dorsal laminectomy L7-S1
◦ ± stabilization L7-S1
◦ Success: 70% ?

35
Q

DLSS: Prognosis

A

— Surgery requires ≥12 weeks confinement
— Recurrences: More likely in active-working dogs
— Only pain: Good-Excellent
— Motor deficits: Good-Guarded
— Incontinence: guarded-POOR

3. Cat & Dog 3 (26 decks)

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