Neurology Flashcards
Nakamoto
Progressive Myelomalacia
Vet Surg 2021
Extensive hemilaminectomy & Durotomy = 100% survival
Woelfel
Paraplegia in Med-Large dogs
Vet Surg 2021
Factors independently associated with outcome included
- clinical severity = poor
- number of vertebrae with signal interruption in HASTEi = more extensive epidural hemorrhage
- ratio of vertebral sites decompressed to HASTEi = better
Fenn
Anesthesia duration and outcome
JVIM 2020
Median anesthesia time
Regain ambulation 4 h
Did not 4.5 h
Zidan
Long-term pain
JVIM 2020
15% chronic pain
others normalized by 6 months
Longo
MRI assessed disc degeneration recurrence in dogs tx for IVDD
JVIM 2021
Finding a completely degenerate disc in the T10 to L3 region (in addition to the operated site) at the time of surgery was associated with a hazard ratio of 2.92 for recurrence of clinical signs.
Bosch
Facetectomy on Biomechanics in C-spine
VCOT 2017
Facetectomy increased range of motion of primary motions in all directions.
Axial rotation was significantly influenced by facetectomy.
Schneider
Incidence of abnormalities of C-spine with AA Instability
VCOT 2017
The incidence of anomalies affecting the C2/3
- dogs with AAI was 38.46%
- control group it was 11.97%
The majority of the observed anomalies involved the intervertebral disc.
Crawford
Compare Hemilaminectomy with anulectomy or partial discectomy
VCOT 2018
Early postoperative neurological deterioration
HA group 16/29*
HPD group 7/24
Sustained clinical improvement
HA group 9/22
HPD group 17/23*
Clinical Significance Hemilaminectomy with partial discectomy for decompression of thoracolumbar intervertebral disc protrusion was associated with decreased postoperative neurological deterioration and increased sustained clinical improvement compared with hemilaminectomy with anulectomy.
Conte
T Vertebral Stenosis w/ Screw Tail
VCOT 2021
Stenotic ratio of 0.56 associated with clinical signs
Caraty
Tail avulsion
JSAP 2018
11/15 cats recovered voluntary tail function and pain sensation within 14 to 90 days (mean 39 days).
5/8 previously incontinent cats recovered urinary continence within a month of surgery.
Skytte
Pre-op neurologic score w/ intervals to regain micturition and ambulation
JAVMA 2018
regaining micturition was 4.1 d (3 at 2.9, 2 at 6)
regaining ambulation was 13.8 d (3 at 6.9, 2 at 28.8)
negative correlations with MFS were identified for interval to regaining micturition (r = –0.63) and interval to regaining ambulation (r = –0.64)
Tirrito
Agreement of Sx decompression and PO MRI
JAVMA 2020
The correlation between surgeons’ perception and postoperative MRI findings for the degree of spinal cord decompression achieved was only fair.
Unsatisfactory spinal cord decompression as assessed via postoperative MRI was associated with
~severity of preoperative neurologic grade
~preoperative compression, thoracolumbar (vs cervical) IVDE
~ventral (vs ventrolateral or dorsolateral) circumferential distribution of extruded material.
Satisfactory (vs unsatisfactory) decompression as assessed via MRI was associated with
~lower postoperative neurologic grade
~greater likelihood of a successful outcome
~lower mean recovery time.
Spence
MRI related to Body Weight
JAVMA 2021
IVDD
< 15 kg 94.7%
≥ 15 kg 58.4%
Dogs weighing < 15 kg had a significantly higher inci- dence of IVDD lesions in the T12-13 segment, compared with dogs weighing ≥ 15 kg.
Dogs weighing ≥ 15 kg were Neoplastic 11.9 times
FCE 7.4 times
Modified Frankel Score
0: Tretraplegic with no DP
1: Tetraplegia with superficial sensation
2: Tetraplegia with nociception
3: Nonambulatory tetraparesis
4: Ambulatory tetraparesis
5: Hyperesthesia
Patellar Reflex
L4/L6
Biceps Reflex
C7/T2
Withdrawal FL
C6/T2
Withdrawal HL
L6/S1
M-Wave
Initial Negative (upward) deflection
Stimulate motor nerve
Travels to muscle
Recorded by sensor in muscle
F-Wave
Supramaximal antidromic motor n.
Stimulate motor nerve
Travels up to ventral gray matter, back down to muscle
Recorded by sensor in muscle
H-Wave
Sensory, efferent arm in ventral horn cells & alpha motor neuron
Stimulate motor nerve
Ravels up to ventral gray mater, through afferent arm of reflex arc, back down to muscle
Recorded by sensor in muscle
Hounsfield units
Air Fat Water Brain Acute Clot Bone/Mineral Metal
Substances with high signal on T1
Fat Methemoglobin Protein binding Gadnium Melanin
Substances with high signal on T2
CSF Edema Necrosis Inflammation Demyelination
Abs with good BBB penetration
3rd Generation Cephlasporin Fluoroquinolones Metronidazole Sulfonamides Chloramphenicol Trimethoprim
Perineal Reflex
Sacral n.
Pudendal n.
Sensory nerves to FL
Craniomedial- Radial n
Medial antebrachium- Musculocutaneous n.
Caudolateral- Ulnar n.
Surgery for AA lux Dorsal approach
AA wiring
Nuchal Ligament
Dorsal Cross Pin
Kishigami AA Tension Band
Surgery for AA lux Ventral approach
Transarticular screws or pins - 30 degrees
Pins & PMMA - 30 degrees
Screws & PMMA - 90 degrees
Ventral Plating
Grades of Nerve Damage
I: Interruption of function, not structure II: Axon damage, internal preserved III: Axon and Endoneurm injured IV: Perineurium V: Entire nerve severed
Cervical IVDD Sx Tx
Ventral Slot Slanted Ventral Slot Dorsal Laminectomy Limited Dorsolateral Approach for Hemilaminectomy Fenestration
Complications associated with Cervical Sx
Respiratory Compromise Intraoperative Cardiac Dysrhythmias Blood Loss Neurologic Deterioration Ventral Instability and Subluxation Seroma Formation
Components of Disc Associated Spondylomyelopathy
Ventral compression by disc protrusion
Dorsal compression hypertrophy of dorsal longitudinal ligament and yellow ligament
Asymmetric disc protrusion causing compression of SC and nerve root compression
Components of Osseous Associated Spondylomyelopathy
OA proliferation of articular process
Dorsal hypertrophy of yellow ligament
Nerves associated with Micturition
Hypogastric n - sympathetic
Pelvic n - Parasympathetic
Pudendal n - Somatic
Urine storage
Sympathetic
~Beta: Detursor Relax
~Alpha: Internal Urethral Tone
Cholinergic
~Parasympathetic- increase detrusor tone
~Somatic- decrease urethral sphincter tone
Components of the Lumbar Intumescence
L4/6- Femoral n. L6/S1- Sciatic n. S1/3- Pelvic n. S1/3- Pudendal n. Cd1/5 Caudal n.
Function of Femoral n.
Flex hip
Extend Stifle
Function of Sciatic n.
Extend Hip
Flex Stifle
Flex/ Ext Tarsus
Components of LS Stenosis
Bulging annulus & nucleus pulpous Thinking of dorsal annulus Spondylosis deformans Osteophyte within caudal ventral foramen Thickening of joint capsule & zygapophyseal joint Thicking of the yellow ligament
Position that exacerbates LS Herniation
Extension
Postion that alleviates LS Herniation
Flexion
Horner’s syndrome associated with Cervical Spine
C6/T2
Disc Associated Spondylomyelopathy Distraction-Stabilization
Pins & PMMA Screw Bar- PMMA PMMA Plug Locking Place Disc Arthroplasty
Complications associated with Wobler Sx
Neurologic Deterioration ~Dorsal 70% ~Ventral 42% Vertebral Foramen & Transverse Foramina Penetration 25-57% Domino Effect 20% Laminectomy Membrane 8% Implant Failure 7-30% Collapse of Intervertebral Foramina Insufficient Decompression
Fixation of Lumbar Fx/ Lux/ Sublux
Pin & PMMA - 30-60 degrees
External Fixator
SOP Plates
Fixation of Cervical Fx/ Lux/ Sublux
Screws & PMMA
Unilock System
3 compartment model of vertebra
Dorsal ~Spinous process ~vertebral laminae ~articular process ~vertebral pedicles ~dorsal ligament complex
Middle
~dorsal longitudinal ligament
~dorsal portion oof annulus fibrosus
~dorsal portion of the vertebral body
Ventral ~vertebral body ~lateral and ventral portions of the annulus fibrosus ~nucleus pulposus ~ventral longitudinal ligament
