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ACVS Phase II 2023 > Neurology > Flashcards

Neurology Flashcards

1
Q

Bonelli and da Costa, JVIM, 2019:
What % were giant breed dogs?
Most common clinical signs?
Most common sites of compression?
What % had 2 or more sites of compression?
What were the most common cause(s) of compression?
What % had intervertebral disc degeneration?

A

80% giant breed dogs
Proprioceptive ataxia (90%), cervical pain (45%)
C5-6, C6-7 or both
60% had 2 or more sites of compression
Articular process proliferation (40%), disc protrusion (10%)
45% had intervertebral disc degeneration

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2
Q

Bok, Vet Surg, 2019:
Cervical fusion
What % improved?
What % subsidence was seen?
What % developed implant failure and what % required plate removal?
Long-term outcome?

A

89% improved
11% subsidence
44% developed implant failure, 22% required plate removal
Long-term outcome was good

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3
Q

Rohner, VCOT, 2019:
DACSM treated with C-LOX anchored intervertebral spacer
What % improved or had normal neuro exam at 3 months post-op?
Most common post-op complication?
Short-term outcome?

A

89% improved or had normal neuro exam at 3 months post-op
Screw loosening was the most common post-op complication, but only 5% had displacement of the implant
Good short-term outcomes

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4
Q

Saunders, Vet Surg, 2018:
Was there an association between a greater rostral projection of the sacral lamina and a diagnosis of DLSS?
Is the height of the vertebral canal at L7/S1 diagnostic or predictive of DLSS?
Risk factor(s) for development of cauda equina syndrome?

A

Saunders, Vet Surg, 2018:
No association between greater rostral projection of the sacral lamina and DLSS
Height of the vertebral canal at L7/S1 was neither diagnostic nor predictive of DLSS
Dogs >5 years of age had a greater risk of developing cauda equina syndrome

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5
Q

Zindl, Vet Surg, 2018:
Pedicle screw-rod fixation system
Effect(s) on motion at L7-S1 and L6-7?

A

Zindl, Vet Surg, 2018:
Significantly reduced primary and coupled motion at L7-S1 with a concomitant increase in motion at L6-7, which may suggest the potential for adjacent level effects

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6
Q

Worth, VCOT, 2018:
Effect(s) of lateral foraminotomy on volume of the LS lateral intervertebral neurovascular foramen?
Regrowth of bone at the foraminotomy site occurred despite having excellent outcomes - true or false?
Increased foraminal volume was still evident at long-term follow-up, but in 33% of those dogs, what was the % increase in foraminal volume compared to pre-op?

A

Worth, VCOT, 2018:
Lateral foraminotomy increased the volume of the LS lateral intervertebral neurovascular foramen to >7 times its initial volume
True
In 33% of the dogs, the long-term increase in foraminal volume was only 125% of the pre-op volume

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7
Q

Nel, Vet Surg, 2017:
Fixation of LS fracture-luxations with pins + PMMA or SOP plates provide similar stability - true or false?

A

Nel, Vet Surg, 2017:
True

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8
Q

Tran, Vet Surg, 2017:
Lateral vs dorsal stabilization of lumbar spinal fracture-luxations
Advantages and disadvantages of the lateral approach?

A

Tran, Vet Surg, 2017:
Advantages: superior for pin angle accuracy and bone purchase - clinically important consequences of breach are less common
Disadvantages: prevents observation of the articular facets

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9
Q

Fujioka, Vet Surg, 2019:
Patient-specific drill guide template
What % of screws were placed without vertebral canal invasion?
Was greater accuracy achieved for screws placed in the cranial lumbar or caudal thoracic vertebrae?

A

Fujioka, Vet Surg, 2019:
90% of the screws were placed without vertebral canal invasion
Greater accuracy of screw placement was achieved in the cranial lumbar vertebrae than the caudal thoracic vertebrae

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10
Q

Gallastegui, VRU, 2019:
What % of fractured vertebrae had complete agreement for exact fracture location between MRI and CT?

A

Gallastegui, VRU, 2019:
Complete agreement between MRI and CT was achieved in only 14-33% of fractured vertebrae

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11
Q

Schmidli, VCOT, 2019:
C2 fractures
What % only showed cervical pain?
What % had fractures involving the dens?
Chances for full or functional recovery with conservatively vs surgically managed cases?

A

Schmidli, VCOT, 2019:
32% showed only cervical pain
23% had fractures involving the dens
Chances of full or functional recovery were very good for both conservatively and surgically managed cases

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12
Q

Kohler, JAVMA, 2018:
Cytoreductive surgery for suspected primary intracranial masses
Mortality rate?
Major complication rate?
What factors were associated with development of major complications or death?
What % were non-tumorous lesions?
What factor was associated with the lowest survival rate?

A

Kohler, JAVMA, 2018:
13% mortality rate
19% major complication rate
Abnormal findings on pre-op neuro exam, dogs undergoing a suboccipital approach
8% were non-tumorous lesions
Dogs that developed aspiration pneumonia had the lowest survival rate

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13
Q

Forward, Vet Surg, 2018:
Post-op complication rate following intracranial surgery?
Most common post-op complication?

A

Forward, Vet Surg, 2018:
47% post-op complication rate
Aspiration pneumonia was the most common post-op complication

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14
Q

Nakano, Vet Surg, 2018:
Agreement between intensities and pattern of pre-op gadolinium enhancement on MRI and intra-op fluorescein sodium staining?

A

Nakano, Vet Surg, 2018:
Intensities and pattern of pre-op gadolinium enhancement on MRI agreed with intra-op fluorescein staining

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15
Q

MacLellan, JAVMA, 2018:
What was predictive of outcome - tumor grade or pre-op tumor volume?

A

MacLellan, JAVMA, 2018:
Tumor grade was predictive of outcome

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16
Q

Noyes, Vet Surg, 2017:
Size of planned laminectomy defects based on MRI vs CT?

A

Noyes, Vet Surg, 2017:
Size of planned laminectomy defects tended to be larger based on MRI compared to CT

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17
Q

Mathieson, Vet Surg, 2018:
Ventral stabilisation of thoracic kyphosis through bilateral intercostal thoracotomies and SOP plates
Post-op complications?
% improvement in neuro scoring long-term?

A

Mathieson, Vet Surg, 2018:
Seroma (33%), screw breakage (33%)
83% improved in neuro scoring long-term

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18
Q

Bertram, VRU, 2019:
Neurologically normal Frenchies, English Bulldogs and Pugs
Most common congenital vertebral malformation?
Most common congenital vertebral malformations by breed?

A

Bertram, VRU, 2019:
Lumbosacral transitional vertebrae most common (34%)
Frenchies: Hemivertebrae (32%), lumbosacral transitional vertebrae (26%)
English Bulldogs: Hemivertebrae (24%), lumbosacral transitional vertebrae (14%)
Pugs: Lumbosacral transitional vertebrae (54%)

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19
Q

De Decker, JVIM, 2019:
Most common location of kyphotic segment?
What factors are associated with higher likelihood of neurological disease?
What Cobb angle corresponds with the highest combined sensitivity and specificity to differentiate between clinically affected and unaffected dogs?

A

De Decker, JVIM, 2019:
Kyphotic segment most often centred at T7-8
Pug breed, more severe kyphosis, fewer rather than more hemivertebrae, ventrolateral hypoplasia hemivertebrae subtype
Cobb angle of 34.5 degrees

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20
Q

Schneider, VCOT, 2017:
Incidence of C2-3 anomalies in dogs with and without AAI?

A

Schneider, VCOT, 2017:
38% of dogs with AAI vs 12% of dogs without AAI

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21
Q

Leblond, VCOT, 2017:
Safety of implant placement is optimized by limiting implant diameter to what size in toy breed dogs?

A

Leblond, VCOT, 2017:
1.5mm

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22
Q

Leblond, VCOT, 2018:
Transarticular fixation using 2 screws vs multi-implant construct using 5 or 6 screws
Which screw(s) were the most successfully placed?
Which screw(s) were the most challenging to place?
Which constructs were more prone to failure?

A

Leblond, VCOT, 2018:
C2 pedicle screws in the 6-screw construct, but these screws would also inevitably result in vertebral artery injury
Monocortical screws in the C2 caudal vertebral body
The constructs using 2 screws were more prone to failure

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23
Q

Noyes, Vet Surg, 2017:
Planned laminectomy defects tended to be smaller or larger based on MRI compared to CT?

A

Noyes, Vet Surg, 2017:
Planned laminectomy defects tended to be larger based on MRI compared to CT

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24
Q

Chai, JAVMA, 2018:
What was associated with increased odds of IVDD in Pekingese?

A

Chai, JAVMA, 2018:
Presence of calcified discs in the T10-L4 region, greater body weight, and female dogs

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25
Q

Hamilton-Bennett and Behr, Vet Surg, 2019:
Cats with IVDD treated with hemilaminectomy
What outcomes were achieved?
What % had dispersal of extruded disc material beyond the disc space evident on MRI?
What % had complete degeneration of the extruded disc and lateralization of the extruded disc material?

A

Hamilton-Bennett and Behr, Vet Surg, 2019:
50% excellent outcome, 17% good outcome, 17% poor outcome
83% had dispersal of disc material beyond the disc space
50% had complete degeneration of extruded disc and lateralization of disc material

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26
Q

Gordon-Evans, Vet Surg, 2019:
What is associated with a slower recovery post-op in Dachshunds that receive post-op rehab?

A

Gordon-Evans, Vet Surg, 2019:
Increased pre-op disability is associated with slower recovery but not body condition

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27
Q

Hermann, VCOT, 2018:
Standard ventral slot vs inverted cone slot vs slanted slot vs fenestration
Which procedure(s) increased the ROM of the C4-5 VMU?
Do the inverted cone slot and slanted slot provide any biomechanics benefit over the standard ventral slot?

A

Hermann, VCOT, 2018:
All procedures increased the ROM of C4-5 VMU
No benefit over standard ventral slot

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28
Q

Crawford and De Decker, VCOT, 2018:
Peri-op complication rate for hemilaminectomy + annulectomy vs hemilaminectomy + partial discectomy?
% early post-op neuro deterioration for hemi + annulectomy vs hemi + partial discectomy?
Median time to ambulation for hemi + annulectomy vs hemi + partial discectomy?
Recurrence rate for hemi + annulectomy vs hemi + partial discectomy?

A

Crawford and De Decker, VCOT, 2018:
27% vs 21%
55% vs 29%
7 days vs 4.5 days
50% vs 26%

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29
Q

Skytte and Schmokel, JAVMA, 2018:
Mean interval from surgery to regaining micturition?
Correlation between pre-op modified Frankel score and interval to regaining micturition?
Mean interval from surgery to regaining ambulation?
Correlation between pre-op modified Frankel score and interval to regaining ambulation?
What % regained micturition before ambulation and what % regained both at the same time?
What % developed UTI post-op?

A

Skytte and Schmokel, JAVMA, 2018:
4 days to regaining micturition
Negative correlation between pre-op modified Frankel score and interval to regaining micturition
14 days to regaining ambulation
Negative correlation between pre-op modified Frankel score and interval to regaining ambulation
52% regained micturition before ambulation, 37% regained both at the same time
17% developed UTI

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30
Q

Drury, Vet Surg, 2019:
Integrated endoscopic thoracolumbar hemilaminectomy
What sized lesions and in what locations were accessible?
What affected the size of the hemilaminectomy?

A

Drury, Vet Surg, 2019:
Lesions <70% the diameter of the cannula size and located with the area 1/3 cranial and 2/3 caudal to the center of the disc space could be accessed
Size of cannula used affected the size of the hemi

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31
Q

Nakamoto
Progressive Myelomalacia
Vet Surg 2021

A

Extensive hemilaminectomy & Durotomy = 100% survival

32
Q

Woelfel
Paraplegia in Med-Large dogs
Vet Surg 2021

A

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
33
Q

Fenn
Anesthesia duration and outcome
JVIM 2020

A

Median anesthesia time
Regain ambulation 4 h
Did not 4.5 h

34
Q

Zidan
Long-term pain
JVIM 2020

A

15% chronic pain

others normalized by 6 months

35
Q

Longo
MRI assessed disc degeneration recurrence in dogs tx for IVDD
JVIM 2021

A

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.

36
Q

Bosch
Facetectomy on Biomechanics in C-spine
VCOT 2017

A

Facetectomy increased range of motion of primary motions in all directions.

Axial rotation was significantly influenced by facetectomy.

37
Q

Schneider
Incidence of abnormalities of C-spine with AA Instability
VCOT 2017

A

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.

38
Q

Crawford
Compare Hemilaminectomy with anulectomy or partial discectomy
VCOT 2018

A

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.

39
Q

Conte
T Vertebral Stenosis w/ Screw Tail
VCOT 2021

A

Stenotic ratio of 0.56 associated with clinical signs

40
Q

Caraty
Tail avulsion
JSAP 2018

A

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.

41
Q

Skytte
Pre-op neurologic score w/ intervals to regain micturition and ambulation
JAVMA 2018

A

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)

42
Q

Tirrito
Agreement of Sx decompression and PO MRI
JAVMA 2020

A

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.

43
Q

Spence
MRI related to Body Weight
JAVMA 2021

A

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

44
Q

Gomes JFMS 2020

Which site was affected in 50% of cases?

What was a characteristic MRI feature?

Most common Radiographic features of this condition?

A

The L7–S1 intervertebral disc space (IVDS) was affected in 7/14 (50%) cases.

Characteristic MRI features ~hyperintense nucleus pulposus signal
~involvement of adjacent vertebral endplates (n = 11/14 [79%])
~hyperintense neighbouring soft tissue
~presence of spondylosis deformans (n=10/14 [71%]).

Radiographs
~collapse or narrowing of the affected IVDS (80%)
~endplate erosion (60%)

45
Q

Gillespie JFMS 2020

Thoracic vertebral canal stenosis in cats

Median age?

Improved with medical treatment?

Improved with surgical treatment?

A

Age 9y

Medical management 2/5 improvement

Sx 2/3 improvement

British shorthair over-represented

46
Q

Gomes JFMS 2022

Median age of Discospondylitis?

Median duration of clinical sings?

All cats had what clinical sign?

Neurological dysfunction in what % of cats?

Antibiotic therapy for how long?

A

Median age?
~9 years

Median duration of clinical signs? ~3 weeks

All cats presented with
~spinal hyperaesthesia

Neurological dysfunction?
~64.7% of cats

Sustained antibiotic therapy
~3 months

47
Q

Kerr JSAP 2021

What % of Frenchies returned for reoccurrence of IVDD extrusion?

Median time between surgery and reoccurrence of sings?

Localization of reoccurrence

A

What % of Frenchies returned for reoccurrence of IVDD extrusion?
51%

The median time between surgery and reoccurrence of signs?
9m 21 days

Localization of reoccurrence
-original TL: 5/29 cervical
-original cervical: 5/14 TL

48
Q

Pfund JSAP 2022

Caudal lumber IVDD

Urinary continence recovered in what %?

Fecal continence recovered in what %?

Tail function recovered in what %?

A

Urinary continence recovered in what %?
86%

Fecal continence recovered in what %?
90%

Tail function recovered in what %?
87%

49
Q

Argent JSAP 2022

Complete recovery after medical vs. surgical management

Overall recurrence
M vs S

In medically managed patients, location of recurrence

In surgically managed patients, location of recurrence
-occurred at adjacent disc

80% of recurrence occurred in what time frame?

Significant difference in recurrence between M & S management?

A

Complete recovery after medical vs. surgical management
M: 30.3%
S: 69.7%

Overall recurrence
34%
M: 36%
S: 33%

In medically managed patients, the location of recurrence
-occurred at the same site

80% occurred
-within 2 years of diagnosis

A significant difference in recurrence between M & S management?
NO

50
Q

Murthy JVIM 2021

In serum phosphorylated neurofilament heavy chain (pNF-H) in progressive myelomalacia dogs with T/L IVDD, dogs that developed PMM had an elevation at what time point?

What concentration was associated with identifying PMM?

A

Dogs that developed PMM had significantly higher serum pNF-H concentrations after surgery compared to all other cohorts at 24 hours: 39.88 ng/mL

≥31.39 ng/mL was 83.33% sensitive and 100% specific for identifying PMM in this cohort

51
Q

McBride JVIM 2022

Odds of spinal shock decreased with?

A

Odds of spinal shock decreased with
-increased weight
-increased duration
-decreased pelvic limb tone
-increased presence of paraplegia

52
Q

Johnson JVIM 2022

Hydromyelia is associated with what in IVDD?

A

Chronicity

53
Q

Bridges JVIM 2022

Which breed was overrepresented for dic-associated epidural hemorrhage?

What clinical signs were associated with EH?

What MRI findings were associated with EH?

Location in Frenchies?

A

Which breed was overrepresented for dic-associated epidural hemorrhage?
-Frenchies

What clinical signs were associated with EH?
-less than 48h of signs
-more likely non ambulatory

What MRI findings were associated with EH?
-<50% cross-sectional SC compression
-longer compression (3 vs 1 space)
-greater intrinsic SC change

Location in Frenchies?
T/L

54
Q

Dongaonkar Vet Surg 2021

T/F: Intermittent bolus irrigation was associated with lower peak vertebral canal temperatures than continuous irrigation

A

True

55
Q

Schmitt Vet Surg 2021

Vertebral corridors width?

Widest corridor at?

Corridor length?

Shortest corridor?

Widest corridor?

A

Vertebral corridors width
3.8-5.2 mm

Widest corridor
T1

Corridor length
13.3 to 17.5 mm

Shortest corridor
T1

Widest corridor
T6

56
Q

Falconer-Hall VCOT 2021

Disc Fenestration

A

Neurologist more likely than surgeons

41% complication rate- hemorrhage

57
Q

Discospondylitis

common signalment

A

Breed:
Great Dane
Lab
Rotti
GSD
Dobi
English Bulldog

Male>Female

Young to Middle-aged

58
Q

Common sites for discospondylitis

A

Caudal cervical
Mid-thoracic
Thoracolumbar
Lubosacral intervertebral disk

59
Q

The most common concurrent condition in dogs with discospondylitis

A

UTI

60
Q

Organisms associated with discospondylitis

A

Staphylococcus
E. coli

61
Q

Radiographic progression of discospondylitis

A

-Initial narrowing of IVD space
-Focal lysis of vertebral end plates
-Finally marked lysis, sclerosis and spondylosis

62
Q

MRI changes with discosponylitis

A

T2 hyper intensity
T1 hypo intensity
Contrast enhancement w/in IVD, vertebral body end plates, soft tissue ventral to vertebral body and epidural fat

63
Q

Additional diagnostics with discosponylitis to find causative agent

A

Urine culture
Blood culture
Echocardiogram
TxR

Fungal culture in GSD

64
Q

White et al VetSurg 2019

What is the best flexed angle on lateral radiographs to diagnose AA instability?

A

51 degrees of flexion

90% sensitive and 90% specific

65
Q

Schneider et al VCOT 2017

What is the most common concurrent abnormalitiy associated with AA instability?

A

IVD anomalies (33.34% of dogs)

66
Q

Noyes et al VetSurg 2017

What are the difference made when planning hemilaminectomies using CT vs MRI?

A
  • Lots of variation in surgical location and size
  • Would plan a different overall approach ~50% of the time between the two modalities

-Side of approach was most consistent between the two modalities

67
Q

Dixon et al JAVMA 2017

What were the conclusions regarding anesthesia related hypotension and oucome of dogs with IVDD?

A
  1. 60% of patients experieinced hypotension
  2. Regaining motor or urinary function not associated with occurence of hypotension, duration or severity of hypotension
68
Q

Zidan et al JVIM 2020

What percentage of dogs with spinal cord injury will develop chronic neuropathic pain?

A

15%

69
Q

Dyall et al VCOT 2018

What is the SSI rate for dogs undergoing hemilaminectomy without perioperative antimicrobials?

A

0.6%

70
Q

Mari et al JVIM 2019

What are the risk factors/predictors of urinary or fecal incontinence in dogs with TL ANNPE?

A
  1. paraplegia
  2. intramedullary hyperintensity >40% of cross sectional area of the spinal cord
  3. No NSAID treatment
  4. Clinical signs of spinal shock
71
Q

Skytte et al JAVMA 2018

What is the average time to regain micturition and ambulation after TL decompression surgery?

A
  1. Micturition 4.1 days
  2. Ambulation 13.8 days
72
Q

Nessler et al JVIM 2018

What was the conclusion regarding prognosis for medical vs surgical treatmetn of hydrated nucleus pulposus extrusion in dogs?

A

33/36 dogs had a functional recovery

*Lesion relative to length of C3 = longer lesion = more dogs died acutely, less likely to have functional outcome

73
Q

Crawford et al VCOT 2018

Which method had a better clinical outcome when combined with a hemilaminectomy - annulectomy vs partial discectomy?

A

Partial discectomy

Annulectomy - more patients had acute neuro deterioration after surgery

74
Q

Alisauskaite et al JVIM 2019

What is the outcome of pugs treated surgically for T-L spinal arachnoid diverticula?

A

Good improvement in the short term (80%)

Poor long term outcome (86% deteriorated)

75
Q

De Decker JVIM 2019

What findings related to hemivertebrae are assoaciated with clinical signs in Frenchies, Pugs and English Bulldogs?

A

-Pug breed
-More severe kyphosis
-fewer hemivertebrae
-Ventrolateral hypoplasia hemivertebre

All associated wtih higher likelihood of neurological disease

ACVS Phase II 2023 (52 decks)

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