Sa Spinal 3 Flashcards
CSM
Two major forms - osseous or disc associated
Both have a dynamic form
Signalment for CSM - disc associated
Middle age large breed - Doberman, Weimaraner
Symmetric or asymmetric
Acute or chronic - painful
Caudal cervical region (c5-6, 6-7)
CSM osseous associated
Young, giant breeds - Great Danes, mastiffs
Often symmetric
Acute or chronic - painful
More likely congenital, absolute stenosis
CSM-DA diagnosis
3 facts
- relative vertebral canal stenosis
- torsion in caudal cervical vertebral column
- protrusion of larger volume of disc compared to normal dogs
Treatment for both form of CSM medial management
Mildly affected, non progressive
- rest, chest harness, taper course to steroids
50% improve 30% static
Treatment for CSM surgical
More severe cases, progressive
Ventral slot, dorsal surgery, various procedures
70% improve, 20% static
Atlantoaxial instability - congenital
Generally young, small or toy breed
May be acute or chronic onset
Dens hypoplasia or fracture, ligament malformations, avulsion
Atlantoaxial instability signalment for traumatic
Could be any
AAI diagnosis
C1-5 myelopathy - episodic pain
Radiographs +/- fluoroscopy, CT, MRI
Cervical ventroflexion can cause death or make signs worse
Medical management of AAI
Mild clinical signs, young animals, traumatic form
High recurrence rate for congenital form
External coaptation (8-12wk) worry abt atrophy
Analgesics/anti inflammatory
Surgical management of AAI
Moderate to severe clinical signs
Mature bone
70-90% success, approx 5% risk of mortality, approx 25% complication rate
Ventral approach : pins or screws & bone cement, plating
Vertebral malformations
Numerous anomalies
Block, hemi, butterfly vertebrae
Spina bifida
Caudal articular facet hypoplasia
Cause for vertebral malformations
Often caused by a failure of formation or ossification or neural tube closure
Signalment for vertebral anomalies
Most common in screw tail breeds or pugs
Common T7-12
May present with no clinical signs
Spina bifida
Neural tube closure deficiency
Young animals - inability to walk, English bulldogs
Caudal articular process dysplasia
Common in pugs, English & French bulldogs
May cause no clinical signs
Insidious onset T3-L3 myelopathy
Often with fecal & urinary in continent
CAP dysplasia Pathophys
T10-13 commonly affected
Articulations may be hypoplasia or aplastic
May be incidental finding
CAP dysplasia diagnosis
Radiographs
CT is ideal ***
MRI could evaluate for other disease
CAP dysplasia associated disease
Most present T3-L3 myelopathy - gait abnormalities, 50% incontinence
IVDP - 50% of patients
Subarachnoid diverticulum - 20%
Pia-arachnoid fibrosis - 15%
Vertebral instability - 5%
CAP dysplasia treatment/prognosis
No treatment but possible to treat secondary diseases
Prognosis is variable
Spinal arachnoid diverticulum
Large breeds - Rottweiler
Small breeds - pugs
Chronic progressive myelopathy +/- fecal/urinary incontinence
Pathophys for SAD
Cervical - common in large breeds
Thoracolumbar - common in small breeds
Usually non painful
Developmental or aquired
Diagnosing SAD
Myelogram or CT Myelogram MRI
Dilation of subarachnoid space often appears teardrop shaped
Medial management of SAD
Corticosteroids or NSAIDS
Approximately 30% stable, 30% improve, 40% worsen
Surgical management of SAD
Various - open and drain cyst /fluid
Approx 80% improve short term
80% of those who do improve release within 2 yrs
Chari-like malformations & Syringomyelia (caudal occipital malformation syndrome)
CM or SM - occur separately or together
Cavalier King Charles, spaniels, chihuahua, Frenchie
Could be any age, various manifestations of pain
Common Pathophys is malformation of skull or craniovcervical junction
CM & SM treatment - medical
Pain only
NSAIDS, other meds, corticosteroids
May do well, if progressive consider surgery
CM & SM treatment - surgical
Severe pain, failure of medical management
Foramen magnum decompression
May require post op medical management
Neoplasia
Middle aged to older dogs
Slow progressive loss of function
May be painful, any part of the spinal cord
Pathophys for neoplasia
Primary - originate in affected area
Secondary - originated and metastasized other locations
Extra dural neoplasia
50%
Intradural- extramedullary
Intramedullary
20% - least common
Originate from spinal cord themselves
Glioma, ependymoma, metastatic
Diagnosing neoplasia
Radiographs, CT, MRI, Histopath or cytology
Treatment types of neoplasia a
Palliative - pain management/anti inflammatory
Surgery- location and removal of mass
Radiation - primary or adjunctive
Chemotherapy
Prognosis is guarded to poor
Inflammation of spinal cord
Affects meninges or spinal cord or both
Infectious causes uncommon
Immune mediated - more common
Discospondylitis
Infection of intervertebraldisks or adjacent VB
Large/giant breeds - GD, GS, boxer (MALES)
Pain, chronic /progressive
Hyperesthesia, systemic signs &/or neurologic deficit
Pathogenesis of discospondylitis
Destruction of vertberal endpaltes by infectious agent
Various - hematogenous, iatrogenic, foreign bodies
Pathogens - staph, strep, e. Coli, brucella, aspergillus
Diagnosing discospondylitis
Radiographs - most common
CBC/Chem
Urinalysis + culture
Ancillary testing : brucella, +/- fungal
Treatment for discospondylitis
Antibiotics, analgesics, minimum 8-12 wks of treatment. Lifelong infection for some
Prognosis can be good for treatable bacteria
Poorer prognosis for fungal /brucella
Steroid responsive meningitis - arteritis
Young large breed dogs - beagle, boxer, bernes, golden
Acute form <1 month: lethargy, inappetance, fever, cervical hyperpathia, abnormal gait. Normal neuro
Chronic form : persistent or relapsing pain in vertebral column
Diagnosing SRMA
CSF: neutrophilia pleocytosis (non degen)
C-reactive protein - supportive
MRI - normal or thickening meninges
Treat w steroids
Vertebral fracture /luxation
Could happen to anyone
Trauma, fights, missile object, poly trauma common
Immobilize in lateral recumbency/stabilize
**is deep pain present
Diagnosing vertebral fracture/lux
Lateral radiograph
Horizontal beam radiograph or CT
Assess stability
Treatment & prognosis of vertebral fracture/lux
DO NOT MAKE THINGS WORSE
Treatment depends on stability - surgery/conserve
80% with TL fractures
60-70% for cervical injury
Grave with no deep pain
Tail pull injuries
Sacrocaudal luxation
Cats**
Bladder incontinence
Outdoor cats, platigrade stance/paresis
Treatment/prognosis for sacrocaudal luxation
Cage rest, analgesics, surgery
Most improve within 2 weeks
>75% of cats w pain will improve w urinary function
50-60% of cats w absent sensation will regain urine function
Lack of improvement for >30 days is poorer
