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surgery > Spinal Assesssment/Disease > Flashcards

Spinal Assesssment/Disease Flashcards

1
Q

5 important questions for spinal assessment

A
  1. Is there a neurological problem?
  2. Where is the problem?
  3. What is the severity of the problem?
  4. What is the problem?
  5. What is the appropriate treatment and prognosis?
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2
Q

how are a reflex and a response different?

A

reflexes are involuntary where responses are voluntary (higher cerebral integration)

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3
Q

mental status levels

A
  1. Alert
  2. Depressed
  3. Stuporous
  4. Comatose
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4
Q

gait assessment factors

A
  1. Ambulatory?
  2. Ataxic?
  3. Paresis/plegic? (voluntary motor function)
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5
Q

List 6 types of postural reactions

A
  1. Conscious proprioception: knuckling, paperslide
  2. Hopping
  3. Extensor postural thrust
  4. Wheel barrowing
  5. Placing reaction: tactile/visual
  6. Hemi- standing/walking
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6
Q

UMN reflexes are

A

increased

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7
Q

LMN reflexes

A

decreased/absent

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8
Q

LMN signs

A
  1. Reflexes: decreased/asbent
  2. Voluntary motor: decreased/absent
  3. Tone: decreased/absent
  4. Atrophy: severe, rapid, neurogenic
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9
Q

UMN signs

A
  1. Reflexes: increased
  2. Voluntary motor: decreased/absent
  3. Tone: increased
  4. Atrophy: slow, disuse
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10
Q

4 basic functional spinal segments

A

Cervical C1-C5
Cervical intumescence C6-T2
Thoracolumbar T3-L3
Lumbar intumescence L4 - Cd5

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11
Q

UMN of FL + UMN of HL indicates segment?

A

C1-C5

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12
Q

LMN of FL + UMN of HL indicates segment?

A

C6- T2

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13
Q

Normal FL + UMN HL indicates?

A

T3-L3

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14
Q

Normal FL + LMN HL indicates?

A

L4 - Cd5

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15
Q

3 spinal reflex groups

A
  • myotatic (stretch)
  • withdrawal (flexors)
  • misc/other
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16
Q

HL myotatic reflex tests

A

patellar, sciatic, cranial tibial, common peroneal, gastrocnemius

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17
Q

FL myotatic reflex tests

A

extensor carpi radialis, triceps, biceps

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18
Q

perform a flexor/withdrawal test

A
  • least noxious stim to foot to elicit withdrawal (reflex NOT response)
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19
Q

list 3 misc spinal reflexes

A
  • perineal reflex
  • panniculus
  • crossed extensor reflex
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20
Q

absence of the pannicular reflex indicates a lesion…

A

2 vertebrae cranial to where reflex reappears

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21
Q

Grade 1 spine

A

painful only - no neuro deficits

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22
Q

Grade 2 spine

A

ambulatory paraparesis

23
Q

Grade 3 spine

A

non ambulatory paraparesis (VM present)

24
Q

Grade 4 spine

A

paraplegia (no VM) + pain present

25
Q

Grade 5

A

paraplegia + no deep pain response

26
Q

prognosis of grade 2-4 spines w/ surgical intervention is

A

success 50-90% of time

27
Q

compare of prognosis grade 5 spine w/ sx intervention <48hrs or >48hrs from signs

A 
<48hs = 50-90% success
>48h = 5-50% success
28
Q

acute spinal disease ddxx

A
  1. Hansen Type I IVDD
  2. FCE
  3. Trauma
  4. GME
29
Q

intermediate onset spinal ddx

A
  1. Discospondylitis
  2. GME
  3. Neoplasia
30
Q

rad findings of discospondylitis

A
  • lysis of vertebral end plates
  • remodelling or production of reactive bone adjacent to areas of lysis
  • collapse of disc space
31
Q

pathogen commonly assoc. w/ discospondylitis

A

Staph intermedius

32
Q

chronic spinal dz ddx

A
  1. Hansen Type II IVDD
  2. Degenerative myelopathy/chronic degenerative radiculomyelopathy
  3. Neoplasia
33
Q

how useful is the genetic test for degen myelopathy of GSD?

A
  • can only rule out - if gene absent

- cannot confirm

34
Q

define: lumbosacral disease

A

Hansen Type II IVDD of L7-S1

35
Q

define: wobblers

A

Hansen Type II IVDD of C4-C7

“ Cervical spondylomyelopathy”

36
Q

signalment of hansen type I IVDD

A
  • chondrodystrophoid breeds: dachshunds, pekingese

- age: 3-7yo

37
Q

signalment of hansen type II IVDD

A
  • non-chondrodystophoid usu. larger breeds

- age: 8-10yo

38
Q

pathogenesis of hansen type I IVDD

A
  • -> early chondroid degeneration of the nucleus pulposus of the disc occurs before 2yo –> the nucleus pulposus loses its gelatinous hydroelastic shock absorbing nature + becomes more cartilaginous + granular
  • -> the risk of rupture of the annulus fibrosis + disc extrusion = herniation of the nucleus often w/ explosive force into the spinal canal
  • -> eventually some discs may calficy which further decreases any shock absorbing capacity
39
Q

pathogenesis of hansen type II IVDD

A

annulus fibrosis undergoes fibrous metaplasia –> leads to partial rupture of the fibrous annular bands w/ subsequently ‘bulging’ of the annulus dorsally into the spinal canal

40
Q

common sites of IVDD

A

cervical (15%) C2-C3

thoracolumbar (85%) T11-12, L1-L2 *dt lack of intercapital ligament

41
Q

radiographic signs of IVDD

A
  • narrowing/wedging/collapse of IV space
  • sclerosis of the vertebral end plates
    +/- calcified material w/in the IV space or the spinal canal
42
Q

goal of IVDD surgery

A

remove compressive material from spinal canal + prevent recurrence

43
Q

sx approaches to IVDD

A
  • hemilaminectomy
  • ventral slot
    +/- fenestration
44
Q

describe post-op IVDD care considerations

A
  1. Restricted phys activity: 30d, w/ no running/jumping 6mnths
  2. Analgesia: opiates, NSAIDs, NO corticosteroids
  3. Recumbency: turn q2-3hrs
  4. GIT care: H2 receptors/PPI/mucosal protectants, constipation - metamucil (avoid enemas)
  5. Bladder and perineal care: indwelling U-cath w/ cleaning 2x/daily
  6. Physio: PROM 15-30mins 3-4x/day + massage
    - walking w/ sling
    - hydrotherapy onces sx site healed (5days)
45
Q

FCE presentation

A
  • usu larger dogs, per/acute during exercise - initially painful but then non-painful
  • often asymmetric
46
Q

location assoc. w/ worse prognosis in FCE

A

L3-S1

47
Q

tx of FCE

A

time + supportive care

48
Q

use of corticosteroids in spinal trauma risks

A
  1. gastric ulceration
  2. Colonic perforation
  3. Secondary infections
  4. Prolonged hospitalisation
49
Q

pathogens associated with discopondylitis

A

aspergillus, staph

50
Q

2 types of wobblers

A
  1. Osseous -associated: facet malformations + lig. hypertrophy (Great Danes)
  2. Disc associated: Hansen type II IVDD w/ stenotic spinal canal (Dobermans)
51
Q

eg. intramedullary neoplasia

A

metastatic astrocytoma

52
Q

eg. intradural-extramedullary neoplasia

A

meningiomas, nerve sheath tumours

53
Q

eg. extradural neoplasa

A

osteosarcoma

54
Q

mutation associated with degenerative myelopathy?

A

SOD-1 mutation

surgery (22 decks)

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