Spinal Cord Disease - Acute & Non-Progressive

Question 1

what are differentials for acute, non-progressive myelopathies

Answer 1

1. trauma/luxation
2. vascular (FCE, ANNPE)

Question 2

vertebral column fracture/luxation

Answer 2

caused by major physical trauma (HBC, GSW, animal fights, blunt trauma, falling)

localization: anywhere - most common in spinal joints with high mobility

Question 3

vertebral fracture/luxation clinical signs

Answer 3

• hyperesthesia
• paresis/plegia
• CP deficits
• +/- spinal shock
• external trauma (comorbidities likely)

can be difficult to localize if multifocal lesions

Question 4

vertebral fracture/luxation diagnosis

Answer 4

1. PE/neuro exam
2. radiographs - careful moving if unstable
3. CT - gold standard

Question 5

three compartment system of the vertebral column

Answer 5

each vertebrae has 3 compartments:
1. dorsal
2. middle
3. ventral

of compartments injured indicates which treatment course should be used

Question 6

vertebral fracture/luxation treatment

Answer 6

if 2+ compartments affected: unstable fracture, recommend surgery

if <2 compartments affected: stable fracture, recommend conservative management

Question 7

vertebral fracture/luxation conservative management

Answer 7

stable fractures w/ no evidence of spinal cord compression

• rigid immobilization
• splinting/bandaging
• strict cage rest 8-12 weeks

Question 8

vertebral fracture/luxation surgical management

Answer 8

decompressive surgery
realignment
stabilization

Question 9

vertebral fracture/luxation prognosis

Answer 9

depends on degree of deficits and localization

no deep pain –> poor prognosis
intact pain –> good prognosis
lumbosacral –> very good w/ conservative

Question 10

fibrocartilaginous embolism (FCE)

Answer 10

acute spinal cord infarction caused by entry of fibrocartilage from the disc into the vascular system –> embolization into gray matter –> ischemic necrosis

Question 11

FCE signalment

Answer 11

breed: non-chondrodystrophic, large breeds
age: any

Question 12

FCE clinical signs

Answer 12

peracute onset associated with exercise
asymmetrical signs

• paresis
• paralysis
• NO hyperesthesia

Question 13

FCE diagnosis

Answer 13

diagnosis of exclusion
- history, clinical signs, MRI

histopathology is definitive but biopsies of spinal cord usually not done

Question 14

FCE treatment and prognosis

Answer 14

physical rehabilitation
supportive care

prognosis fair to excellent if pain sensation intact
- recovery within 2 weeks but may have residual signs

Question 15

acute, non-progressive nucleus pulpous extrusion (ANNPE)

Answer 15

disc degeneration leading to a low volume, high velocity “missile” extrusion –> causes a concussive spinal cord injury

Question 16

ANNPE clinical signs

Answer 16

similar to FCE; peracute onset associated with exercise in large breed dogs

• paresis
• paralysis
• NO hyperesthesia

Question 17

ANNPE diagnosis and treatment

Answer 17

same as FCE; can only differentiate on histopathology but not commonly done

diagnosis of exclusion to FCE vs ANNPE based on MRI
- same treatment for both