Spinal Cord Syndromes Flashcards
1
Q
What is Lumbosacral Syndrome?
A
- Damage to cord at the L4-S3 spinal cord segment
- Flaccid weakness/paralysis of pelvic limbs and tail
- Bladder incontinence
- Proprioceptive deficits
- Decreased or absent reflexes
2
Q
What is Thoracolumbar Syndrome?
A
- Damage to spinal cord segments T3-L3
- Hyperreflexia (UMN) to rear limbs
- UMN bladder
- Hindlimb paresis/paralysis
- Proprioceptive deficits to pelvic limbs
- +/- Schiff-Sherrington (rare occurrence)
3
Q
What is Cervicothoracic Syndrome?
A
- Lesion in the C6–T2 spinal cord segment
- Mono-, hemi- or tetraparesis
- LMN signs to thoracic limbs
- UMN signs to pelvic limbs
- Proprioceptive deficits all limbs
4
Q
What is Cervical Syndrome?
A
- Lesion in C1-C5 spinal cord segments
- UMN to thoracic and pelvic limbs
- Cervical pain and rigidity
- Proprioceptive deficits all limbs
- Abnormal postural reactions in all limbs
5
Q
Why is there imperfect localization?
A
- anatomic variations within each species
- Cervicothoracic and Lumbosacral lesions can have variable effects on flexors and extensors resulting in confusion
- Understanding that the lesion is “probably cervical” but “possibly cervicothoracic” is sufficient for differential diagnoses and a diagnostic plan
6
Q
How is Spinal Cord Function scored?
A
- 1 - Pain without deficits (neurologically normal)
- 2 - Ambulatory paresis (mono-, hemi-, para-, tetra-)
- 3 - Non-ambulatory paresis (mono- hemi- para- tetra-)
- 4 - Paralysis (plegia) with intact nociception
- 5 - Paralysis without nociception
7
Q
What are the different Intervertebral Disk Diseases?
A
- Hansen’s Type I IVDD
- Hansen’s Type II IVDD
- Acute Noncompressive Nucleus Pulposus Extrusion
- Fibrocartilaginous Emboli
- Diskospondylitis
8
Q
What happens with Hansen’s Type I IVDD? Causes?
A
- Nucleus pulposus degenerates
- Weakened/torn/degenerated dorsal annulus
- Rapid extrusion of nucleus pulposus
- Seen in chondrodystrophic breeds
- Dachshund, beagle, Pekingese, Lhasa (3 - 8 years)
- Most common type in large breed dogs
- Also reported in cats (9years)
- Damage created by:
- Compression (duration, amount)
- Velocity of extrusion
9
Q
What are therapeutic options of Hansen’s Type I IVDD?
A
- Surgical Decompression
- Improves recovery vs conservative management in grades 1 &2 (mild) 3&4 (moderate) and 5(marked)
- Hemilaminectomy, fenestration
- Conservative management
- No benefit of corticosteroids
- Analgesia
- Strict cage rest
10
Q
How is Hansen’s Type I diagnosed?
A
- Clinical diagnosis
- Index of suspicion
- signalment, history, findings
- What level of diagnostics are needed if conservative management is pursued
- Plain radiographs and Myelography
- CT scan
- MRI scan
11
Q
What is Hansen’s Type II IVDD (Chronic progressive IVDD)
A
- Progressive thickening of anulus fibrosus
- Seen in older, large breed dogs
- Cervical spondylomyelopthy
- Degenerative lumbosacral stenosis
- Slow onset (weeks-months)
- Damage results from compression only
- No hemorrhage, no edema
- Motor, sensory deficit
- Less painful
- Diagnosis MRI, CT (often with traction)
12
Q
What are the key features of IVDD?
A
- The result of extrusion is hemorrhage, edema, and necrosis
- Fatal consequences is myelomalacia (progressive hemorrhagic myelomalacia)
- _Cervical IVDD (t_ype I)
- results in severe neck pain and rigidity
-
Cervical IVDD (type II)
- results in less pain
- pelvic limb signs are first
-
T-L IVDD (type I)
- T1-T11 lesions are rare
- T11-L3 lesions are most common
- neurological deficits with pain are common
- The absence of deep pain is the most significant negative prognostic factor, reducing likelihood of recovery to less than 5%
13
Q
How should Spinal cord trauma be managed?
A
- Patient stabilization
- IV fluids
- Pain control with opioids
- Maintain normoxia, normocapnia
- Prognostication (radiographs, neuro exam)
- Surgical stabilization or decompression
- Unknowns (not recommended)
- High dose methylprednisolone sodium succinate
- Oscillating field stimulation
- Polyethylene glycol
- Hypothermia
14
Q
What is acute Noncompressive Nucleus Pulposus Extrusion (ANNPE)
A
- High velocity extrusion of very small amount of NP (Type III)
- Results in concussive injury
- Rapid onset - instantaneous, momentary pain
- Less painful due to lack of compression
- Usually improves w/in 24-48 hours without treatment
- Variable distribution (most common in thoracolumbar spinal cord)
- Dx with MRI or clinical suscpicion
- Main DDx: Fibrocartilaginous emboli
15
Q
What is a Fibrocartilaginous Emboli (FCE)?
A
- Ischemic Myelopathy
- Disc-like material obstructs a vertebral artery branch
- Acute cord ischemia (“lights-on, Lights-off”)
- Disc-like material obstructs a vertebral artery branch
- Not noticeably progressive
- Non-painful
- Variable distribution (most commonly thoracolumbar)
- Diagnosed with MRI
- Usually younger than dogs with ANNPE; any size dog
22
Q
How is Cervical Spondylomyelopathy managed/treated?
A
- Medical management:
- Conservative may result in a favorable outcome in 81% of dogs
- Exercise restriction to minimize dynamic component of compression
- Body harness and not a neck collar
- Corticosteroids at anti-inflammatory doses, NSAIDS (preferred)
- Surgical treatment
- Disc-associated CSM: ventral slot, distraction-stabilization, hemilaminectomy
- Osseous-associated: dorsal laminectomy or cervical hemilaminectomy
23
Q
What is Cauda Equina Syndrome?
A
- AKA lumbrosacral vertebral canal stenosis
- Chronic instability results in
- Type II disk protrusion
- Hypertrophy of interarcuate ligament
- Thickening of vertebral arches/articular facets
- Large breed dogs, especially German Shepherd
- Middle-aged
- Clinical signs
- Pain on palpation, extension of limbs, tial elevation
- Difficulty rising
- Tail paresis
- Urinary, fecal incontinence
- Pelvic limb weakness/lameness/atrophy (root signature pain)
- Depressed conscious proprioception
- Possible 3+ patellars; depressed flexion respone
- Decreased anal tone; atonic bladder
