The Spinal Cord Syndrome Flashcards by Courtney Smith

Lumbosacral Syndrom

Damage to cord at the L4-S3 spinal cord segment

Flaccid weakness / paralysis of pelvic limbs and tail

Bladder incontinence - LMN bladder - expresses easily

Proprioceptive deficit

Decreased or absent reflexes

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Thoracolumbar Syndrome

Damage to spinal cord segments T3-L3

Hyperreflexia (UMN) to rear limbs

UMN bladder - not easily expressed (urinate in small spirts)

Hindlimb paresis / paralysis

Proprioceptive deficits to pelvic limbs

+/- Schiff Sherrington

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Schiff Sherrington

Massive trauma to the thoracolumbar spine

When lying on their side they look hyperreflexive on their form limbs, increased muscle tone, increased reflexes

They will look normal on their front limbs when they stand

Some ascending control for the thoracic limbs

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Cervicothroacic Syndrome

Lesion in the C6-T2 spinal cord segments

Mono-, Hemi-, or Tetraparesis

LMN signs to thoracic limbs

UMN signs to pelvic limbs

Proprioceptive deficits all limbs

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Cervical Syndrome

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

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Imperfect Localization

Allow for anatomic variations withing 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

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Spinal Cord functional Score

1 - pain without dficits (neurologically normal)

2 - Ambulatory paresis (mono-, hemi-, para-, Tetra-)

3 - Nonambulatory paresis (mono-, hemi-, para-, tetra-)

4 - paralysis (plegia) with intact nociception

5 - Paralysis without nociception

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Intervertebral Disk Disease

Hansen’s Type 1 IVDD

Hansen’s Type 2 IVDD

Acute noncompressive Nucleus Pulposus Extrusion

Fibrocartilaginous emboli

Diskospondylitis

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Hansen’s Type 1 IVDD

Nucleus pulposus degenerates

Weakened/torn/degenerated dorsal annulus

Rapid extrusion of nucleus pulposus

Seen in Chondrodystrophic breeds

Damage Created by: Compression; velocity of extrusion

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Hansen’s Type 1 IVDD

Therapeutic Options

Surgical Decompression

Improves recovery vs. conservative management in grade 1,2

Imporves recovery vs. conservative management in grade 3,4

Improves recovery vs. conservative management in grade 5

Hemilaminectomy, Fenestration

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Hansen’s Type 1 IVDD

Therapeutic Options

Conservative Management

No benefit of corticosteroids

Analgesia

Strict cage rest

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Hansen’s Type 1 IVDD
Diagnosis

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

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Hansen’s Type 2 IVDD

Chronic Progressive IVDD

Progressive thickening of annulus fibrosus

Seen in older, large breed dogs: cervical spondylomyelopathy; degenerative lumbosacral stenosis

Slow onset

Damage results form compression only: NO hemorrhave, NO edema, Motor and sensory deficit, less painful

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Hansen’s Type 2 IVDD

Chronic Progressive IVDD

Diagnosis

MRI, CT

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Key Features to Remember about IVDD

The result of extrusion is hemorrhage, edema, and necrosis

Fatal consequence is myelomalacia

Cervical IVDD (type 1) results in severe neck pain and rigidity

Cervical IVDD (type 2) Results in less pain, pelvic limb sings first

with T-L IVDD (type 1) T1-T11 lesions are rare, T11-L3 lesions are most common, and 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%

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Management of Spinal Cord Trauma (any cause)

Patient stabilization: IV fluids, Pain control with opiods, Maintain normoxia, normocapnia

Prognostication

Surgical Stabilization or decompression

Unknowns: high dose methylprednisolone sodium succinate, oscillating field stimulaiton, Polyethylene glycol, Hypothermia

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Acute Noncompressive Nucleus Pulposus Extrusion (ANNPE)

High velocity extrusion of very small amount of NP (Type 3)

Results in concussive injury

Rapid onset - instantaneous, momentary pain

Less painful dut o lack of compression

Usually improves within 24-48 hours without treatment

Variable Distribution - most common thoracolumbar

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ANNPE

Differintal Diagnosis

Fibrocartilaginous emboli

ANNPE

Diagnosis

MRI or Clinical Suspicion

Fibrocartilaginous Emboli (FCE)

Ischemic Myelopathy

Usually younger than dogs with ANNPE, any size dog

Disc-like material obstructs a vertebral artery branch

Acute cord ischemia (lights-on, lights-off)

Not noticeably progressive

NON-painful

Variable distribution

Fibrocartilaginous Emboli (FCE)

Ischemic Myelopathy

Diagnosis

MRI

Recovery of FCE and ANNPE

Ambulatory at discharge: 73% ANNPE, 48% of FCE

Long-term recovery: Normal - 19% ANNPE, 15% of FCE

Long-term problems: urinary incontinence; fecal incontinence; Perceived Successful Outcome

Diskospondylitis

Infection of intervetebral disk

Concurrent osteomyelitis

Grass Awns, UTI, Prostatits, Pyoderma

Medium to large breed dogs

Spinal Pain: reluctant to jump, climb, play

Fever, depression, anorexia

Neurologic deficits are uncommon

Diskospondylitis

Diagnostics

CBC/ Chemistry: usually normal

DX: Radiographs: end-plate lysis and erosion, disk space collapse, sclerosis

Culture: blood, urine, bone, disk

Brucella Testing

Diskospondylitis treatment

Long term antibiotics (8-12 weeks)

Atlantoaxial Subluxation

toy breeds Variable in progression Signs range from mild pain to tetraparesis/plegia Support the neck during radiographs, handling

Cervical Spondylomyelopathy Woobbler Syndrome

Vertebral Canal stenosis is the most important factor in disease development

Cervical Spondylomyelopathy Osseous-associated compression

Young, adult giant breeds Bony proliferation is more dorsal and lateral

Cervical Spondylomyelopathy Disc-associated compression

Middle-aged to older dogs Ventral spinal cord compression

Cervical Spondylomyelopathy Wobblers Syndrome Lesion

C5-6 and C6-7 disk spaces are most commonly affected Gradually progressive pelvic limb ataxia, wide-base crouching, and mild thoracic limb abnormalities Diagnosis si best achieved my myelography using traction or stressed radiographs

Cervical Spondylomyelopathy 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

Cervical Spondylomyelopathy Surgical Treatment

Disc-associated CMS: Ventral slot, distraction-stabilization, hemilaminectomy Osseous-associated: Dorsal laminectomy or cervical hemilaminectomy

Cauda Equine Syndrome

AKA Lumbosacral Vertebral Canal Stenosis large breed dogs (german shepherd) Middle-aged

Cauda Equina Syndrome Chronic instability results in:

type 2 protrusion Hypertrophy of interarcuate ligament Thickening of vertebral arches/articular facets

Cuada Equina Syndrome Clinical Signs

Pain on palpation, extension of limbs, tail elevation Difficulty rising Tail paresis Urinary, fecal incontinence Pelvic limb weakness / lameness/ atrophy (root signature pain)

Cauda Equine Syndrome Diagnosis

Radiographs: spondylosis, sclerosis, wedging Myelogram, epidurography, diskography CT, MRI

Cauda Equine Syndrome Therapy

Change in exercise, weight reduction, NSAIDs Lumbosacral epidural corticosteroids injection Surgery for moderate to severe pain and in dogs with neurological deficits: Decompressive laminectomy, lumbosacral fusion

Spinal Cord Neoplasia

Older, large breed dogs more common Spinal lymphoma in young cats Signs related to location Variably progressive Lateralizing early

Spinal Cord Diagnosis

Radiographs CSF Myelography

Degenerative Myelopathy

Demyelination and axonal degeneration of the spinal cord * Amyotrophic lateral sclerosis * SOD-1 gene mutation Superficial pain remains intact May see apparent LMN signs to pelvic limbs late in disease

Degenerative Myelopathy Progression

Slowly progressive, nonpainful ataxia, and paresis of the pelvic limbs * mild signs seen most on slick surfaces → marked paresis * Worn pelvic limb toenails * Usually a t3-l3 lesion initially: **no bladder or bowel dysfunction** * Marked muscle atrophy late in course

Degenerative Myelopathy common breed

german shepherd!! Also seen in boxers, great danes,chesapeake, labs, corgi, older dogs

Degenerative Myelopathy Diagnostics

radiographs, myelography: no specific findings CSF: increased protein content SOD1 gene testing

Degenerative Myelopathy Differentials

Chronic IVDD, degenerative lumbosacral stenosis, neoplasia, cysts