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Medicine 1 VCS860 > The Spinal Cord Syndrome > Flashcards

The Spinal Cord Syndrome Flashcards

1
Q

Lumbosacral Syndrom

A

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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2
Q

Thoracolumbar Syndrome

A

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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3
Q

Schiff Sherrington

A

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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4
Q

Cervicothroacic Syndrome

A

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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5
Q

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

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6
Q

Imperfect Localization

A

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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7
Q

Spinal Cord functional Score

A

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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8
Q

Intervertebral Disk Disease

A

Hansen’s Type 1 IVDD

Hansen’s Type 2 IVDD

Acute noncompressive Nucleus Pulposus Extrusion

Fibrocartilaginous emboli

Diskospondylitis

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9
Q

Hansen’s Type 1 IVDD

A

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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10
Q

Hansen’s Type 1 IVDD

Therapeutic Options

Surgical Decompression

A

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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11
Q

Hansen’s Type 1 IVDD

Therapeutic Options

Conservative Management

A

No benefit of corticosteroids

Analgesia

Strict cage rest

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12
Q

Hansen’s Type 1 IVDD
Diagnosis

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

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13
Q

Hansen’s Type 2 IVDD

Chronic Progressive IVDD

A

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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14
Q

Hansen’s Type 2 IVDD

Chronic Progressive IVDD

Diagnosis

A

MRI, CT

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15
Q

Key Features to Remember about IVDD

A

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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16
Q

Management of Spinal Cord Trauma (any cause)

A

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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17
Q

Acute Noncompressive Nucleus Pulposus Extrusion (ANNPE)

A

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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18
Q

ANNPE

Differintal Diagnosis

A

Fibrocartilaginous emboli

19
Q

ANNPE

Diagnosis

A

MRI or Clinical Suspicion

20
Q

Fibrocartilaginous Emboli (FCE)

Ischemic Myelopathy

A

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

21
Q

Fibrocartilaginous Emboli (FCE)

Ischemic Myelopathy

Diagnosis

A

MRI

22
Q

Recovery of FCE and ANNPE

A

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

23
Q

Diskospondylitis

A

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

24
Q

Diskospondylitis

Diagnostics

A

CBC/ Chemistry: usually normal

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

Culture: blood, urine, bone, disk

Brucella Testing

25
Q

Diskospondylitis

treatment

A

Long term antibiotics (8-12 weeks)

26
Q

Atlantoaxial Subluxation

A

toy breeds

Variable in progression

Signs range from mild pain to tetraparesis/plegia

Support the neck during radiographs, handling

27
Q

Cervical Spondylomyelopathy

Woobbler Syndrome

A

Vertebral Canal stenosis is the most important factor in disease development

28
Q

Cervical Spondylomyelopathy

Osseous-associated compression

A

Young, adult giant breeds

Bony proliferation is more dorsal and lateral

29
Q

Cervical Spondylomyelopathy

Disc-associated compression

A

Middle-aged to older dogs

Ventral spinal cord compression

30
Q

Cervical Spondylomyelopathy

Wobblers Syndrome

Lesion

A

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

31
Q

Cervical Spondylomyelopathy

Medical management

A

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

32
Q

Cervical Spondylomyelopathy

Surgical Treatment

A

Disc-associated CMS: Ventral slot, distraction-stabilization, hemilaminectomy

Osseous-associated: Dorsal laminectomy or cervical hemilaminectomy

33
Q

Cauda Equine Syndrome

A

AKA Lumbosacral Vertebral Canal Stenosis

large breed dogs (german shepherd)

Middle-aged

34
Q

Cauda Equina Syndrome

Chronic instability results in:

A

type 2 protrusion

Hypertrophy of interarcuate ligament

Thickening of vertebral arches/articular facets

35
Q

Cuada Equina Syndrome

Clinical Signs

A

Pain on palpation, extension of limbs, tail elevation

Difficulty rising

Tail paresis

Urinary, fecal incontinence

Pelvic limb weakness / lameness/ atrophy (root signature pain)

36
Q

Cauda Equine Syndrome

Diagnosis

A

Radiographs: spondylosis, sclerosis, wedging

Myelogram, epidurography, diskography

CT, MRI

37
Q

Cauda Equine Syndrome

Therapy

A

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

38
Q

Spinal Cord Neoplasia

A

Older, large breed dogs more common

Spinal lymphoma in young cats

Signs related to location

Variably progressive

Lateralizing early

39
Q

Spinal Cord Diagnosis

A

Radiographs

CSF

Myelography

40
Q

Degenerative Myelopathy

A

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

41
Q

Degenerative Myelopathy

Progression

A

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
42
Q

Degenerative Myelopathy

common breed

A

german shepherd!!

Also seen in boxers, great danes,chesapeake, labs, corgi,

older dogs

43
Q

Degenerative Myelopathy

Diagnostics

A

radiographs, myelography: no specific findings

CSF: increased protein content

SOD1 gene testing

44
Q

Degenerative Myelopathy

Differentials

A

Chronic IVDD, degenerative lumbosacral stenosis, neoplasia, cysts

Medicine 1 VCS860 (13 decks)

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