Spinal Cord Disease

What is included in the lumbosacral region?

L4-S3

Describe the signs of lumbosacral disease

Flaccid weakness/paralysis of pelvic limbs and tail

Bladder incontinence

Proprioceptive deficits

Decreased or absent reflexes

What does the lumbosacral region effect?

Pelvic limbs

What does the thoracolumbar include?

T-3-L3

What are the signs of thoracolumbar disease?

Hyperreflexia (UMN) to rear limbs

UMN bladder

Hindlimb paresis/paralysis

Proprioceptive deficits to pelvic limbs

± Schiff-Sherrington (rare)

What is a common cause of thoracolumbar disease?

Hit by car

What does the cervical region include?

C1-C5

What does the cervicothoracic region include?

C6-T12

What are the signs of cervical and cervicothoracic disease?

Mono, hemi, or tetarparesis with proprioceptive deficits

LMN signs to thoracic limbs with C6-T2

UMN signs to thoracic limbs with C1-C5

UMN signs to pelvic limbs with both

Cervical pain and rigidity

T/F localization to cervicothoracic vs cervical is very difficult?

True

What can cause imperfect localization?

Anatomic variations within species

Cervicothoracic and lumbosacral lesions can have variable effects on flexors and extensors

What is the most common intervertebral disk disease?

IVD extrusion

What happens during an IVD extrusion?

Extensive epidural hemorrhage

Hydrated nucleus pulposus extrusion

What are the types of intervertebral disk disease?

IVD extrusion

IVD protrusion

Acute noncompressive nucleus pulposus

Intradural/intramedullary IVD extrusion

Fibrocartilaginous embolic myelopathy

Diskospondylitis

What patients are more likely to get IVD protrusion?

Older patients

What is acute noncompressive nucleus pulposus extrusion (ANNPE)

High velocity extrusion of very small amount of NP (type III) usually during exercise or with trauma

Rapid onset

Improves in 24-48 hours

What does ANNPE (acute noncompressive nucleus pulposus extrusion) result in?

Contusion with minimal compression

Where is ANNPE and HNPE restricted to?

Extradural space

What is IIVDE (intradural/intramedullary IVD extrusion)?

Nucleus penetrates the dura mater but stays extramedullary

Nucleus penetrates the parenchyma of the cord

Where is IIVDE most common?

Thoracolumbar (can be cervical tho)

How do you diagnose ANNPE?

MRI or clinical suspicion

What is FCE (fibrocartilaginous emboli)?

A disc-like material obstructs a vertebral artery branch

Exertion associated

What are the C/S of FCE?

Lateralizing, non-painful paresis or paralysis

Not progressive

How do you diagnose FCE?

MRI

What is diskospondylitis?

Infection of the intervertebral disk disease

Concurrent with osteomyelitis

What can cause diskospondylits?

Grass awns

UTI

Prostatitis

Pyoderma

What are the C/S of diskospondylitis?

Reluctant to jump, climb or play

Fever, depression, anorexia

Neurological deficits are uncommon

Normal CBC and chem

What dogs are more likely to get diskospondylitis?

Large breeds

How do you diagnose diskospondylitis?

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

Culture: blood, urine, bone, disk

Brucella testing

Urine Ag test for Aspergillus

What is the treatment for diskospondylitis?

Long term antibiotics (8-12 weeks)

Fungal causes are not responsive to therapy

If you see diskospondylitis with multiple disk spaces what is the likely cause?

Fungus

What are the general practice guidelines for diskospondylitis?

Take radiographs and re-take if needed because lesions can be delayed

Treat with cephalexin (first-choice)

Fungi can also cause it

Describe spinal cord neoplasia

Common in older dogs (large breeds)

Spinal lymphoma in cats usually

Signs depend on location

Progressive

Lateralize early

How do you diagnose spinal cord neoplasia?

Radiographs

MRI

CSF

What are the general practice guidelines of spinal tumors?

Start with a radiograph to save money and not do an MRI

What is degenerative myelopathy?

Demyelination and axonal degeneration of the spinal cord

What is the most common dog to get degenerative myelopathy?

German Shepherd, Great Dane, Chesapeake, Labrador retriever, Corgi

What are the C/S of degenerative myelopathy?

Slowly progressive, nonpainful ataxia and paresis of pelvic limbs

Muscle atrophy atrophy late in course

What gene is associated with degenerative myelopathy?

SOD-1

What type of pain remains intact with degenerative myelopathy?

Superficial pain

How do you diagnose degenerative myelopathy?

CSF: increased phosphorylated neurofilament heavy chain

SOD1 gene testing

What are some differentials of degenerative myelopathy?

Chronic IVDD, degenerative lumbosacral stenosis, neoplasia, cysts

How do you treat degenerative myelopathy?

Exercise/PT

Aminocaproic acid, Vit E, L-serine, stem cell therapy

Ultimately will be euthanized