Conditions Involving Both Hind Limbs Flashcards by Jen Whitmore

Spinal cord lesions caudal to what vertebrae can cause paraparesis or paraplegia?

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What is a myelopathy?

Any disorder of the spinal cord or of bone marrow.

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What condition occurs due to degeneration of axons and their myelin sheaths in the thoracolumbar spinal cord?

Degenerative myelopathy

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Degenerative myelopathy affects what size dog mainly?

Large and giant breeds

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Are lesions seen with degenerative myelopathy inflammatory?

How is the response to immunosuppressive therapy?

- Poor

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Is the loss of voluntary motor functions and position sense quick or gradual with degenerative myelopathy?

Gradual

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Knuckling, dragging of the toes, crossing of the legs when walking/turning, dysmetria and ataxia of the pelvic limbs are the most common clinical signs seen with what condition?

Degenerative myelopathy

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In what age range is degenerative myelopathy seen in dogs?

Older than 8 years

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With degenerative myelopathy, are LMN or UMN signs generally seen in the hind limbs?

UMN

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Is spinal hyperesthesia seen with degenerative myelopathy?

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How is pain sensation in the pelvic limbs of a dog with degenerative myelopathy?

Usually normal

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How do you get a definitive diagnosis for degenerative myelopathy?

See axonal and myelin degeneration with astrogliosis on histopathology.

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What is astrogliosis?

Abnormal increase in number of astrocytes dye to destruction of nearby neurons.

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What are two conditions that need to be excluded for a clinical diagnosis of degenerative myelopathy to be made?

Inflammatory

- Compressive causes

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A genetic mutation of what gene has been linked to degenerative myelopathy?

Superoxide dismutase 1 protein gene (SOD 1)

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What is the treatment for degenerative myelopathy?

None

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What type of degeneration can be seen at the lumbosacral articulation?

Hansen type II degeneration

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Instability at L7-S1 causing proliferation of the interarcuate ligaments and formation of osteophytes on articulation facets which further compress the spinal cord and sciatic and pudendal nerve can be seen with what 4 conditions?

Lumbosacral malarticulation-malformation
Cauda equina syndrome
Lumbosacral stenosis
Spondylolisthesis

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Compressive forces in the L7-S1 region can result in pain and LMN signs in what 2 nerves?

Sciatic

- Pudendal

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Is there disc degeneration seen with lumbosacral malarticulation-malformation, cauda equine syndrome, lumbosacral stenosis and spondylolisthesis?
What age range and size dogs are these conditions more common in?
Are these seen in cats?

No
5-8 years old/large breed dogs
Very rarely seen in cats

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At what point is rear limb paresis usually seen in dogs with lumbosacral conditions?

Usually only in advanced cases.

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What are 3 early signs that can be seen with problems in the lumbosacral area?

Lumbosacral pain
Difficulty rising
Difficulty negotiating stairs

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Decreased extension of the hock indicates what nerve is being affected?

Sciatic nerve

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In which test for pain are the hips extended and a downward force applied to the lumbosacral region?

“Lordosis test”

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Pain as a result of what action is more specific for lumbosacral problems vs hip problems?

Hyperextension of the tail head (tail jack)

With advanced cases involving the lumbosacral region, which reflex may show pseudohyperreflexia?

Patellar reflex

Can urinary and fecal incontinence be seen with lumbosacral conditions?

Yes in advanced cases

What is diagnosis of lumbosacral conditions based on?

Documentation of nerve compression

What is spondylosis?

Immobility and fusion of vertebral joints.

Dogs with what condition are about 8 times more likely to develop a cauda equina syndrome? Where is the lesion usually located in this case?

- Lumbosacral transitional vertebra (LTV) | - Between the last true lumbar vertebra and the LTV

Cauda equina syndrome must be confirmed by what? | Why?

- Contrast radiography | - Many normal dogs have abnormalities at L7/S1 on plain radiographs

What are 2 diagnostic procedures that enable both lumbosacral compression and nerve entrapment in foramina to be assessed?

- MRI | - CT

Is CSF analysis helpful in diagnosing cauda equina syndrome? Why?

- No | - Spinal cord proper has usually terminated cranial to level of compression (L7/S1)

What are 5 drugs that can be used in addition to cage rest for the medical management of lumbosacral injuries?

- NSAIDs - Gabapentin - Muscle relaxants - Tramadol - Prednisone

What is a laminectomy?

Surgical removal of part of the posterior arch of a vertebra to provide access to the spinal canal.

What are 2 surgical options for the treatment of lumbosacral injuries?

- Lumbosacral dorsal laminectomy | - Removal of the ligaments and bone putting pressure on the nerves

Does lumbosacral surgery usually improve incontinence?

What is a foramenotomy?

Surgery that widens the opening in the intervertebral foramina where nerve roots leave the spinal canal.

All vertebrae besides which 2 have discs between them which act as shock absorbers and facilitate movement between vertebrae?

C1 and C2

What are the 2 components of a disc?

- Outer fibrous ring (annulus fibrosis) | - Inner gelatinous mass (nucleus pulposus)

How is the nucleus pulposus positioned in the annulus fibrosis?

Eccentrically between the middle and dorsal third of the disc.

As the dog ages, the gel-like nucleus pulposus degenerates and is replace with what?

Cartilage

In most breeds, replacement with fibrocartilage is complete by what age? In chondrodystrophic breeds?

- 7-8 years of age | - 4-18 months of age

What is common in the central areas of the discs of chondrodystrophic dogs?

Calcification

Dorsal displacement of the nucleus pulposus can result in what 2 occurrences as a result of impact injury or mechanical compression?

- Stretching of the dorsal longitudinal ligaments causing pain - Spinal cord damage causing neurological dysfunction

An explosive extrusion of nuclear pulposus material into the spinal canal through the annulus fibrosis is known as what?

Hansen type 1 displacement

Hansen type 1 displacement is seen most commonly in what type of dogs?

Chondrodystrophic

In which form of displacement do small tears appear in the annulus fibrosis leading to slow protrusion of the nucleus pulposus?

Hansen type 2 displacement

Hansen type 2 displacement occurs more commonly in what type of dogs?

Large breed dogs

Thoracolumbar intervertebral disc disease is usually seen in what age group?

3-7 years of age

Is calcification of discs common in cats? | Where is it most often seen?

- Yes | - Upper cervical and mid-lumbar (L4-L5)

There are seldom disc protrusion in what area of the spine? | Why?

- T2-T10 | - Intercapital ligament

Most disc protrusions occur in what area of the spine?

T11-L2

Disc protrusions between T11 and L2 give what kind of sings to where?

UMN signs to the hind limbs

What is the sequence of the loss of neurological function typically seen with spinal cord compression?

- Conscious proprioception - Voluntary motor function and usually control of urination and defecation - Superficial pain sensation - Deep pain sensation

What is proprioception?

Awareness of the position on one's body.

Spinal radiographs showing collapse of disc spaces with calcified disc material in the vertebral canal can be indicative of what condition? What is needed to definitely locate the lesion?

- Thoracolumbar intervertebral disc disease | - Myelography

Medical or surgical therapy for thoracolumbar intervertebral disc disease is chosen depending on what 2 factors?

- Severity of compression | - Clinical signs

What are the neurological deficits seen with Grade 1 thoracolumbar intervertebral disc disease?

Spinal hyperesthesia without neurological defects

What are the neurological deficits seen with Grade 2 thoracolumbar intervertebral disc disease?

Paresis but ambulatory

What are the neurological deficits seen with Grade 3 thoracolumbar intervertebral disc disease?

Paresis but non-ambulatory

What are the neurological deficits seen with Grade 4 thoracolumbar intervertebral disc disease?

Paralysis with deep pain sensation intact

What are the neurological deficits seen with Grade 5 thoracolumbar intervertebral disc disease?

Paralysis with loss of deep pain

Strict cage rest for 2 weeks is usually successful in 80-100% of which grade patients?

Grades 1, 2, 3

Which is more effective for pain with dogs on cage rest from thoracolumbar intervertebral disc disease, NSAIDs or prednisone?

Prednisone

What are 2 drugs that can be given to help with the expression of UMN bladders by reducing the tone in the smooth muscle of the urethral sphincter?

- Prazosin | - Phenozybenzamine

What is recommended for all grade 4 patients?

Surgery

What is the technique of choice for surgery on grade 4 patients?

Dorsolateral hemilaminectomy

Which grade will most likely not recover regardless of treatment?

Grade 5

If deep pain sensation has not returned in a grade 5 patient by 2 weeks post surgery, is it likely to return?

Is there a difference in prognosis for a grade 5 patient with LMN signs vs UMN signs?

Which has a worse prognosis, dogs with type 1 or type 2 discs?

Type 2

Are there any preventative measures for thoracolumbar intervertebral disc disease?

No known behavioral risk factors

An infection of the cartilaginous endplates with secondary involvement of the intervertebral disc is known as what?

Discospondylitis

What are the 3 most common agents causing discospondylitis?

- Staphylococcus intermedius - Brucella canis - Streptococcus spp.

What type of dogs are predisposed to discospondylosis? | Is it seen in cats?

- Large middle-aged male dogs | - Rare in cats

What are the 3 most common sites affected by discospondylosis?

- Caudal cervical (C6-C7) - Mid-thoracic (T4-T6) - Lumbosacral (L7-S1)

Initially, dogs infected with discospondylitis have what 4 clinical signs?

- Hyperesthesia - Pyrexia - Depression - Weight loss

What is pyrexia?

Fever

If discospondylitis remains untreated, proliferation of what 2 things can cause spinal cord compression and paresis caudal to the lesion?

- Fibrous connective tissue | - New bone

Spinal cord lesions with concurrent systemic signs should raise a high level of suspicion of what condition?

Discospondylitis

A definitive diagnosis of discospondylitis can be made with what? What are 3 things that can be seen?

- Spinal radiographs | - Vertebral lysis, sclerosis, spondylosis

Serology for which bacteria should be performed on affected intact dogs with discospondylitis?

Brucella canis

What are 3 antibiotics that can be used to treat discospondylitis cause by Staphylococcus intermedius?

- Cephalexin - Cephazolin - Cloxacillin

How long should antibiotic treatment be given for the treatment of discospondylitis?

Until there are no radiographic signs of active infection.

Discospondylitis dogs with neurological dysfunction are surgical candidates for decompression or stabilization using what technique?

Hemi-laminectomy

What is the prognosis of discospondylitis?

Generally favorable, except for fungal infections.

What are 4 possible positions of neoplasms within the spine?

- Intramedullary - Metastatic intramedullary - Intradural-extramedullary - Extradural

What are 3 examples of intramedullary neoplasms?

- Astrocytoma - Oligodendroglioma - Ependymoma

What are 3 examples of metastatic intramedullary neoplasms?

- Hemangiosarcoma - Melanoma - Carcinoma

What are 3 examples of intradural-extramedullary neoplasms?

- Meningioma - Nephroblastoma - MPNSTs

Which location of tumor is the most common in cats and dogs?

Extradural

What is the most common primary spinal cord tumor in the dog? Where is it most frequently found?

- Meningiomas | - Thoracolumbar area

What is the second most common spinal tumor in dogs?

Hemangiosarcoma

What is the most common spinal cord tumor in cats? | Is it also common in the brain?

- Extradural lymphosarcoma | - No, rare in the brain

Where do extradural lymphosarcomas mainly occur in the cat?

Thoracolumbar area

What are 2 characteristics of cats with extradural lymphosarcoma?

- Young (3.5 years old) | - FeLV positive

Where do meningiomas mainly occur in the cat?

Brain

Are intramedullary tumors common or rare in cats?

Rare

Partial/complete loss of voluntary motor function in both pelvic limbs is known as what?

Paraparesis/paraplegia

Conditions Involving Both Hind Limbs Flashcards

(100 cards)