Spinal Assesssment/Disease Flashcards
(54 cards)
1
Q
5 important questions for spinal assessment
A
- Is there a neurological problem?
- Where is the problem?
- What is the severity of the problem?
- What is the problem?
- What is the appropriate treatment and prognosis?
2
Q
how are a reflex and a response different?
A
reflexes are involuntary where responses are voluntary (higher cerebral integration)
3
Q
mental status levels
A
- Alert
- Depressed
- Stuporous
- Comatose
4
Q
gait assessment factors
A
- Ambulatory?
- Ataxic?
- Paresis/plegic? (voluntary motor function)
5
Q
List 6 types of postural reactions
A
- Conscious proprioception: knuckling, paperslide
- Hopping
- Extensor postural thrust
- Wheel barrowing
- Placing reaction: tactile/visual
- Hemi- standing/walking
6
Q
UMN reflexes are
A
increased
7
Q
LMN reflexes
A
decreased/absent
8
Q
LMN signs
A
- Reflexes: decreased/asbent
- Voluntary motor: decreased/absent
- Tone: decreased/absent
- Atrophy: severe, rapid, neurogenic
9
Q
UMN signs
A
- Reflexes: increased
- Voluntary motor: decreased/absent
- Tone: increased
- Atrophy: slow, disuse
10
Q
4 basic functional spinal segments
A
Cervical C1-C5
Cervical intumescence C6-T2
Thoracolumbar T3-L3
Lumbar intumescence L4 - Cd5
11
Q
UMN of FL + UMN of HL indicates segment?
A
C1-C5
12
Q
LMN of FL + UMN of HL indicates segment?
A
C6- T2
13
Q
Normal FL + UMN HL indicates?
A
T3-L3
14
Q
Normal FL + LMN HL indicates?
A
L4 - Cd5
15
Q
3 spinal reflex groups
A
- myotatic (stretch)
- withdrawal (flexors)
- misc/other
16
Q
HL myotatic reflex tests
A
patellar, sciatic, cranial tibial, common peroneal, gastrocnemius
17
Q
FL myotatic reflex tests
A
extensor carpi radialis, triceps, biceps
18
Q
perform a flexor/withdrawal test
A
- least noxious stim to foot to elicit withdrawal (reflex NOT response)
19
Q
list 3 misc spinal reflexes
A
- perineal reflex
- panniculus
- crossed extensor reflex
20
Q
absence of the pannicular reflex indicates a lesion…
A
2 vertebrae cranial to where reflex reappears
21
Q
Grade 1 spine
A
painful only - no neuro deficits
22
Q
Grade 2 spine
A
ambulatory paraparesis
23
Q
Grade 3 spine
A
non ambulatory paraparesis (VM present)
24
Q
Grade 4 spine
A
paraplegia (no VM) + pain present
25
Grade 5
paraplegia + no deep pain response
26
prognosis of grade 2-4 spines w/ surgical intervention is
success 50-90% of time
27
compare of prognosis grade 5 spine w/ sx intervention <48hrs or >48hrs from signs
```
<48hs = 50-90% success
>48h = 5-50% success
```
28
acute spinal disease ddxx
1. Hansen Type I IVDD
2. FCE
3. Trauma
4. GME
29
intermediate onset spinal ddx
1. Discospondylitis
2. GME
3. Neoplasia
30
rad findings of discospondylitis
- lysis of vertebral end plates
- remodelling or production of reactive bone adjacent to areas of lysis
- collapse of disc space
31
pathogen commonly assoc. w/ discospondylitis
Staph intermedius
32
chronic spinal dz ddx
1. Hansen Type II IVDD
2. Degenerative myelopathy/chronic degenerative radiculomyelopathy
3. Neoplasia
33
how useful is the genetic test for degen myelopathy of GSD?
- can only rule out - if gene absent
| - cannot confirm
34
define: lumbosacral disease
Hansen Type II IVDD of L7-S1
35
define: wobblers
Hansen Type II IVDD of C4-C7
| " Cervical spondylomyelopathy"
36
signalment of hansen type I IVDD
- chondrodystrophoid breeds: dachshunds, pekingese
| - age: 3-7yo
37
signalment of hansen type II IVDD
- non-chondrodystophoid usu. larger breeds
| - age: 8-10yo
38
pathogenesis of hansen type I IVDD
- -> early chondroid degeneration of the nucleus pulposus of the disc occurs before 2yo --> the nucleus pulposus loses its gelatinous hydroelastic shock absorbing nature + becomes more cartilaginous + granular
- -> the risk of rupture of the annulus fibrosis + disc extrusion = herniation of the nucleus often w/ explosive force into the spinal canal
- -> eventually some discs may calficy which further decreases any shock absorbing capacity
39
pathogenesis of hansen type II IVDD
annulus fibrosis undergoes fibrous metaplasia --> leads to partial rupture of the fibrous annular bands w/ subsequently 'bulging' of the annulus dorsally into the spinal canal
40
common sites of IVDD
cervical (15%) C2-C3
| thoracolumbar (85%) T11-12, L1-L2 *dt lack of intercapital ligament
41
radiographic signs of IVDD
- narrowing/wedging/collapse of IV space
- sclerosis of the vertebral end plates
+/- calcified material w/in the IV space or the spinal canal
42
goal of IVDD surgery
remove compressive material from spinal canal + prevent recurrence
43
sx approaches to IVDD
- hemilaminectomy
- ventral slot
+/- fenestration
44
describe post-op IVDD care considerations
1. Restricted phys activity: 30d, w/ no running/jumping 6mnths
2. Analgesia: opiates, NSAIDs, NO corticosteroids
3. Recumbency: turn q2-3hrs
4. GIT care: H2 receptors/PPI/mucosal protectants, constipation - metamucil (avoid enemas)
5. Bladder and perineal care: indwelling U-cath w/ cleaning 2x/daily
6. Physio: PROM 15-30mins 3-4x/day + massage
- walking w/ sling
- hydrotherapy onces sx site healed (5days)
45
FCE presentation
- usu larger dogs, per/acute during exercise - initially painful but then non-painful
- often asymmetric
46
location assoc. w/ worse prognosis in FCE
L3-S1
47
tx of FCE
time + supportive care
48
use of corticosteroids in spinal trauma risks
1. gastric ulceration
2. Colonic perforation
3. Secondary infections
4. Prolonged hospitalisation
49
pathogens associated with discopondylitis
aspergillus, staph
50
2 types of wobblers
1. Osseous -associated: facet malformations + lig. hypertrophy (Great Danes)
2. Disc associated: Hansen type II IVDD w/ stenotic spinal canal (Dobermans)
51
eg. intramedullary neoplasia
metastatic astrocytoma
52
eg. intradural-extramedullary neoplasia
meningiomas, nerve sheath tumours
53
eg. extradural neoplasa
osteosarcoma
54
mutation associated with degenerative myelopathy?
SOD-1 mutation
