Web-Vet TM Neurology Specialists
Spinal Trauma
Acute spinal cord injury can result from compression, contusion, laceration, ischaemia or inflammation, with there often being a combination of these problems. The consequence of trauma is a series of harmful biochemical, vascular and metabolic events, typically referred to as secondary spinal cord injury. This process ultimately results in the death of neurons and supporting cells in an expanding zone of spinal cord tissue necrosis. The majority of this secondary damage occurs within the first 24 hours, depending on the nature of the initial insult. Neurons within the CNS cannot effectively regenerate axons, and so recovery following axonal transection or neuronal death is dependent on developing alternative routes of conduction through the surviving tissue. As a result, prognosis is greatly influenced by the severity of the damage at the time of evaluation. Treatment focuses on surgical decompression of compressive lesions, stabilization of unstable vertebral fractures, supportive care and physical rehabilitation to facilitate and maximize recovery.
This article looks at the physiology associated with "bed rest" and inactivity and how it may relate to the veterinary patient with spinal cord injury and physical rehabilitation (PR).
Strict cage rest is commonly used in veterinary medicine as a standard of treatment for dogs with spinal cord injury and disease. It goes without saying that this form of 'bed rest' is often essential with our patients who are unable to grasp the concept of reinjury and neurologic worsening secondary to over activity. However, have you considered the deleterious effect on the body of inactivity and 'bed rest'?
In this article, the author discusses the effects of inactivity on the musculoskeletal system as well as other body systems and how PR can be beneficial to help reverse or decrease these deleterious effects.
Spinal shock in severe SCI dogs and early implementation of intensive neurorehabilitation programs
This prospective controlled blinded cohort study aims to understand the implications of spinal shock in the neurorehabilitation of severe SCI dogs and the importance of its evaluation through a spinal shock scale (SSS). 371 dogs were randomized by stratification according the presence of spinal shock in the SG (n = 245) or CG (n = 126). The SSS, a punctuation scale (0–7), was evaluated at admission and each 6 h for 3 days, each day for 15 days, each week for 6 weeks, each month until 3 months, followed by 3 monthly follow-ups. All dogs had similar land and underwater treadmill training with functional electrical stimulation. Observational dataset allowed an approximate level of power (1-β) of 0.90 and an α (Type I error) of 0.01, with a total of 11,088 SSS observations between two blinded observers and 18% of disagreement. 75% of the dogs were admitted in 24-48 h after injury, allowing early detection of spinal shock, and dogs admitted at 72 h with SSS ≥ 4 were not able to achieve ambulation. Regarding ambulation rate, there was a significant difference between groups, with 66.9% of ambulation in the SG and 97.6% in the CG. Also, there was a difference in regard to time until ambulation, with a mean of 31.57 days for the SG and 23.02 for the CG. The SSS estimated marginal means had an exponential decrease within the first 6 h, followed by a slower decrease, but always faster in spinal shock dogs diagnosed with non-compressive myelopathies.
Central cord syndrome: clinical features, etiological diagnosis, and outcome in 74 dogs
The aim of this study was to describe the clinical and neurologic signs, diagnostic investigations, definitive or presumptive diagnosis, treatment, and outcome of 74 dogs presented with acute onset central cord syndrome (CCS).
C1-C5 spinal cord segments were affected in 65 of 74 (88%) dogs and C6-T2 in 9 (12%) dogs. Neurolocalization did not correlate with the imaging findings in 43 (58%) dogs. The most common associated condition was Hansen type I disk herniation in 27 (36%) dogs and hydrated nucleus pulposus extrusion in 16 (22%) dogs. Main lesion locations within the vertebral column associated with CCS were C3-C4 and C4-C5 intervertebral disk spaces in 21 (28%) and 18 (24%) dogs, respectively. Outcome was favorable in 69 (93%) dogs. Patients presenting with hypoventilation were 14.7 times more likely to have a poor outcome.
The purpose of this case report is to describe the use of cortical screws, VCPs, and PMMA to provide an alternative reduction and fixation technique for C2 fractures. Cortical screws were placed in the cranial and caudal fracture fragments with VCPs situated between the screws to maintain reduction and were incorporated into the final PMMA construct for further stability.
The aim of this study was to evaluate outcomes and prognostic factors for cats with sacrocaudal luxation.
Fifty-five of 61 cats (90%) regained voluntary urinary function. A higher neurological grade was associated with a decreased likelihood and longer duration of regaining urinary function. No significant associations were found between urinary outcome and age, sex, anal tone, perineal sensation, tail base sensation, degree of craniocaudal or dorsoventral sacrocaudal displacement, concurrent orthopaedic injury, tail amputation, defecatory function at diagnosis and survival. Cats that regained defecatory function had longer survival times than those that did not recover defecatory function (P = 0.03). Defecatory outcome was not significantly associated with any other variables.