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Intervertebral disc disease - Coggle Diagram
Intervertebral disc disease
IVDE - Hansen type I
chondroid metaplasia (degeneration) of nucleus pulpous characterised by loss of glycosaminoglycans and decrease in water content
loss of shock absorbency
nuclear material extrudes through all layers of the ruptured dorsal annulus fibrosis into the vertebral canal causing spinal cord compression
often seen in chondrodystrophic breeds
acute disc extrusion is characterised by extradural haemorrhage and soft disc material
acute onset non-traumatic spinal cord pathology, pain --> lack of deep pain sensation
presenting signs
acute onset spinal disease, but animal otherwise BAR
may begin with pain only then progress to a deteriorating neurological status
history of trauma or previous disc disease
agitation/aggression/restlessness
rare before 2yo, peaks 3-7 years old.
clinical signs
upper motor neuron/lower motor neurone signs of cord dysfunction suggests level of damage
pain on palpation/manipulation of spine
spinal hyperaesthesia with varying degrees of limb dysfunction
spinal hyperaesthesia without paresis may result in agitation, aggression and increased activities such as walking or pacing
root signature (affected limb may be held flexed off the ground)
differential diagnosis
traumatic disease
spinal injury
pelvic fracture
non traumatic causes of spinal disease
neoplasia
fibrocartilagenous embolism
type II disc protrusion
discospondylitis
myelitis
meningitis
other causes of gait abnormality
bilateral osteoarthritis
bilateral cruciate ligament rupture
myopathy
aortic/iliac thromboembolism
treatment
depend on severity of clinical signs
mildly affected animals (pain alone or mild paresis) may be managed with cage confinement for 2 weeks, if no improvement --> definitive diagnosis and surgery should be considered
IVDP - Hansen type II
any area of the spinal cord caudal to C1-2
myelopathy usually seen in older animals of large non-chondrodystrophic breeds
middle age to older
raging is related to fibroid degeneration of annulus fibrosus
examples
GSD
lab
St Bernard
Dalmatian
Rottweiler
mixed breeds
large breeds
cause
fibroid degeneration and weakening of dorsal annulus
bulging of the nucleus pulpous within the weakened annulus fibrosus
protrusion of the disk into the vertebral canal
signs
pain -> paresis -> paralysis
may be acute but more commonly slowly progressive onset
neurological deficits
spinal hyperaesthesia
may present without paresis and could result in agitation, aggression and increased activities such as walking or pacing
maybe lameness of one thoracic limb with neck pain or lameness of one pelvic limb with lower back pain
varies with lesion
T3-L3
UMN neurological deficits
increased patellar reflexes
cervical lesion
UMN signs in all four limbs with neck pain and a thoracic limb lameness
conscious proprioceptive deficits
pain on manipulation of lame limb
acute collapse without previous signs
diagnosis
presence or absence of pain, response to a short course of analgesics/anti-inflammatory drugs (esp. glucocorticoids)
helps differentiate degenerative from compressive spinal pathology
Imaging
MRI
radiography
narrowing of the intervertebral disk space
altered shape of the intervertebral foramina
decrease in size of the dorsal articular joint space
spondylosis deformans
CSF
collected caudal to the lesion may contain elevated protein concentration and or pleocytosis
differentials for spinal hyperaesthesia
trauma (spinal cord concussion)
vertebral fracture
discospondylitis
tumours
myelitis
meningitis
differentials if no pain present
degenerative myelopathy
lumbosacral disease
cervical vertebral abnormalities (UMN signs)
orthopaedic conditions of pelvic or thoracic limb
treatment
rest
cage confinement for 2 weeks
if no improvement after 2 weeks, definitive diagnosis and surgery should be considered
if worsens consider different approach earlier
if improvement continue cage rest for 1-2 weeks
only if mild paresis or pain alone
a disc disease is rare in animals older than 10 years
a more aggressive evaluation of milder spinal signs in these animals is warranted
analgesia
surgery
animals that retain deep pain sensation have an 80-90% chance of being able to walk at some point after surgery
if absent, prognosis for walking falls to 50%
if absent for longer than 48h the prognosis for return to walking falls below 5%
prognosis is guarded
caution
care with handling spinal cases for radiography
General anaesthesia --> protective muscle spasms will be removed
Acute non-compressive nucleus pulpous extrusion (ANNPE)
cause
extrusion of non-degenerated nucleus pulpous during strenuous exercise or trauma
signs
paracute onset of non-progressive (after the first 24h) + often asymmetrical myelopathy
paresis or paralysis
usually non painful, but discomfort or hyperesthesia during palpation of the affected spinal segments during first 1-3 days
often lateralised, unaffected side usually mildly affected
urinary incontinence may be present with severe lesion affecting T3-L3 or L4-S3 spinal cord segments
treatment
nursing care
physiotherapy
hydrotherapy
prognosis is good if nociception unaffected
acute onset, non-painful, non-progressive, often asymmetric paresis or paralysis
occurs when non-degenerate nucleus pulpous extrudes through a tear in the annulus fibrosis during strenuous exercise or trauma
leads to spinal cord contusion and nuclear material dissipates within the epidural space causing minimal to no spinal cord compression
commonly affected intervertebral disk spaces
T12-T13
T13-L1
L1-L2
Acute Hydrated Nucleus Pulpous Extrusion (AHNPE)
cause
extrusion of non-degenerated nucleus pulpous material through a tear in the annulus fibrosis after sudden changes of intradiscal pressure and biomechanics e.g. vigorous exercise/running/jumping
clinical presentation
parachute onset of often lateralised myelopathy that is non-progressive after the first 24h, with some degree of physical activity at time of onset
differentiate from ischaemic myelopathy... dogs with AHNCNPE more likely to
have a history of vocalisation at onset of clinical signs
have hyperaesthesia on palpation of the vertebral column during initial examination
MRI best for diagnosis
prognosis
good
73% of dogs ambulatory without assistance and complete urinary and faecal continence
more likely to develop faecal incontinence than ischaemic myelopathy
Acute Intramedullar Nucleus pulposus extrusion (AIMNPE)