IVDD

Question 1

Objectives (6)

Answer 1

1. List commonly affected breeds with IVDD
2. Recognize CS of myelopathy
3. Recognize who is at risk of myelomalacia
4. Recognize clinical signs of myelomalacia
5. Recognize when to manage medically versus surgically for IVDD
6. List treatments for bladder dysfunction associated with T3-L3 and L4-S3 spinal lesions

Question 2

There is less upper thoracic disk dz because of

Answer 2

Dorsal and Ventral longitudinal ligaments

Question 3

Nucleus pulposis

Answer 3

central jelly like material

Question 4

Annulus fibrosis

Answer 4

Collagen, outer/inner/and transition zones

Question 5

Extrusion (Hansen Type I) (3)

Answer 5

1. CHONDROID METAPLASIA of nucleus pulposus
2. Dehydration and accumulation of mineral in nucleus, can’t withstand pressure
3. Nucleus expelled through tear

Question 6

Clinical signs extrusion (type I) (4)

Answer 6

1. Acute onset
2. Pain
3. Ataxia
4. Paresis/Paralysis

Question 7

Signalment of Extrusion (type I dogs) (3)

Answer 7

1. Chondrodystrophoid dogs (Dachshund)
2. Younger dogs 3-6 yrs (range 1-14yrs)
3. Can be seen in large dogs too

Question 8

Extrusion (type I) lesion

Answer 8

Ush TL herniations between T11/12 and L1/2

Question 9

Presentation of Frenchies with Extrusion

Answer 9

lumbar spine, away from malformations

Question 10

Presentation of Cockers with extrusion

Answer 10

Caudal lumbar spine

Question 11

Protrusion (type II) (4)

Answer 11

1. FIBROID METAPLASIA (hypertrophy and protrusion)
2. Nucleus progressively dehydrated and replaced by fibroid tissue
3. Fibers of annulus rupture over months
4. Disk protrudes dorsally

Question 12

Signalment of protrusion (2)

Answer 12

1. Non-chondrodystrophic breeds (large breeds)

2. Older dogs > 5 years

Question 13

Clinical signs of protrusion (3)

Answer 13

1. Chronic
2. Progressive ataxia and paresis
3. +/- pain

Question 14

Acute non-compressive nucleus pulposus extrusion (type III) (3)

Answer 14

1. Low volume/high velocity peracute rupture of annulus
2. Minimal to no compression
3. Similar clinical and imaging findings as FCE

Question 15

Hydrated nucleus pulposis extrusions

Answer 15

seagull sign, not common

Question 16

Cervical IVDD Clinical signs (3)

Answer 16

1. Neck pain
2. Nerve Root signiature
3. C2-C3 in chondrodystrophic dogs; C6-C7 large dogs

Question 17

Cervical IVDD R/O (3)

Answer 17

1. Diskospondylitis
2. Vertebral tumors
3. Trauma

Question 18

Signs of cervical IVDD (2)

Answer 18

1. Narrowing disc space

2. Mineralized disc material in canal

Question 19

Imaging for cervical spine

Answer 19

MRI preferred over CT

Question 20

Thoracolumbar IVDD CS (4)

Answer 20

Classic signs

1. Loc T3-L3 or L4-S3
2. ADR, reluctant to jump
3. Differentiate back pain from abd pain
4. Kyphotic stance

Question 21

Thoracolumbar IVDD R/Os (4)

Answer 21

1. Disko
2. Fractures/Luxation
3. Vertebral tumors
4. Abd dz

Question 22

Signs of IVDD (3)

Answer 22

1. Mineralization of IVD
2. Narrowing of disc space
3. Opacity in woodstock foramen

Question 23

TX/Prog Cervical IVDD (2)

Answer 23

1. Conservative managment: Cage rest and anti-inflammatores

2. 49% recovered, 33% recurrence

Question 24

Prognosis TL IVDD (5)

Answer 24

1. Pain only-med 100% succ/sx 97% succ
2. Paresis, walking-med 84%/sx 95%
3. Paresis, not walking-med 84%/sx 93%
4. Paraplegia-med 81%/sx 95%
5. Loss of deep pain-med 7%/sx 64%

Question 25

If you can move, you can

Answer 25

pee

Question 26

Conservative tx IVDD (5)

Answer 26

1. Case rest 6-8 weeks 2. 2 weeks meds 3. short leashed walks (no neck leads) 4. No running, jumping, playing 5. Minimal PT (ROM)

Question 27

Drugs for IVDD (3)

Answer 27

1. Pain-tramadol, Gabapentin 2. Anti-inflammatories-steroids or NSAIDS 3. Muscle relaxant/sedation-valium, methocarbamol, ace, trazadone

Question 28

Conservative therapy good for cervical IVDD if (3)

Answer 28

1. Pain only 2. Significant concurrent disease 3. If other deficits refer for work-up

Question 29

Conservative therapy good for Thoracolumbar IVDD if

Answer 29

1. Pain only 2. Ambulatory ataxia, paresis 3. refer non-ambulatory

Question 30

Malacia

Answer 30

Ascending/Descending death of spinal cord within 1-10 days post sx/injury

Question 31

Signs of malacia

Answer 31

1. Loss of reflexes with TL panniculus 2. Extreme pain/mentation change 3. Increased body temp 4. Abdominal breathing

Question 32

High risk disks to fenestrate if possible

Answer 32

T11, T12, L2, L3

Question 33

Post op care

Answer 33

1. Strict cage rest-2 weeks 2. Med therapy 3. Nursing care 4. Physical therapy-Passive, massage, standing, hydrother 5. Acupuncture/Laser tx

Question 34

Bladder control nerves

Answer 34

1. hypogastric n. - detrusor relax, IS cont 2. Pelvic n. - detrusor cont, IS relax 3. Pudendal n. - skeletal muscle (striated/ES)

Question 35

T3-L3 bladder dysfunction (6)

Answer 35

1. UMN bladder 2. Hypogastric nerve 3. Full, turgid bladder 4. Tight urinary sphincter 5. Can NOT empty 6. Difficult to express

Question 36

L4-S3 (6)

Answer 36

1. LMN bladder 2. Pelvic nerve 3. Large, flaccid bladder 4. Loose urinary sphincter 5. Dribbling urine 6. Easy to express

Question 37

Med management UMN Bladder (3)

Answer 37

1. Prazosin-a adrenergic blocker, side effects hypotension 2. Phenoxybenzamine-don't use here 3. Diazepam-skeletal m. relaxant, side effects-sedation

Question 38

Management UMN bladder (3)

Answer 38

1. Non-ambulatory patients 2. Express/evacuate 3X/day 3. Risk of UTI-appropriate abx - female, low body temp during anesth, pred