cute pinlcord injurie - Today’s Veterinary Practice

Today’s Veterinary Practice May/June 201238

Acute SpinAl cord injurieSAdam Moeser, DVM, and

Charles Vite, DVM, PhD,

Diplomate ACVIM (Neurology)

Acute spinal cord

injury is a major

cause of neurologic

dysfunction in dogs and

somewhat less so in cats.

peer reviewed

Acute SpinAl cord inJurieS:

Step by Step1. History: When a dog or cat presents with evidence

of acute spinal cord injury, obtain a detailed history

and ascertain whether trauma may have occurred.

2. Stabilization: Whenever spinal cord injuries

secondary to trauma are suspected, manipulate the

patient as little as possible. Evaluate the patient’s

overall stability first; then address neurologic deficits.

3. neurologic examination: The findings from a

comprehensive neurologic examination are the most

important part of the diagnostic evaluation.

4. differentials: If no trauma or obvious instability

has occurred, consider differentials, such as

intervertebral disk disease and fibrocartilagenous

embolism.

5. radiographs: Spinal radiographs are essential in

order to identify spinal instability prior to extensive

manipulation of the patient.

6. ct & Mri: Advanced imaging is valuable in

diagnosis of acute spinal cord injury. If severe

neurologic deficits are present, refer the patient to a

hospital with appropriate diagnostic capabilities.

7. treatment: Depending on diagnosis, pursue medical

management (indicated for patients with pain or

minor deficits) or surgery (indicated in patients with

severe neurologic deficits, vertebral instability, or

significant extradural compression).

8. Secondary damage: Be prepared for secondary

damage and initiate treatment if necessary.

May/June 2012 Today’s Veterinary Practice 39

The most commonly encountered causes of

acute spinal cord injury in dogs are, in order

of incidence:1-4

•Intervertebraldiskdisease(IVDD)

•Trauma(automobiletrauma,gunshots)

•Infarction(fibrocartilagenousembolism).

Incats,themostcommoncausesofacutespinalcord

injuryrecordedfromapopulationofcatsthathadbeen

necropsied are, in order of incidence:5

•Trauma(fallingfromwindows,automobiletrauma)

•IVDD

•Ischemic disease (infarction, fibrocartilagenous

embolism[FCE]).

PATIENT ASSESSMENT

Stabilization

Wheneverspinalcordinjuriessecondarytotraumaare

suspected, it is important to manipulate the patient as

littleaspossible.

•Transport:Theuseofastretcherorboardcanbe

veryhelpfulfortransportation.Thepatientshould

berestrainedandpossiblystrappedtotheboard

duringtransport.

•Overall Stability:Whenevaluatingapatientwith

neurologic deficits due to suspect trauma,

evaluatethepatient’soverallstabil-

ity first (ie, evalu-

ationof pulmonary and cardiovascular systems).

Traumapatientsmaysuffersignificantdamageto

bodysystemsthatposemoreimmediatethreatsto

theirlivesthanneurologicdeficits.

Neurologic Examination

•Theneurologicexaminationisthefirstandmost

important tool used by the clinician to localize

the site of injury. Please refer to Chapter 3 ofA

Practical Guide to Canine & Feline Neurology

(Dewey CW, Wiley-Blackwell, 2003) for more

specifics on the neurologic examination. The

presenceofcertainexaminationfindingswillhelp

localize the lesion(Table 1,page40)anddirect

furtherdiagnostics.

•However,itisnotuncommontofindsomediscrep-

ancybetweenneurolocalizationbasedontheneuro-

logicexaminationandtheactualinjurylocalization.

•One study showed an incorrect neuroanatomic

localizationwithinthecervicalcordin12/26dogs

withcervicaldiskdisease,mainlyduetoinconsis-

tent withdrawal reflexes.6 In addition, incorrect

neuroanatomic localization from L4 to S3 can

occur due to spinal shock in cases of T3 to L3

myelopathy(spinalcorddisease).7

Whenassessingapatientwithevidenceofamyelopa-

thy, thepresence/absenceofplegiaanddeeppainare

veryimportantindicatorsofprognosisregardlessofthe

etiology.Plegiaandlossofdeeppainareusuallyassoci-

atedwithseverelesionsthatarecausingpathologyto

asignificantpercentageofthewhitematter,while

patientsthatareonlypainfulandataxiclikelyhave

lesswhitematter involvement (Table 2, page

41).Atheoreticalprogressionofclinical signs

followingprogressionofpathologywouldbe:

Pain/ataxia/paresis Plegia Lossof

deep pain sensation

DIFFERENTIAL DIAGNOSIS

Intervertebral Disk Disease

IVDDisamajorcauseofacutespinalcordinjury

indogs; less so in cats. The intervertebral disk is

composedofanouterannulusfibrosisandaninner

nucleuspulposus(Figure 1,page40).Themajority

oftheannulusandtheentirenucleusisavascular;only

theperipheralpartsoftheannulusareinnervated.

Types of IVDD

•Fibrous metaplasia is part of the normal aging

processindogsandcats,whichresultsinweaken-

ingoftheannulusandfibrouscollagenizationof

thenucleuspulposus.Thiscanleadtobulgingof

theintervertebraldiskandaHansen Type II inter-

vertebraldisklesion(outermostlayersofannulus

fibrosusremainintact).

•Chondroid metaplasiaoccurswithinthenucleus

pulposus at an early age in chondrodystrophic

| AcuTE SPInAl corD InjurIES


breeds, such as the dachshund.8 With chondroid

metaplasia,thenucleuspulposusbecomesabnor-

malandisnolongerabletodisperseforcesevenly,

leading to herniation. This herniation can occur

acutely and cause a Hansen Type I intervertebral

disklesion(completeperforationofannulusfibro-

sus with extrusion of nucleus pulposus into the

spinalcanal).Sincethenucleuspulposusiseccen-

tricallyplacedmoredorsallywithin theannulus,

the herniatedmaterial tends to herniate toward

thespinalcord.

•Traumatic noncompressive intervertebral disk

herniationoccurswhenthenucleuspulposusis

extruded and causes a concussive injury to the

spinalparenchyma(Figure 2).Insomecasesthis

extrudedmaterialcausesadural tear,whichcan

befoundbelowtheleveloftheduramater.9,10

Imaging•Plain radiographs can help determine the cor-

rect region of interest by identifying abnormali-

ties, suchasnarrowingof the intervertebraldisk

space,mineralopacitieswithinthecanal/foramen,

and the vacuum effect (area of radiolucency at

the levelof theaffected intervertebraldiskspace

causedbylossofdiskmaterial).

» However,plainradiographs(withoutcontrast)can-

not accurately diagnose IVDD with spinal cord

compression.

» Theaccuracyofidentifyingthecorrectsitebased

on plain radiographs alone is reported to range

from51%to61%,andadvancedimagingisneeded

foraccuratelocalizationanddiagnosisofIVDD.11

•Computed tomography (CT) and myelogra-

phyhaveasensitivityover80%forlocalizingthe

correct site, butmagnetic resonance imaging

(MRI)remainsthebestimagingmodalityforcases

ofIVDD(Figure 3,page42).12,13

» CT and/or myelogram may be appropriate for

youngandmiddle-agechondrodystrophicbreeds

whereIVDDisveryhighonthedifferentiallist.

» In older animals and nonchondrodystrophic

breeds, MRI should be recommended to the

ownerasanoptionsincemostareasnowhave

afacilitywithMRIwithinareasonabledistance.

» MRIhasbeenreportedtohavecompleteagree-

mentwithsurgicalfindings,withrespecttothe

siteofdiskextrusion.

» In cases of noncompressive traumatic interver-

tebral disk herniation, the affected disk space

mayhavedecreasedsignalonMRIT2weighted

images,alongwithmildextraduralcompression

seenattheleveloftheaffecteddiskspace.14,15

TreatmentOncespinalcordimagingiscomplete,adecisioncan

bemadewhethertopursuesurgicaldecompressionor

medicalmanagement.

Figure 1. Cross-sectional image of the interver-

tebral disk showing the annulus fibrosus and

nucleus pulposus.

TAble 1. examination Findings Related to

Spinal Cord lesion localization

lesion localization Clinical Findings

C1 to C5 • Crossedextensorreflex×4• Neckpain• Hornersyndrome• Proprioceptivedeficits×4• Increasedmyotaticreflexes×4• Tetraparesis/plegia• Increasedtone×4• Uppermotorneuronbladder

C6 to T2 • Absentcutaneoustruncireflex• Neckpain• Decreasedthoraciclimbtone/with-

drawal reflexes• Pelviclimbcrossedextensorreflexes• Proprioceptivedeficits×4• Hornersyndrome• Tetraparesis/plegia• Increasedpelviclimbmyotaticreflexes• Uppermotorneuronbladder• Increasedpelviclimbtone

T3 to l3 • Absentcutaneoustruncinearleveloflesion• Paraparesis/plegia• Pelviclimbcrossedextensorreflexes• Backpain• Proprioceptivedeficitsinpelviclimbs• Increasedpelviclimbmyotaticreflexes• Uppermotorneuronbladder• Increasedpelviclimbtone*

l4 to S3 • Decreasedanaltone/reflex• Lowermotorneuronbladder• Decreasedpelviclimbmyotaticreflexes• Lumbosacralpain• Decreasedpelviclimbtone/withdrawal

reflexes• Paraparesis/plegia• Pelviclimbproprioceptivedeficits• Limptail

*Potentially Schiff-Scherrington phenomenon if identified in thoracic limbs.

C = cervical; L = lumbar; T = thoracic


AcuTE SPInAl corD InjurIES |

Medical Management

Conservativemanagementtypicallyconsistsof:1,2,16

•Strictcagerestfor2to6weeks

•Anti-inflammatorydrugs

•Analgesics

•Physicaltherapy.

Alternative therapies, such as acupuncture, have

beendescribed,butnotenoughevidenceisavailable

todeterminetheirefficacy.

Arecentretrospectivereportdescribingtheuseof

medical management for suspected thoracolumbar

IVDDreportedasuccessrateofabout55%oncedogs

withepisodesofrelapsewerefactoredin17;ifdogswith

onlyminordeficits(ie,pain)areincludedinthesuccess

group, the success rate increases to 66%. A similar

retrospectivestudyshowedcomparableresultswhen

diskherniationwaslocalizedtothecervicalregion.18

Conservativemanagementisnotanidealchoicefor

patientswithsevereneurologicdeficits(severeparesis,

plegia, lossofdeeppain)or those thathavealready

failedconservativemanagement.However,iftheclient

cannotpursuesurgery,conservativemanagementisan

optionforthesepatients.

Surgical Management

In patients that have severe neurologic dysfunction

at time of presentation, significant compression of

thecordmaybepresent,whichhas thepotential to

severely impair local blood flow and cause progres-

sive secondary damage to the cord. Candidates for

surgery include:

•Significantvertebralinstability(luxation,fracture)

•Patientswithsignificantneurologicdeficits,such

assevereparesisorparalysis

•Deep-painnegativedogs.

Thelatterconditionhasasignificantlyworseprog-

nosisiftreatedwithmedicalmanagementalone.Seven

percentorlessofdeep-painnegativedogsrecoverwith

medicalmanagementalone.19

Surgicaltreatmentforacutediskextrusionsincludes:

•Cervical IVDD:Ventralslotorhemilaminectomy

•Thoracic/Lumbar IVDD: Hemilaminectomy or

dorsallaminectomy.

•Modifications of the typical hemilaminectomy,

such as a pediculectomy and mini-hemilaminec-

tomy,canalsobeperformed.

PrognosisIndicatorsbydiseasetype/presentationinclude:

•Acute Hansen Type 1 Disk Herniation/Intact

Nociception:Patientshaveanexcellentprogno-

sis with surgery. One retrospective study found

that96%ofthesepatientswereambulatorywithin

3monthsofsurgery.19

•Loss of Deep Pain Sensation/Lack of Noci-

ception: Thesepatientshaveamoreguardedprog-

Figure 2. Transverse T2-weighted MRI image

showing a right-sided intramedullary hyperin-

tensity, along with a comparatively hypointense

nucleus pulposus at the C2 to C3 intervertebral

disk space. These findings are consistent with a

traumatic noncompressive disk herniation.

TAble 2. Neurologic Function Related to

Spinal Cord Tract

Function Tracts location

Proprio-

ception

• Cuneateandgracili

fascicles• Dorsal/ventral/cranial

spinocerebellar• Spinocuneocerebellar

Periphery of the white matter

Motor

Skills

• Corticospinal

• Reticulospinal

• Rubrospinal

• Tectospinal

• Vestibulospinal

Deeper within the white matter

Pin-Prick

Pain

• Spinothalamic Deeper within the white matter

Deep

Pain

• Spinoreticular Very deep within the white matter

Histologiccrosssectionof thecervical spinal cordofa

dog showing the approximate location of certain ascend-ing and descending tracts. Note: Tracts are not depicted

per actual size.



nosis.Decompressive

surgery allows about

62% of deep pain

negative dogs with

thoracolumbar disk

extrusions to regain

nociceptionandabil-

ity toambulatewith-

outassistance.20

•Noncompressive

Traumatic

Intervertebral Disk

Herniation: One

retrospectivestudy

reportedthat46/48

dogswiththiscondi-

tion made significant

improvementsand

allwereambulatory

withmedicalman-

agement.21Prognosis

maybeworseforpatientsthathavelostdeep

painsensation.Surgeryisapotentialtherapyfor

patientswithsuspectedduraltears,andprogno-

sisappearsgoodbasedonlimitedreports.22,23

trauma

Commoncausesoftraumainclude:

•Automobileaccidents

•Gun-shotwounds

•Verticalfallsincats,amongothers.

Incasesofacutespinalinjuryrelatedtotrauma,sta-

bilizationisthemostimportantaspectofinitialcare.

SeePatient Assessment,page39.

Imaging•Lateral and dorsal/ventral radiographs of the

entirevertebralcolumncanhelpidentifyanyfrac-

tures(Figure 4)or luxationswithoutmanipulat-

ingthepatientexcessively.

•Atlanto-axialluxationsmustbeconsideredindogs

with a lesion localized from theC1 toC5 spinal

cord after suffering suspected trauma; it is impor-

tanttominimizecervicalflexioninthesedogs.

•CT is the gold standard for detecting vertebral

fractures and instability, and should be recom-

mended for anypatientwith suspected vertebral

fracturesorinstability.24

•While anMRI provides good evaluation of the

spinalcord,aCTscanoffersmuchbettervisualiza-

tionofthevertebralcolumn’spathology.

•Insomepatientswithvertebralfracture(s)and/or

luxations,bothMRIandCTmaybeideal.Figure

5showsanatlanto-axialluxationforwhichtheCT

allowedpropersurgicalplanning.

TreatmentTreatment of trauma patientswith significant neuro-

logicdeficitsrangesfromresttoimmobilizationusing

externalbracestosurgicalintervention/stabilization.

•Rest: Rest is appropriate for a patientwith pain

and/orminor deficits andno evidenceof signifi-

cantinstabilityofthecord.

•Stabilization: Cervical lesions needmore rigor-

ous stabilization due to the inherentmobility of

this region. When using braces and/or bandage

material to decrease motion, significant cutaneous

lesionsduetorubbingormoisturecanoccur,and

respiratory status can be compromised by tight

neck bandaging. Frequent bandage changes and

rechecksmaybenecessary.

•Surgery: Surgery may be indicated for patients

withsignificantneurologicdeficitsandinstability.

Once stabilized, these patients should be trans-

ported toaveterinarian that is comfortablewith

suchproceduresforevaluationandtreatment.

PrognosisAccording to available literature, prognosis for acute

spinal cord injuries related to trauma seems to be

more guarded than for other types of acute spinal cord

injuries.

•Onereportevaluatingprog-

nosis for dogswith vertebral

fractures and/or luxations as

well as absent nociception

reported that 0/9 had return

of nociception.25 Therefore,

obvious vertebral instability

(ie,fracture,luxation),paraly-

sis, and no evidence of noci-

ception indicates a poor prog-

nosis.

•Abetterprognosisisindicat-

ed ifpatientswithsignificant

deficits but intact sensation

receive surgical stabilization.

Unfortunately, these patients

areofteneuthanized.

Figure 4. Lateral (A) and ventrodorsal (B) thoracic radiographs showing a

pathologic compression fracture at T7; a CT confirmed these findings.

bA

Figure 3. Transverse T2-weighted

MRI image at the level of the C3

to C4 intervertebral disk space

showing a left-sided extradural

compression consistent with a

Hansen type I herniated disk.



Fibrocartilagenous embolism

FCE isencountered frequently indogs; catsarealso

affectedbyit,butmuchlessfrequently.

•An FCE occurs when material identical to the

nucleuspulposusoftheintervertebraldiskspace

forms an embolus that obstructs either arterial,

venous, or both types of vasculaturewithin the

spinalcord.

•FCE commonly affects large- and giant-breed

dogs,butmay also affect small-breedandchon-

drodystrophic dogs.14,15,26-28 Miniature schnauzers

appear tobeaffectedatahigher incidence than

othersmallbreeds.29

•Dogs typicallypresentwith ahistoryofperacute

neurologicdeficitsthatprogresswithina24-hour

period.15,26,27 History often involves some form of

physicalactivityatthetimeclinicalsignsdevelop.15

•Patients are usually not painful at presentation

andasubstantialpercentagewillhaveasymmetri-

calneurologicaldeficits.15,26

ImagingDiagnosis is usually made using advanced imaging.

MRI is the best antemortemdiagnostic tool, butCT

and myelography can also be used to make a pre-

sumptivediagnosis.

•MRIwillusuallyshowanintramedullaryhyperin-

tensityonT2-weightedimages(Figure 6,page44).

•In some instances, lesions detected byMRIwill

notbedetectablesincethechangesmayrequire

severaldaystodevelop.28

•ThemainfeaturethathelpsdifferentiateanFCE

from other common causes of acute spinal cord

injury is the lack of extradural compression. A

herniateddiskwillhaveextraduralcompression.

Histopathology

Definitive diagnosis of FCE is made using histopa-

thology.Embolifoundwithinthespinalcordvascu-

laturewillbehistologically identical to thenucleus

pulposus.

TreatmentTreatment of FCE usually includes physical therapy

andrest.Different treatments,suchassteroids,have

beenattempted,butnosignificantpositiveassociation

hasbeenfound.28

Prognosis•Prognosis is generally good, and most patients

will show signsof significant improvementwithin

2weeks,27,28butmaximal

improvement may take

months.15 When patients

aregiventimetorecover,

Figure 5. Lateral T2-weighted MRI saggital image of cervical spinal cord in a dog with an atlanto-axial luxation (A);

transverse CT image of the atlas used for surgical planning and pin placement (B); 3D reconstruction of the CT (C)

bA C

SurGery: tiMe iS

oF tHe eSSenceSurgery should be performed as early as possible in patients with severe deficits in an effort to minimize secondary damage from extradural compression.

Most papers regarding this subject show the following trend: once the patient loses deep pain sensation, as more time passes, the prognosis worsens. The recommended time frame for pursuing surgery varies but, for patients that have lost deep pain inthepast12to24hours,mostpublicationssupport

emergency surgery. As the time frame extends past 24hours,theevidencesupportingemergencysurgery

becomes weaker and these patients may be able to wait until the morning for surgery without worsening their prognosis.

Similarly, patients that have become plegic in theprevious24hoursarealsoconsideredsurgical

emergencies in order to preserve an excellent prognosis, by intervening prior to development of extensive secondary damage to the spinal cord and loss of deep pain sensation (more guarded prognosis).



successratesashighas84%havebeencited.14

•Negative prognostic factors may include lack of

nociception,involvementofanintumescence(dis-

putedintheliterature),andintramedullaryhyper-

intensity on (1) T2-weighted images of the spinal

cord thatare longer thanthe lengthof twoL2or

twoC6 vertebral bodiesor (2) an intramedullary

hyperintensityontransversesectionthatisgreater

than66%theheightofthespinalcord.15,26-28

SecondAry dAMAGe

The pathology that results secondary to a primary

spinal cord injury (IVDD, trauma, infarct) is often

more serious than the primary injury.1-4,30 Secondary

pathology can result from changes in the local ion con-

centrations,disturbancestobloodflowandischemia,

productionoffreeradicals,andinflammation.1-4,30The

chemical environmentof an injured spinal cordmay

alsodelaytheregenerationofinjuredaxons.31

therapeutic recommendations

Currently, treatment is aimed at relieving the insult

causedbytheprimaryinjurywith:

•Surgery(ifindicated)

•Medical management (anti-inflammatory drugs

andanalgesics).

Potentialtherapiesforsecondaryinjuriesinclude:

•Calciumchannelantagonists

•Free-radical scavengers (ie, vitamin E, selenium,

methylprednisolone)

•N-methyl-D-aspartate(NMDA)antagonists

•Opioidagonistsandantagonists

•Thyroidreleasinghormone.2,3

Free-radical Scavengers

Most of these therapies are still being tested for

efficacy, but the free-radical scavenger methylpred-

nisolonehasbeenusedwithmodest success to treat

Figure 6. Sagittal T2-weighted MRI image

showing an intramedullary hyperintensity at the

level of C6 consistent with a FCE.

BREAKTHROUGH TECHNOLOGY!

“I found Hot Dog warming to be superior to forced-air

and warm water pads. It’s effective and the blankets are

durable.” - Jeff K., DVM, Eden Prairie, MN

(866) 484-3505

www.vetwarming.com

It’s great for cats, dogs, exotics and more....

Safe

Patient Warming

®

Conductive Fabric Warming

Satisfaction Guaranteed!

...from the inventor of forced-air patient warming.

Effective

Durable

ReusableMade in

U S A

http://www.vetwarming.com



humanpatients.Itisbelievedtoexertaprotectiveeffect

through its free radical scavenging properties, which

may prevent further lipid peroxidation. In humans,

methylprednisolonemayoffersomebenefitagainstsec-

ondarydamagetothecordifusedwithin8hoursofthe

primary injury.32 Limited studies have beenperformed

in veterinary medicine, and mixed results have been

seeninsmallnumbersofdogs.22,23

Asweunderstandmoreaboutthesecondarydamage

thatoccurswithinthespinalcord followingaprimary

insult,hopefullynewandmoreeffectivetreatmentswill

becomeavailable.■

cT = computed tomography; FcE = fibrocartilagenous embolism; IVDD = intervertebral disk disease; MrI = mag-netic resonance imaging; nMDA = n-methyl-D-aspartate

References

1. olby n. current concepts in the management of acute spinal cord injury.

J Vet Intern Med 1999; 13:399-407.

2. olby n. the pathogenesis and treatment of acute spinal cord injuries in

dogs. Vet Clin North Am Small Anim Pract 2010; 40:791-807.

3. webb AA, ngan S, Fowler jd. Spinal cord injury i: A synopsis of the

basic science. Can Vet J 2010; 51:485-492.

4. webb AA, ngan S, Fowler d. Spinal cord injury ii: prognostic indicators,

standards of care, and clinical trials. Can Vet J 2010; 51:598-604.

5. Marioni HK. Feline spinal cord diseases. Vet Clin North Am Small Anim

Pract 2010; 40:1011-1028.

6. Forterre F, Konar M, tomek A, et al. Accuracy of the withdrawal reflex for

localization of the site of cervical disk herniation in dogs: 35 cases (2004-

2007). JAVMA 2008; 232:559-563.

Adam Moeser, DVM, is a

second-year neurology resident

at University of Pennsylvania

School of Veterinary Medicine.

He received his DVM from

University of Wisconsin –

Madison and completed a

rotating internship at the VCA

Aurora/Berwyn veterinary hos-

pitals in the Chicago, Illinois, area.

Charles Vite, DVM, PhD,

Diplomate ACVIM (Neurology),

is an assistant professor in the

section of neurology and neu-

rosurgery in the Department of

Clinical Sciences at University

of Pennsylvania School of

Veterinary Medicine. His clini-

cal interests include epilepsy

as well as neurodegenera-

tive and neurodevelopmental processes. He also

has specific interests in vestibular dysfunction and

myotonia congenita. Dr. Vite received his DVM from

Purdue University and completed a residency in

neurology at UPenn, followed by a fellowship in

neuromagnetic resonance. He received his PhD

from the same university.

Looking for a way to expand your services and grow your business? Now it’s easier than ever to bring state-of-the-art digital imaging performance to your veterinary practice. Our comprehensive, user-friendly packages come with everything you need, a complete turnkey solution designed for easy integration.

ALLPRO 360° CR Packages. Crystal-clear digital radiography, hassle-free integration – at an affordable price.

Packages include: • PACSmart™ or Metron Imaging Software • Choice of ScanX® digital imaging system

featuring phosphor plate technology • Desktop workstation or laptop computer • Imaging plates and accessories

Several package configurations are available to best meet the individual needs of your practice. For an in-office demonstration, visit www.allproimaging.comor call 888-862-4050.

www.allproimaging.comDICOM 3.0, HL7 Interface, Modality Worklist

Scan this QR code to learn more about ALLPRO 360 CR Packages.

Superior Digital Imaging, A Complete Turnkey Solution.

OUR TURNKEY SOLUTION WILL UNLOCK NEW OPPORTUNITIES.

ALLPRO 360° CR Packages for Veterinary Practices.

(continued on page 84)

http://www.allproimaging.com

http://www.allproimaging.com


| PracTice To PracTice

cOnTinuing eDucaTiOn

Manyofthelatestoculardiagnostic,treatment,andsurgi-

cal recommendations are best presented by a specialist. A

great venue for continuing education in ophthalmology

is the ACVO Annual Conference, which offers a general

practitioner’s course that provides 8 hours of CE. After

attending the 2011 conference, I can attest that the board-

certified instructors provide helpful visuals and practical

advice. The ratio of attendees to speakers fosters discus-

sion with other practitioners and provides time to ask the

presenters specific questions.

You can also combine the ACVO general practitioner’s

course with general registration. The resident’s workshops,

research presentations, and exhibit hall provide additional

opportunities to pursue your interest in veterinary ophthal-

mology. The 2012 conference will be held October 17 to 20

in Portland, Oregon (acvoconferance.org).

Finally, another great way to obtain ophthalmic CE is to

see what courses your local veterinary school offers. You

canalsovisittheAmericanVeterinaryMedicalAssociation’s

MeetingsandCECalendar(avma.org/meetings/calendar/

default.asp), which provides a complete list of CE oppor-

tunities across the country and is searchable by keyword.n

BNP = bacitracin/neomycin/polymyxin B; KcS = kerato-conjunctivitissicca;PDS=polydioxanonesuture;STT=

Schirmer tear test

References

1. Moore PA. Examination techniques and interpretation of ophthalmic

findings. Clin Tech Small Anim Pract 2001; 16(1):1-11.

2. Ollivier FJ, Plummer CE, Barrie KP. The eye examination and diagnostic

procedures. In Gelatt KN (ed): Veterinary Ophthalmology, 4th ed. Ames. IA:

Blackwell Publishing, 2007, pp 438-483.

3. Willis M, Bounous DI, Hirsh S, et al. Conjunctival brush cytology: Evaluation

of a new cytological collection technique in dogs and cats with a

comparison to conjunctival scraping. Vet Comp Ophthalmol 1997; 7:74-81.

4. Weigt A. General practitioners course: ocular pharmacology. ACVO Conf

Proc, 2011.

5. Martin CL. Prolapse of third eyelid gland (cherry eye). Ophthalmic Disease

in Veterinary Medicine. London: Manson Publishing, 2005, pp 206-209.

6. Morgan R, Duddy JM, McClurg K. Prolapse of the gland of the third eyelid in

dogs: A retrospective study of 89 cases (1980 to 1990). JAAHA 1993; 29:56-60.

Elizabeth Barfield Laminack,

DVM, practices at Companion

Animal Hospital in Athens,

Georgia. She received her

DVM from University of

Georgia and her undergradu-

ate degree in biology from

Reinhardt University. Dr.

Laminack continues to study

small animal ophthalmology at

the UGA Veterinary Teaching

Hospital and recently presented an abstract on

canine glaucoma at the Association for Research in

Vision and Ophthalmology (ARVO) Annual Meeting.

She wishes to thank Drs. Denise Weaver and Troy

Pickerel and the practice team of Companion Animal

Hospital for their support of her ophthalmic pursuits;

she also extends gratitude to her mentors, Drs.

Anthony Moore and Kate Myrna of UGA–VTH.

7. Smith PM, Jeffery ND. Spinal shock-comparative aspects and clinical

relevance. J Vet Intern Med 2005; 19:788-793.

8. Ghosh P, Taylor TK, Braund KG. The variation of the glycosaminoglycans

of the canine intervertebral disc with aging; I. Chondrodystrophoid breed.

Gerontol 1977; 23(2):87-98.

9. Kent M, Holmes S, Cohen E, et al. Imaging diagnosis—CT myelography in

dog with intramedullary intervertebral disc herniation. Vet Radiol Ultrasound

2011; 52(2):185-187.

10. Poncelet L, Heimann M. Intradural vertebral disc herniation in a dog. Vet Rec

2011; 168:486A.

11. Lamb CR, Nichols A, Targett M, Mannion P. Accuracy of survey

radiographic diagnosis of intervertebral disc protrusion in dogs. Vet Radiol

Ultra 2002; 43:222-228.

12. Israel SK, Levine JM, Kerwin SC, et al. The relative sensitivity of computed

tomography and myelography for identification of thoracolumbar

intervertebral disk herniations in dogs. Vet Radiol Ultra 2009; 50:247-252.

13. Robertson I, Thrall DE. Imaging dogs with suspected disc herniation: Pros

and cons of myelography, computed tomography, and magnetic resonance.

Vet Radiol Ultra 2011; 42:S81-S84.

14. Risio LD, Adams V, Dennis R, et al. Association of clinical and magnetic

resonance imaging findings with outcome in dogs suspected to have ischemic

myelopathy: 50 cases (2000–2006). JAVMA 2008; 233:129-135.

15. Risio LD, Platt, SR. Fibrocartilaginous embolic myelopathy in small animals.

Vet Clin North Am Small Anim Pract 2010; 40:859-869.

16. Brisson BA. Intervertebral disc disease in dogs. Vet Clin North Am Small

Anim Pract 2010; 40:829-858.

17. Levine JM, Levine GJ, Johnson SI, et al. Evaluation of the success of

medical management for presumptive thoracolumbar intervertebral disk

herniation in dogs. Vet Surg 2007; 36:482-491.

18. Levine JM, Levine GJ, Johnson SI, et al. Evaluation of the success of

medical management for presumptive cervical intervertebral disk herniation

in dogs. Vet Surg 2007; 36:492-499.

19. Davis GL, Brown DC. Prognostic indicators for time to ambulation after

surgical decompression in nonambulatory dogs with acute thoracolumbar

disk extrusions: 112 cases. Vet Surg 2002; 31:513-518.

20. Scott HW, McKee WM. Laminectomy for 34 dogs with thoracolumbar

intervertebral disc disease and loss of deep pain perception. J Small Anim

Pract 1999; 40:417-422.

21. McKee WM, Downes CJ, Pink JJ, Gemmill TJ. Presumptive exercise-

associated peracute thoracolumbar disc extrusion in 48 dogs. Vet Rec

2010; 166:523-528.

22. Coates JR, Sorjonen DC, Simpson ST, et al. Clinicopathologic effects of a

21-aminosteroid compound (U74389G) and high-dose methylprednisolone

on spinal cord function after simulated spinal cord trauma. Vet Surg 1995;

24:128-139.

23. Siemering GB, Vomering ML. High dose methylprednisolone sodium

succinate: An adjunct to surgery for canine intervertebral disc herniation. Vet

Surg 1992; 21:406 (abstract).

24. Jeffery ND. Vertebral fracture and luxation in small animals. Vet Clin North

Am Small Anim Pract 2010; 40:809-828.

25. Olby N, Levine J, Harris T, et al. Long-term functional outcome of dogs with

severe injuries of the thoracolumbar spinal cord: 87 cases (1996–2001).

JAVMA 2003; 222:762–769.

26. Cauzinille L, Kornegay JN. Fibrocartilaginous embolism of the spinal cord in

dogs: Review of 36 histologically confirmed cases and retrospective study of

26 suspected cases. J Vet Intern Med 1996; 10(4):241-245.

27. Gandini G, Cizinauskas S, Lang J, et al. Fibrocartilaginous embolism in 75

dogs: Clinical findings and factors influencing the recovery rate. J Small

Anim Pract 2003; 44:76-80.

28. Nakamoto Y, Ozawa T, Katakabe K, et al. Fibrocartilaginous embolism of

the spinal cord diagnosed by characteristic clinical findings and magnetic

resonance imaging in 26 dogs. J Vet Med Sci 2009; 71(2):171-176.

29. Hawthorne JC, Wallace LJ, Fenner WR, Waters DJ. Fibrocartilaginous

embolic myelopathy in miniature schnauzers. JAAHA 2001; 37:374-383.

30. Jeffry ND, Blakemore WF. Spinal cord injury in small animals; 2. Current and

future options for therapy. Vet Rec 1999; 145:183-190.

31. Brosamle C, Huber AB, Fiedler M, et al. Regeneration of lesioned

corticospinal tract fibers in the adult rat induced by a recombinant,

humanized IN-1 antibody fragment. J Neurosci 2000; 20:8061-8068.

32. Bracken MB, Shepard MJ, Holford TR, et al. Methylprednisolone or tirilazad

mesylate administration after acute spinal cord injury: 1-year follow up. J

Neurosurg 1998; 89:699-706.

(Acute Spinal Injuries continued from page 45)

http://acvoconferance.org

http://avma.org/meetings/calendar/default.asp

http://avma.org/meetings/calendar/default.asp

Documents

cute pinlcord injurie - Today’s Veterinary Practice