Current Concepts in the Management of Acute Spinal Cord Injury

Acute injury to the spinal cord initiates a sequence of vascular, biochemical, and inflammatory events that result in the development of secondary tissue damage. Experimental studies and clinical trials in humans have demonstrated that the extent of this secondary tissue damage can be limited by pharmacologic intervention at appropriate intervals after injury. High doses of methylprednisolone sodium succinate (MPSS) improve the outcome of acute spinal cord injury in humans if treatment is initiated within 8 hours of injury. Starting therapy more than 8 hours after injury is detrimental to outcome. The clinical efficacy of methylprednisolone in improving the outcome of canine spinal cord injuries has not yet been demonstrated and its use by veterinarians is controversial. Many dogs are not seen by a veterinarian within the 8-hour window after injury, and these dogs frequently are treated with nonsteroidal anti-inflammatory drugs or large doses of dexamethasone or prednisone before methylprednisolone treatment can be initiated, thus increasing the risk of severe adverse effects. Other drugs that may provide safer and more effective alternatives to methylprednisolone include thyrotropin-releasing hormone (TRH), the 21-aminosteroids, and kappa opioid agonists. Recent studies suggest that modulation of the influx of inflammatory cells and activation of endogenous microglial cells may provide another means of improving the outcome of acute spinal cord injuries. Many drugs being developed to treat acute spinal cord injury have shown promising results when evaluated experimentally. However, any proposed therapeutic strategy should be evaluated in prospective blinded clinical trials before being adopted in clinics.     

Prognostic Application of Cortical Evoked Responses in Dogs with Spinal Cord Injury

Twenty-six dogs were used in a study to determine the correlation between cortical evoked responses (CER) testing and the reversibility of paraplegia in dogs experiencing spinal cord trauma. Twenty-four dogs were client owned and presented to the University of Missouri Veterinary Teaching Hospital over a period of approximately one year. Two dogs were used as controls. Testing was done with minimal risk to the patient. Results indicate that CER testing may be valuable as an aid in the long term evaluation of whether a paraplegic patient will ever regain the ability to walk normally again.     

Epidural Idiopathic Sterile Pyogranulomatous Inflammation Causing Spinal Cord Compressive Injury in Five Miniature Dachshunds

Objective— To characterize the clinical signs, diagnostic and surgical findings, and outcome of dogs with idiopathic sterile pyogranulomatous inflammation (ISP) of epidural fat causing spinal cord compression.
Study Design— Retrospective study.
Animals— Dogs (n=5).
Methods— Dogs with epidural ISP (2002–2006) were identified retrospectively. Inclusion criteria were neurologic examination, myelography, and definitive diagnosis of ISP confirmed by surgery and histopathologic examination of epidural spinal cord compressive tissue.
Results— The most common clinical sign was paraparesis/paraplegia. No abnormalities were detected by laboratory testing or survey spine radiographs. On myelography, extradural spinal cord compressions were focal (dogs 1, 3, and 5) or multifocal (dogs 2 and 4). Surgical decompression of the spinal cord was completed by hemilaminectomy. Epidural fat collected surgically had pyogranulomatous inflammation of unknown cause and was histologically similar to subcutaneous ISP. All dogs had good long-term neurologic outcome (10–45 months follow-up). Some dogs had episodes of ISP at other sites before or after surgical treatment of epidural ISP, suggesting there may be a systemic form of ISP.
Conclusion— Epidural ISP may cause a spinal cord compressive lesion in Miniature Dachshunds, which can be treated by surgical decompression of the spinal cord with or without administration of adjunctive steroids.
Clinical Relevance— Epidural ISP should be considered as a possible cause of thoracolumbar myelopathy for Miniature Dachshunds.     

Intramedullary Spinal Cord Metastasis in the Dog

Intramedullary spinal cord metastasis (ISCM) was diagnosed in three dogs with signs of myelopathy. The clinicopathologic features of ISCM in these and previously reported cases in the veterinary and human literature were compared. Myelopathic signs associated with ISCM may be the initial clinical manifestation of malignancy or may develop in the patient with known malignancy. Pain, a frequent manifestation of extradural compressive myelopathy, is not a consistent feature of ISCM. Survey spinal radiographs are usually unrewarding and cerebrospinal fluid (CSF) abnormalities nonspecific. Myelography is indicated to differentiate intramedullary lesions from more common extradural compressive lesions. Myelographic interpretation may be difficult, and intramedullary tumors must be differentiated from spinal cord edema or hemorrhage. Evidence of widely disseminated malignancy should increase suspicion for ISCM; hemangiosarcoma and lymphosarcoma should be considered the most likely histologic types. CSF cytology may be helpful in the diagnosis of patients with lymphosarcoma. Prognosis is poor due to the frequent presence of disseminated disease, although temporary response to corticosteroid therapy may be achieved. More aggressive therapeutic approaches, such as spinal irradiation and microsurgical resection of metastases, have been advocated in humans but have not been reported in the dog. Although it is an uncommon complication of systemic malignancy, ISCM should be considered in the differential diagnosis of myelopathy in the dog.     

Pathophysiology,Clinical Importance,and Management of Neurogenic Lower Urinary Tract Dysfunction Caused by Suprasacral Spinal Cord Injury

Management of persistent lower urinary tract dysfunction resulting from severe thoracolumbar spinal cord injury can be challenging. Severe suprasacral spinal cord injury releases the spinal cord segmental micturition reflex from supraspinal modulation and increases nerve growth factor concentration in the bladder wall, lumbosacral spinal cord, and dorsal root ganglion, which subsequently activates hypermechanosensitive C‐fiber bladder wall afferents. Hyperexcitability of bladder afferents and detrusor overactivity can cause urine leaking during the storage phase. During urine voiding, the loss of supraspinal control that normally coordinates detrusor contraction with sphincter relaxation can lead to spinal cord segmental reflex‐mediated simultaneous detrusor and sphincter contractions or detrusor‐sphincter dyssynergia, resulting in inefficient urine voiding and high residual volume. These disease‐associated changes can impact on the quality of life and life expectancy of spinal‐injured animals. Here, we discuss the pathophysiology and management considerations of lower urinary tract dysfunction as the result of severe, acute, suprasacral spinal cord injury. In addition, drawing from experimental, preclinical, and clinical medicine, we introduce some treatment options for neurogenic lower urinary tract dysfunction that are designed to: (1) prevent urine leakage arising because of detrusor overactivity during bladder filling, (2) preserve upper urinary tract integrity and function by reducing intravesical pressure and subsequent vesicoureteral reflux, and (3) prevent urinary tract and systemic complications by treating and preventing urinary tract infections.     

Arterial Peculiarities of the Thoracolumbar Spinal Cord in Rabbit

The aim of this study was to investigate the arterial blood supply of the thoracolumbar spinal cord in rabbit. The study was carried out on twenty adult New Zealand white rabbits. Ten rabbits were used in the corrosion technique and ten rabbits in the dissection technique. After the killing, the vascular network was perfused with saline. Batson's corrosion casting kit no. 17 © was used as a casting medium. After polymerisation of the medium, in ten rabbits the maceration was carried out in KOH solution, and in ten other rabbits, formaldehyde was injected by the dissection technique into the vertebral canal. We found high variability of segmental arteries supplying blood to the spinal cord. There are 12 intercostal arteries and 1 costo‐abdominal artery. Dorsal branches arising from the dorsal surface of the aorta thoracica were found as follows: in 70% of the cases, 9 pairs were present; in 20% of the cases 8 pairs; and in 10% of the cases 10 pairs. The paired arteriae lumbales were present in 6 pairs in 90% of the cases and in 5 pairs in 10% of the cases. On the dorsal surface of spinal cord, we found two irregular longitudinal arteries in 70% of the cases, no longitudinal arteries in 20% of the cases and three irregular longitudinal arteries in 10% of the cases receiving dorsal branches of rami spinales. Among the dorsal branches observed in the thoracic region, 60.5% were left‐sided, 39.5% right‐sided and in the lumbar region, 52.5% were left‐sided and 47.5% right‐sided.     

IFN-γ在大鼠腰骶髓段脊髓内的分布

为进一步探讨免疫－神经－内分泌三大系统之间的关系，用免疫组织化学SP法，对大鼠腰骶髓段脊髓内IFN－γ样免疫反应产物的分布进行了研究。结果表明，IFN－γ样免疫反应产物广泛分布于腰骶髓段脊髓各板层，其中背角I、Ⅱ、Ⅲ层，中间带骶髓副交感运动核、后连合核，腹角Ⅸ层内可见到较高密度的阳性胞体和树突。中间带和腹角内的阳性胞体的树突还伸向外侧索和腹索，有时可达脊髓边缘。本试验证明了IFN－γ在腰骶髓段脊髓内的分布，从而在细胞水平为“免疫神经内分泌网络”学说提供了形态学依据。     

Segmental Spinal Cord Hypoplasia in a Holstein Friesian Calf

An 8‐day‐old female Holstein Friesian calf was examined because of congenital spastic paresis of the hind limbs. Myelography revealed deviation and thinning of subarachnoid contrast medium columns in the lumbar segment. Upon magnetic resonance imaging, the ‘hour‐glass’ subdural compression appeared as a T1‐hypointense, T2‐hyperintense ovoidal area suggestive of cerebral spinal fluid collection, compatible with hydrosyringomyelia. The calf was euthanized and the necropsy confirmed the diagnosis of segmental spinal cord hypoplasia of the lumbar tract associated to hydromyelic and syringomyelic cavities.     

Early Embryonic Development of the Camel Lumbar Spinal Cord Segment

The lumbar spinal cord segment of the camel embryo at CVRL 2.4 to 28 cm was examined. Major changes are occurring in the organization of the lumbar spinal cord segments during this early developmental period. At the CVRL 2.4, 2.7 and 3.6 cm the three primary layers, ependymal cells layer, mantle cells layer, marginal cells layer in the developing lumber spinal cord segment were demonstrated. The mantle layer is the first to show striking differentiation, while the marginal layer is represented by thin outer rim. Proliferation and differentiation of the neuroepithelial cells in the developing spinal cord produce the thick lateral walls, thin roof and floor plates. The spinal ganglion and dorsal root of the spinal nerve are differentiated. At 2.7 cm CVRL differential thickening of the lateral walls produces a shallow longitudinal groove called sulcus limitans , which separates the dorsal part (alar plate) from ventral part (basal plate). The ventral root of the spinal nerve, the spinal cord and ganglion are embedded in loose mesenchyme, which tends to differentiate into spinal meninges. At 3.6 cm CVRL the basal plate, which is the future ventral gray horn, seem to be quite voluminous and the dorsal and ventral roots unite to form the beginning of the spinal nerve. At 5.5 cm CVRL the alar plates enlarge forming the dorsal septum. At 8.4 cm to 10.5 cm CVRL the basal plates enlarge, and bulge ventrally on each side of the midline producing the future ventral medium fissure, and the white and gray matters can be recognized. At 28 cm CVRL the lumen of the spinal cord is differentiated into the central canal bounded dorsally and ventrally by dorsal and ventral gray commissures, and therefore the gray matter takes the appearance of a butterfly.The lumber spinal nerve and their roots are well distinguished.     

Anatomical Studies on the Spinal Cord Segments of the Impala

The anatomy of the spinal cord segments was studied and recorded for the impala. The root attachment lengths were greatest at C₃, T₁₀ and L₃ cord segment levels in the respective regions. As to the root emergence length the greatest lengths were observed at C7, T_]0> L5 and S₁ cord segment levels respectively. The interroot interval was longest at C₂, T₈ and L₁ segments respectively. The longest cord segments were C2, T13, L₂ and S₂ segments. The widest cord segments of their respective regions were C₇, T₁, L5 and S₁ cord segments. As to segment volume C3, T₁₃, L₂ and S₁ were the most voluminous cord segments in the respective cord regions. Statistical analysis revealed a high correlation among all of the study parameters suggesting a high degree of multicolinearity. Gross anatomical relationships concerning the location of the spinal cord segments with respect to the vertebrae were studied. The cord segments C], T_s–T₄ and Li–L₃ were within their vertebral limits. In the impala the spinal cord terminated at the midlevel of S₄ vertebra.