Chronic cervical compressive myelopathy in horses: clinical correlations with spinal cord alterations

Histological examination was performed on the cervical spinal cord from 13 horses with chronic cervical compressive myelopathy of 4 to 29 months duration. Structural alterations were correlated with clinical features. At the level of compression, the spinal cord was grossly deformed. Histological alterations included nerve fibre swelling and degeneration, occasional spheroids, astrocytic gliosis, increased macrophage activity and increased perivascular collagen. Myelin degeneration or loss at the level of the compressive lesion was greatest in the ventral and lateral funiculi and less consistently present in the dorsal funiculi. Asymmetry of lesions in the dorsal funiculi was associated with asymmetry of clinical signs in 5 horses. Histological alterations in areas of Wallerian degeneration were similar to that at the level of spinal cord compression, except that perivascular collagen was not increased. Wallerian degeneration was present cranial to the compressed site in the superficial portions of the lateral funiculi and in the middle of the dorsal funiculi. Caudal to the compressed site it was present in the ventral funiculi adjacent to the ventral median fissure and in the middle of the lateral funiculi. Deformation of the spinal cord did not correlate with the severity or duration of clinical signs but was positively correlated with the amount of perivascular collagen increase. The amount of nerve fibre swelling was not correlated with the severity of clinical signs but was negatively correlated with their duration. A rapid loss of nerve fibres apparently occurred early in the course of compression, since there was a marked decrease in the amount of nerve fibre swelling and Marchi stained degenerating myelin with increasing clinical duration.(ABSTRACT TRUNCATED AT 250 WORDS)     

Contrast-enhanced computed tomography and myelography in six horses with cervical stenotic myelopathy.

The cervical spines of 6 horses with cervical stenotic myelopathy (CSM) were examined using myelography and contrast-enhanced computed tomography (CECT). Histopathology of the spinal cord of these horses identified 10 neurologically significant compressive lesions. Myelography and CECT were both able to demonstrate all 10 spinal cord compressive lesions, but myelography falsely identified 2 sites and CECT falsely identified 1 site as compressive lesions of the spinal cord which were not supported by histopathology. Additional qualitative information was obtained by CECT regarding the source, severity and location of spinal cord compression. Computed tomography identified stenosis of the vertebral canal with circumferential loss of contrast agent and documented lateral compressive lesions of the spinal cord due to malformed articular facets. Compression of the peripheral nerve roots by malformed articular facets encroaching on the intervertebral foramen was easily identified by CECT in the axial plane. No compressive lesions were identified in 3 unaffected horses by either method. Minimum sagittal diameter (MSD) values obtained from CECT images were strongly correlated with necropsy measurements, validating CECT as an accurate method of obtaining MSD values. The MSD values in the CSM-affected horses were significantly narrowed (P less than 0.05) from C3C6 regardless of the site of spinal cord compression, when compared with the unaffected controls. This finding supports previous reports suggesting that generalised stenosis of the vertebral canal is an important feature in the pathogenesis of cervical stenotic myelopathy.     

Cervical intervertebral disc protrusion in two horses

Two horses with ataxia of all four limbs were found to have cervical intervertebral disc protrusion. Severe pelvic limb ataxia, proprioceptive deficits and spasticity were present in both horses with similar but less severe signs in the thoracic limbs. Cerebrospinal fluid analysis was within normal limits. Metrizamide myelography allowed definitive diagnosis in one case when a compression of the spinal cord was demonstrated at the level of the second intervertebral space. In the second case, an intervertebral disc protrusion between cervical vertebrae 6 and 7 was found at necropsy. Fiber degeneration with poor myelin staining characterized the spinal cords histologically.     

Degenerative myelopathy associated with cobalamin deficiency in a cat

A severe myelopathy was observed in a 9-year-old neutered male cat with a clinical history of chronic pancreatitis associated with deficiency of serum cobalamin and folates concentrations, and progressive spinal ataxia. The spinal cord lesions mainly involved the dorsal columns of the caudal cervical and cervico-thoracic segments, and were characterized by diffuse vacuolated myelin sheaths and axonal degeneration, marked gliosis, fibrosis and presence of gitter cells. The pancreas showed severe atrophy of the exocrine tissue, periductular fibrosis and infiltration of inflammatory cells, consistent with chronic interstitial pancreatitis. This condition can be accountable for cobalamin deficiency, as the pancreas is the only source of intrinsic factor in cats. The spinal cord lesions in the cat of this report resembled the subacute combined degeneration of the spinal cord described in human beings with cobalamin deficiency and hence a similar pathogenetic mechanism is hypothesized.     

Myelopathy and Reactive Microgliosis and Astrogliosis in Equine Back Pain

Equine chronic back pain (CBP) has been linked to different pathologic processes, which directly or indirectly involve spinal structures. Thus, making diagnosis and management very challenging with most horses with the condition recommended for early retirement from athletic activity. This study described the spinal cord lesions and the development of reactive microgliosis and astrocytosis in the spinal cords of horse with CBP. Thoracolumbar spinal cord segments from three horses euthanized because of unresolved CBP were dissected and grossly and histopathologically examined. The expression of activated microglia and astrocytes were demonstrated immunohistochemically using polyclonal rabbit anti-Iba-1 and anti-glial fibrillary acidic protein antibodies, respectively. All horses had radiological evidence of varying degrees of kissing spine involving six to nine vertebrae with the majority of the lesions graded between 2 and 5. Grossly, there was myelomalacia with intramedullary hemorrhages. The gray matters of the spinal cords were characterized by hemorrhagic malacic lesions with medullary disintegration. Reactive microgliosis and astrocytosis were evident in the spinal dorsal horns. White matter lesions include axonal swollen and/or loss, satellitosis, and varying degrees of dilation of myelin sheaths with some containing macrophages. In conclusion, the presence of reactive microgliosis and astrogliosis in the spinal dorsal horn indicates that they are possible precipitating factors in the development of equine CBP.     

Degenerative myelopathy and vitamin A deficiency in a young black-maned lion (Panthera leo).

Degenerative myelopathy and vitamin A deficiency were diagnosed in a 1-year-old, female, black-maned lion (Panthera leo). Diffuse white matter degeneration characterized by dilated myelin sheaths, Wallerian degeneration, and reactive astrocytosis was present at all levels of the spinal cord. With luxol fast blue-resyl echt violet stain, bilaterally symmetrical demyelination was observed in the fasciculus cuneatus of the cervical spinal cord and in peripheral white matter of cervical, thoracic, and lumbar segments. Additionally, the ventral gray columns and brain stem nuclei contained rare chromatolytic neurons with abnormal neurofilament accumulation. Leptomeninges of the cervical spinal cord were focally adhered to the dura and thickened by fibrosis and osseous metaplasia. Vitamin A deficiency was diagnosed based on hepatic vitamin A concentration of 1.71 microg/g dry weight. Adequate hepatic vitamin A concentration for yearling to adult domestic animals ranges between 150 and 1000 microg/g dry weight. Lesions were distinct from those previously described in young captive lions with vitamin A deficiency, which had thickened skull bones and cerebellar herniation. The pathogenesis of vitamin A-associated myelopathy in this lion may be similar to that described in adult cattle, which is believed to result from spinal cord compression secondary to elevated pressure of cerebrospinal fluid.     

THE USE OF MAGNETIC RESONANCE IMAGING IN EVALUATING HORSES WITH SPINAL ATAXIA

To determine the accuracy of magnetic resonance imaging for diagnosing cervical stenotic myelopathy in horses, 39 horses with spinal ataxia and 20 control horses underwent clinical and neurologic examinations, cervical radiographs, euthanasia, magnetic resonance (MR) imaging of the cervical spine and necropsy. Twenty‐four horses were diagnosed with cervical stenotic myelopathy, 5 with cervical vertebral stenosis, 7 with idiopathic ataxia, 3 horses had other causes of ataxia, and 20 were controls. The MR images were assessed for spinal cord intensity changes, presence of spinal cord compression, spinal cord compression direction, shape of spinal cord, and the presence of synovial cysts, joint mice, and degenerative joint disease. The height, width, and area of the spinal cord, dural tube and vertebral canal were measured. The identification of spinal cord compression on MR images was significantly different in horses with cervical stenotic myelopathy (P < 0.02), but in the cervical stenotic myelopathy group the identification of spinal cord compression on MR images had poor to slight agreement with histopathologic evidence of compression (κ = 0.05). Horses with cervical stenotic myelopathy were more likely to have a T2 hyperintensity in the spinal cord (P < 0.05). Horses with cervical stenotic myelopathy or cervical vertebral stenosis were more likely to have degenerative joint disease than control horses or horses with other or idiopathic ataxia.     

Endoscopic anatomy of the cervical vertebral canal in the horse: a cadaver study

Reason for performing study: Localisation of spinal cord compression in horses with cervical vertebral stenotic myelopathy is inexact. Vertebral canal endoscopy has been used in man to localise spinal cord lesions and has the potential to become a useful diagnostic technique in horses. Objective: To establish a surgical approach via the atlanto‐occipital space to the cervical vertebral canal in equine cadavers and describe the endoscopic anatomy of the cervical epidural and subarachnoid spaces. Methods: The cadavers of 25 mature horses were used to assess 3 surgical methods to approach the cervical vertebral canal, including 2 minimally invasive and one open technique. Once the approach had been made, a flexible videoendoscope was inserted into the epidural space (epiduroscopy) or the subarachnoid space (myeloscopy) and advanced caudally until the intervertebral space between C7 and T1 was reached. Results: The epidural and subarachnoid spaces could not be accessed reliably using the minimally invasive techniques. Furthermore, damage to the nervous tissues was a frequent complication with these procedures. The open approach allowed successful insertion of the videoendoscope into the epidural and subarachnoid spaces in all horses and no inadvertent damage was observed. Anatomical structures that could be seen in the epidural space included the dura mater, nerve roots, fat and the ventral internal vertebral venous plexus. In the subarachnoid space, the spinal cord, nerve roots, blood vessels, denticulate ligaments and external branch of the accessory nerve were seen. Conclusions: Using the open approach, epiduroscopy and myeloscopy over the entire length of the cervical vertebral canal are possible in the mature horse. Potential relevance: Cervical vertebral canal endoscopy may become a valuable tool to localise the site of spinal cord injury in horses with cervical vertebral stenotic myelopathy and could aid in the diagnosis of other diseases of the cervical spinal cord.     

Postanesthetic hemorrhagic myelopathy in a horse

Acute hemorrhagic myelopathy developed in the sixth cervical to the eighth thoracic spinal cord segments of a 1-year-old Quarter Horse colt that was castrated under general anesthesia while in dorsal recumbency. Clinical signs were consistent with severe transverse myelopathy caudal to the brachial enlargement and cranial to the lumbosacral enlargement of the spinal cord. Histologic examination of the spinal cord revealed hemorrhage in the gray matter, with multiple blood-filled clefts in otherwise normal neuropil. Hemodynamic changes in the spinal cord associated with anesthesia and dorsal recumbency may have led to hypoxic vessel damage, with massive hemorrhage after surgery, when the horse was returned to lateral recumbency. Postanesthetic hemorrhagic myelopathy is a possible complication of positioning in dorsal recumbency, during anesthesia, in rapidly growing, young horses.     

ATLANTO-AXIAL MALARTICULATION IN ANGORA GOATS

SUMMARY Two male Angora goats presented with ataxia and weakness of the hind limbs. Both tired easily when exercised and often stumbled and fell. In both cases, post-mortem examination revealed focal areas of gliosis and diffuse Wallerian degeneration in the spinal cord at the level of the atlanto-axial joint. There were also two areas of myelomalacia in one of the goats. In the other, the caudal articular surfaces of the atlas were unusually convex and the odontoid process of the axis was laterally compressed. It is suggested that these vertebral anomalies resulted in excessive mobility of the joint leading to the development of a compressive myelopathy.     

MAGNETIC RESONANCE IMAGING OF THE CERVICAL SPINE IN 27 DOGS

The cervical spine of 27 dogs with cervical pain or cervical myelopathy was evaluated using magnetic resonance imaging (MRI). Spin echo T1, T2, and post-contrast T1 weighted imaging sequences were obtained with a 0.5 Tesla magnet in 5 dogs and a 1.5 Tesla magnet in the remaining 22 dogs. MRI provided for visualization of the entire cervical spine including the vertebral bodies, intervertebral discs, vertebral canal, and spinal cord. Disorders noted included intervertebral disc degeneration and/or protrusion (12 dogs), intradural extramedullary mass lesions (3 dogs), intradural and extradural nerve root tumors (3 dogs), hydromyelia/syringomyelia (1 dog), intramedullary ring enhancing lesions (1 dog), extradural synovial cysts (1 dog), and extradural compressive lesions (3 dogs). The MRI findings were consistent with surgical findings in 18 dogs that underwent surgery. Magnetic resonance imaging provided a safe, useful non-invasive method of evaluating the cervical spinal cord.     

Compressive myelopathy due to intervertebral disk extrusion in a llama (Lama glama).

A 12-year-old intact female llama was euthanized following acute onset of spastic tetraparesis and recumbency with inability to rise. Postmortem examination revealed caudal cervical spinal cord compression due to a mass within the ventral spinal canal arising from the C6-C7 intervertebral disk space and attached to an irregularly thickened annulus fibrosis. On histopathologic examination, the mass was composed of amorphous acellular basophilic to amphophilic material admixed with irregularly arranged collagen bundles. The amorphous material was metachromatic and contained multiple small foci of markedly vacuolated round cells, characteristic of origin from the nucleus pulposus. Severe necrosis of all white matter tracts with astrocytic reaction was present in the overlying spinal cord segment. Ascending and descending Wallerian degeneration and dissecting interstitial astrogliosis were present within white matter tracts above and below the lesion, respectively. The diagnosis was compressive myelopathy due to chronic extrusion of the nucleus pulposus of the C6-C7 intervertebral disk. To the authors' knowledge, this is the first report of intervertebral disk disease in a camelid.     

Neuroaxonal dystrophy of the accessory cuneate nucleus in horses

Data were collected from 37 horses with a neurologic disability and compared to a group of 34 normal horses. Affected horses had neuroaxonal dystrophy, gliosis, vacuoles, and sometimes pigment localized to the accessory cuneate nuclei with minimal or no changes in the spinal cord and no changes in the proximal peripheral nerves. The focal nature of the change and usual absence of significant light microscopic spinal cord or peripheral nerve changes are different than previously described equine neuropathologic conditions.     

A Morphological and Stereological Study on Cervical Segment of Spinal Cord of Quails

In this study, volume densities of white and grey matters of cervical segments of spinal cords of quail were investigated stereologically. In both sexes, mature, six quails were used as material of this study. All animals were fixed by perfusing in 10% buffered formalin. Tissue specimens were obtained from cervical spinal cords. These tissue specimens were cut every fiftieth section at 5 μm thickness by a microtome. And mean six or seven sections were examined from every block by this method at microscope. After that, these sections were stained by haematoxylin eosin and photographed. Densities of volumes of all tissues of cervical segments of whole spinal cords and white and grey matters were calculated with principle of Cavalieri. As a result, total volume of spinal cord, volumes of white and grey matters of cervical segment and volume rates of white and grey matters were calculated.     

A morphometric and stereological study on cervical spinal cord segment of goose

In this study, volume density of white matter and grey matter areas of cervical segment of spinal cord in adult geese weighing 3–4 kg was examined using stereological methods. 10 geese were used as material without sex discrimination. All animals underwent perfusion with 10% buffered formaldehyde. Following the perfusion, animals were kept in 10% formaldehyde for 1 week. Geese were then dissected. Cervical area of spinal cord was revealed removing cervical spine. Tissue samples were obtained from each segment of cervical area. 5 μm thick cross‐sections were taken from these tissue samples via microtome. Series of cross‐sections were obtained by sampling in the ratio of 1/250 including 12 cross‐sections from each cervical segment of every animal. Cross‐sections were stained by haematoxylin eosin. They were photographed under microscope. Volume density (volume fractions) of both whole tissue and white matter and grey matter parts in each cervical segment of spinal cord were calculated using Cavalieri’s Principle. In the study, total volume of cervical segment, volume of white matter and grey matter, and ratios of these volumes one another were assessed in goose.     

Cervical vertebral canal endoscopy in a horse with cervical vertebral stenotic myelopathy

A 3-year-old Thoroughbred gelding presented with a history of neurological signs, including incoordination in his hindlimbs, of about 7 months' duration. On initial examination, the horse exhibited ataxia and paresis in all limbs with more severe deficits in the hindlimbs. Cervical radiographs displayed severe osteoarthritis of the articular processes between C5 and C6. On subsequent cervical myelography the dorsal contrast column was reduced by 90% at the level of the intervertebral space between C5 and C6. Cervical vertebral canal endoscopy, including epidural (epiduroscopy) and subarachnoid endoscopy (myeloscopy), was performed under general anaesthesia. A substantial narrowing of the subarachnoid space at the level between C6 and C7 was seen during myeloscopy, while no compression was apparent between C5 and C6. Epiduroscopy showed no abnormalities. After completion of the procedure, the horse was subjected to euthanasia and the cervical spinal cord submitted for histopathological examination. Severe myelin and axon degeneration of the white matter was diagnosed at the level of the intervertebral space between C6 and C7, with Wallerian degeneration cranially and caudally, indicating chronic spinal cord compression at this site. Myeloscopy was successfully used to identify the site of spinal cord compression in a horse with cervical vertebral stenotic myelopathy, while myelography results were misleading.     

Cervical vertebral canal endoscopy in the horse: intra- and post operative observations

Reasons for performing study: Despite modern medical diagnostic imaging, it is not possible to identify reliably the exact location of spinal cord compression in horses with cervical vertebral stenotic myelopathy (CVSM). Vertebral canal endoscopy has been successfully used in man and a technique for cervical vertebral canal endoscopy (CVCE) has been described in equine cadavers. Objective: To determine the feasibility and safety of CVCE in healthy mature horses. Methods: Six healthy mature horses were anaesthetised. A flexible videoendoscope was subsequently introduced via the atlanto‐occipital space into the epidural space (epiduroscopy, Horses 1–3) or the subarachnoid space (myeloscopy, Horses 4–6) and advanced to the 8th cervical nerve. Neurological examinations were performed after surgery and lumbosacral cerebrospinal fluid (CSF) analysed in horses that had undergone myeloscopy. Results: All procedures were completed successfully and all horses recovered from anaesthesia. Anatomical structures in the epidural space (including the dura mater, nerve roots, fat and blood vessels) and subarachnoid space (including the spinal cord, blood vessels, arachnoid trabeculations, nerve roots and the external branch of the accessory nerve) were identified. During epiduroscopy, a significant increase in mean arterial pressure was recognised, when repeated injections of electrolyte solution into the epidural space were performed. In one horse of the myeloscopy group, subarachnoid haemorrhage and air occurred, resulting in transient post operative ataxia and muscle fasciculations. No complications during or after myeloscopy were observed in the other horses. CSF analysis indicated mild inflammation on Day 7 with values approaching normal 21 days after surgery. Conclusions: Endoscopic examination of the epidural and subarachnoid space from the atlanto‐occipital space to the 8th cervical nerve is possible and can be safely performed in healthy horses. Potential relevance: Cervical vertebral canal endoscopy might allow accurate identification of the compression site in horses with CVSM and aid diagnosis of other lesions within the cervical vertebral canal.     

Equine herpesvirus type 1 (EHV-1) myeloencephalopathy: a case report

An outbreak of neurological disease occurred in a well-managed riding school. Ataxia and paresis were observed in several horses, five of which became recumbent and were euthanized. Post-mortem analysis revealed scattered haemorrhages along the spinal cord, that were reflected by multiple haemorrhagic foci on formalin-fixed sections, with the thoracic and lumbar segments being the most affected. Pathohistologically, perivascular mononuclear cuffing and axonal swelling, especially in the white matter, were evident. Parallel to the course of disease, alterations in myelin sheets and activation of astrocytes and microglial cells were also observed. Virological findings confirmed an acute equine herpesvirus type 1 infection and virus was isolated from the spinal cord of a 26-year-old mare.     

Comparison of Hypothermic and Normothermic Spinal Cord Perfusion in the Dog

Lumbar dorsal laminectomies were performed on 24 dogs, and exposed spinal cords were subjected to various time-temperature combinations of perfusion according to the following schedule: 1) 30 minutes of hypothermic perfusion—6 dogs; 2) 30 minutes of normothermic perfusion—6 dogs; 3) 120 minutes of hypothermic perfusion—6 dogs; and 4) 120 minutes of normothermic perfusion—6 dogs.
Surgery, cord perfusion, and exposure of the dorsal aspects of the spinal cord to the epaxial musculature for 5 days following surgery produced histopathologic changes in the dorsal aspects of the cord, especially around the dorsal root area. Hypothermic spinal cord perfusion for 120 minutes produced a marked deleterious effect on normal spinal cord function and spinal cord tissue. Spinal cords exposed to 30 minutes of hypothermic or normothermic perfusion or 120 minutes of normothermic perfusion had less severe clinical and histopathologic changes than those exposed to 120 minutes of hypothermic perfusion. Hypothermic perfusion for 30 minutes and 120 minutes affected not only dorsal aspects of the cord, but also the grey matter. The most severe change in grey matter occurred in cords perfused for 120 minutes.     

RADIOGRAPHIC AND MYELOGRAPHIC EXAMINATION OF THE CERVICAL VERTEBRAL COLUMN IN 306 ATAXIC HORSES

This study consists of a review of 306 ataxic horses subjected to survey radiography and myelography of the cervical vertebral column. Fifty-eight percent of horses had evidence of compressive spinal cord lesion on myelography. Sixty-six percent of horses were less than 3 years old. Age had no effect on the distribution of spinal cord compressive lesions. No conclusion could be drawn from sex and breed distribution. The most common sites of cord compression on myelography in order of decreasing frequency were C_3–4, C_6–7, C_5–6, and C_4–5. Twenty-nine percent of horses with myelographic evidence of cord compression had multiple compressive sites. Survey radiographs were not reliable to diagnose compressive spinal cord lesions. Myelography was a safe and more accurate procedure. Several factors may result in misinterpretation of the myelographic examination.