Page 776 - Clinical Small Animal Internal Medicine

744 Section 8 Neurologic Disease

Figure 69.4 A 3D CT reconstruction of the
VetBooks.ir Fig. 69.2. This ventral view of the spinal
thoracic vertebrae of the case seen in
column assists in the understanding of the
vertebral fracture (arrowhead).

(a)
hyperintensity and/or hemorrhage, which may assist in
the prediction of adverse neurologic outcomes after SCI
(Figure 69.5).
Both CT and MRI are useful to measure vertebral body
size from the transverse views, essential when considering
the maximum depth of surgical implants to be used.

Urinary Tract Assessment
In addition to blood urea and creatinine values and
urine specific gravity levels, urethral catheterization
may be required in patients that have undergone a
severe concurrent abdominal or pelvic trauma in order
that urine production may be assessed over the subse-
quent 72 hours. This will also be of value in those
(b)
patients with systemic shock due to the traumatic
event. Abdominal ultrasonography may be required to
evaluate the bladder wall and kidneys, and to detect the
presence of free abdominal fluid; contrast‐enhanced
imaging of the urinary tract may provide further infor-
mation on the function and form of the individual
structures.

Current Treatment Options for Spinal Cord Injury
The standard of care in veterinary medicine remains to
stabilize the patient physically and medically and decom-
press the spinal cord, although the evidence for early
decompression in dogs has not yet been clearly demon-
strated in a prospective manner. However, there is evi-
dence in humans that early decompressive surgery may
reduce hospitalization time and, hence, complications,
and improve the neurologic outcome in some. Spinal
column surgery is a rapidly changing field but although
operative nuances have seen dramatic change, the reality
is that decompression, realignment, and stabilization
remain the primary offerings of the spine surgeon for the
acute SCI patient.

Initial Management
Figure 69.5 A sagittal (a) and transverse (b) T2‐weighted MRI of The top priority in managing acute SCI secondary to
the case seen in Fig. 69.2. The spinal cord can be seen in detail at
the site of the injury with the cord compressed by hemorrhage exogenous trauma is assessment and stabilization of vital
within the canal (arrowhead). signs, with strict adherence to a life support protocol.