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Neck Pain 683

PEARLS & CONSIDERATIONS • Sympathetic fibers are superficial in the feline • The endotracheal tube may need to be tied to
the lower jaw to allow soft palate retraction.
bulla; development of Horner’s syndrome is • The cuff of the endotracheal tube should be
Comments
VetBooks.ir • Cats can have concurrent nasopharyngeal and Technician Tips inflated because hemorrhage is possible after Diseases and Disorders
likely after bulla osteotomy and may occur
with traction alone.
aural polyps; both areas should be examined
polyp extraction.
under anesthesia.
• CT is more sensitive than survey skull • Cats with large nasopharyngeal polyps can be Client Education
radiographs for detecting otitis media. difficult to intubate. An IV catheter placed Complications with bulla osteotomy are
• For a broad-based mass, fine-needle aspiration before induction permits administration of common but usually temporary.
and cytologic evaluation are indicated to rule IV anesthetics, and a stylette may be needed
out lymphoma. for intubation. SUGGESTED READING
• The feline tympanic bulla has two chambers; • A laryngoscope and several sizes of cuffed Anderson DM, et al: Management of inflammatory
the epithelial lining of both chambers should endotracheal tubes should be available before polyps in 37 cats. Vet Rec 147:684-687, 2000.
be removed during bulla osteotomy, but induction. Mucus and saliva may collect in
dorsal curettage should be avoided. the caudal pharynx; suction or swabs may AUTHOR: Karen M. Tobias, DVM, MS, DACVS
EDITOR: Megan Grobman, DVM, MS, DACVIM
be needed during intubation.

Neck Pain Client Education
Sheet

BASIC INFORMATION ○ Acquired/degenerative: IVDD, CSM in Spinal column:
Doberman pinschers • IVDD: progressive degeneration of inter-
Definition ○ Traumatic vertebral disc, resulting in protrusion or
Sensation of discomfort or distress associ- • Infectious disease: canine distemper myelitis, herniation of disc material into the spinal
ated with the cervical spine or surrounding systemic fungal myelitis, discospondylitis canal. The annulus fibrosus is the portion
tissues • Inflammatory: cranial cervical pain sometimes of the disc that contains pain receptors.
found with meningitis Typically affects dogs 3-8 years of age but
Synonyms • Traumatic: cervical fractures, instability, can also occur in cats
Cervical hyperesthesia or hyperpathia penetrating pharyngeal or neck wounds • Discospondylitis: bacterial infection of
• Neoplastic: spinal tumors, axial skeletal vertebral body endplates; the caudal cervical
Epidemiology osteosarcoma, nerve sheath tumor, and other region is one of the predisposition sites.
SPECIES, AGE, SEX such growths • Malformation: CSM in Great Danes,
Dogs and cats of any age and either sex hemivertebrae, spinal canal stenosis
HISTORY, CHIEF COMPLAINT • Instability: atlantoaxial malformation, CSM,
GENETICS, BREED PREDISPOSITION • Reluctance to rise vertebral subluxation, traumatic fracture or
• Atlantoaxial instability: toy breeds: Chihua- • Reluctance to walk on stairs luxation
hua, toy poodle, Pomeranian, Pekingese • Reluctance to jump • Neoplasia: osteosarcoma, hemangiosarcoma,
• Intervertebral disc disease (IVDD): chondro- • Crying out when changing positions or fibrosarcoma, chondrosarcoma, or metastatic
dystrophoid breeds: dachshund, beagle, basset moving head tumors involving the vertebrae
hound, Pekingese, shih tzu, other breeds • Shaking Meninges:
• Cervical spondylomyelopathy (CSM) (e.g., • Inflammatory, parasitic, protozoal, bacterial,
wobbler syndrome): Great Dane, Doberman PHYSICAL EXAM FINDINGS and neoplastic processes
pinscher, many other large breeds • Abnormal head posture: holding head down, Spinal nerves:
• Corticosteroid-responsive meningitis/arteritis: reluctant to turn head • Nerve root compression, ischemia
beagles, Bernese mountain dog, boxer, Nova • Arched neck or back • Inflammation: immune mediated, infectious
Scotia duck tolling retriever • Pain on manipulation of the neck or palpa- (protozoal, viral, parasitic)
tion ventral process of C6 • Neoplasia
CONTAGION AND ZOONOSIS • Pain on palpation of the cervical musculature
• Canine distemper viral (CDV) myelitis: dog • Reluctance to walk DIAGNOSIS
to dog • Abnormal gait if animal is neurologically
• Brucella canis–associated discospondylitis: impaired Diagnostic Overview
dog to dog • Heat and swelling in cervical tissues The diagnosis of neck pain is made by
• Hypersalivation possible with pharyngeal observation of the patient and physical exam.
ASSOCIATED DISORDERS injuries Determining the underlying cause of neck pain
• Horner’s syndrome possible with caudal • Fever associated with infections or meningitis begins with orthopedic and neurologic exams
cervical spinal lesions • Root signature and a review of the history to identify duration
• Nerve root signature may be sign of nerve and severity of signs and response to treatment.
root pain. Etiology and Pathophysiology
Epaxial musculature: Differential Diagnosis
Clinical Presentation • Traumatic muscle injury A detailed differential diagnosis is provided
DISEASE FORMS/SUBTYPES • Myositis from penetrating injury or foreign on p. 1256.
• Spinal disease body (stick or grass awn migration) • IVDD
○ Congenital: CSM in young Great Danes, • Inflammatory myositis: immune mediated, • Meningitis
atlantoaxial instability parasitic, bacterial, or protozoal • Cervical spondylomyelopathy

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