Page 1854 - Cote clinical veterinary advisor dogs and cats 4th

Spinal Cord Injury 931

• CT: excellent bony detail, useful for identi- ○ Confinement/activity restriction (4-6 perception is maintained below the injury.
fication of mineralized disc herniation and ○ Rehabilitation with a rehabilitation- After pain perception is lost, prognosis is fair
weeks)
VetBooks.ir • Myelography: less commonly used given certified veterinarian/technician or at-home • Prognostic indicators associated with a worse Diseases and Disorders
(secondary to IVDH managed surgically) to
bony abnormalities secondary to trauma
guarded (all other causes).
exercises by owner
widespread availability and superior diag-
nostic capability of MRI; useful to evaluate
○ Presence and dimensions of intramedullary
compressive SCI ○ Pain management: gabapentin 5-15 mg/ outcome
kg PO q 8-12h × 2-4 weeks), NSAIDs as
• Cerebrospinal fluid analysis (pp. 1080 above × 1-2 weeks, or fentanyl transdermal hyperintensity on T2-weighted MRI for
and 1323): recommended when advanced patch 2-4 mcg/kg IVDH, ANNPE, and FCE
imaging is inconclusive; nucleated cell count ○ Bladder management: manual expression ○ CSF elevations of nucleated cell count,
and protein level can be normal or elevated. 2-3 times per day until return of voluntary percentage of macrophages, and macro-
urination; pharmacologic assistance with phage to monocyte ratio in severe IVDH
TREATMENT diazepam 0.25-0.5 mg/kg PO q 8h given • For IVDH, conflicting reports regarding
30 minutes before bladder expression onset and duration of signs and outcome;
Treatment Overview and phenoxybenzamine 0.25 mg/kg PO there is no definitive relationship between
Treatment depends on the nature and severity of q 12h or prazosin 1 mg/DOG < 15 kg, breed, age, body weight, prior surgery,
signs. For nonambulatory or paralyzed animals 2 mg/DOG >15 kg; 1 mg/CAT or administration of glucocorticoids and
with compressive or unstable injuries (i.e., ○ Nursing care: padded, dry bedding; outcome.
IVDH or trauma), prompt surgical decompres- turning/moving nonambulatory animals;
sion ± stabilization is usually recommended. regular bathing and change of bedding PEARLS & CONSIDERATIONS
Pain management, excellent nursing care, and • For ANNPE or FCE: cage rest to prevent
bladder evacuation are essential. further injury of neurologically impaired Comments
animals. Rehabilitation is recommended; • Surgery is generally recommended for non-
Acute General Treatment bladder management and nursing care as ambulatory dogs (due to IVDH or trauma),
• Stabilization for cases of trauma includes above but medical management remains a viable
immobilization of the spine (backboard or • See chapters on IVDD (p. 555), vertebral option with a reasonable chance of recovery
external coaptation) and ensuring respiratory fractures (p. 369), and FCE (p. 336) for as long as pain perception is maintained.
and circulatory function. more information. • Interpret leaking urine in a paralyzed animal
○ Evaluate SpO 2 (ideal > 97%), blood gas • Future therapies for acute and chronic SCI with caution; it frequently represents overflow
(PaCO 2 < 60 mm Hg), blood pressure may include neuroprotective strategies, stem rather than voluntary urination.
(MAP > 60 mm Hg) cell transplantation, or other multimodal
○ Address concurrent injuries as indicated. approaches to treatment. Technician Tips
• Referral to a neurologist or surgeon with • Avoid extensive manipulation of the patient
access to 24-hour, comprehensive care is Possible Complications in cases of suspected or confirmed vertebral
recommended for more severe or extensive • For nonambulatory animals: decubital ulcers, column trauma.
injuries. urine scald, aspiration pneumonia, disuse • Technicians caring for paralyzed animals
• Surgical treatment atrophy; meticulous nursing care can help should be skilled at manual bladder
○ Surgical decompression ± stabilization to prevent expression.
typically recommended for nonambulatory • Neurologic worsening: implant failure or
or paralyzed animals with compressive or infection, recurrent IVDH, or ascending/ Client Education
unstable injuries descending myelomalacia • Manual bladder expression should be per-
○ Paralysis with or without pain perception • Urinary tract infection (UTI): bladder formed 3 times/day for paralyzed animals;
considered a surgical emergency dysfunction is common in animals with failure to evacuate any urine over a 24-hour
• Medical treatment SCI, increasing risk of UTIs; regular bladder period should prompt a veterinarian visit for
○ Pain management expression is important (p. 232). assistance.
Opioids: hydromorphone 0.1 mg/kg IV • Padded bedding that is changed frequently,
■
q 4-6h or methadone 0.1 mg/kg IV q Recommended Monitoring more frequent bathing, and regular turning
4-6h or fentanyl 2-5 mcg/kg/h IV • Re-evaluation after 7-10 days or at any time are important for nonambulatory/recumbent
Nonsteroidal antiinflammatory drugs if neurologic status worsens for animals with patients.
■
(NSAIDs): carprofen 2.2 mg/kg PO q IVDH or trauma managed medically • Rest and rehabilitation exercises are impor-
12h or meloxicam 0.1 mg/kg IV, SQ, • Recheck exam 4 weeks after injury. tant for return of function.
PO q 24h
○ Glucocorticoids are not recommended as PROGNOSIS & OUTCOME SUGGESTED READING
routine therapy for acute SCI. Granger N, et al: Acute spinal cord injury: tetraplegia
○ Manual bladder evacuation or urinary • Prognosis for recovery from acute SCI and paraplegia in small animals. Vet Clin Small
catheterization (paralyzed animals) depends on the underlying cause and severity Anim 44:1131-1156, 2014.
of neurologic injury. The prognosis for a
Chronic Treatment successful outcome (defined as independent AUTHOR: Melissa J. Lewis, VMD, PhD, DACVIM
• For IVDH or trauma managed medically ambulation and continence) is fair to EDITOR: Karen R. Muñana, DVM, MS, DACVIM
or postoperatively excellent regardless of cause as long as pain

www.ExpertConsult.com