Page 1181 - Small Animal Internal Medicine, 6th Edition

CHAPTER 65 Disorders of the Spinal Cord 1153

signs of CSM. All affected animals should be evaluated for
systemic disease before initiating medical or surgical therapy.
VetBooks.ir In particular, Doberman Pinschers should be evaluated for
concurrent hypothyroidism, von Willebrand disease, and
cardiomyopathy.
Severe exercise restriction, use of a harness, and admin-
istration of antiinflammatory doses of prednisone may result
C5 in temporary improvement in neurologic function in dogs
C6 with CSM (prednisone, 0.5 mg/kg PO q12h for 2 days; then
0.5 mg/kg once daily for 2 days; then 0.5 mg/kg once every
other day for 14 days; then 0.25 mg/kg once every other day
for 2 months). NSAIDs can be used in place of corticoster-
oids if neck pain is severe or if the corticosteroids are not
A tolerated, but NSAIDs and corticosteroids should never be
administered together. Medical management can be effective
long term in 40% to 50% of dogs with minimal or mild signs
Traction of neurologic dysfunction.
Surgical treatment of CSM leads to a successful outcome
in about 80% of cases, so it is recommended in most dogs
with significant neurologic deficits. Surgery, however, does
not alter long-term survival in dogs with CSM. Multiple
lesions, chronic disease, and an inability to walk are all asso-
ciated with a poor prognosis. Postoperative rehabilitation is
C6 critical to recovery. Primary factors determining the specific
B C5
surgical procedure to be recommended are the degree and
site of cord compression and the anatomic structures causing
cord compression. Details of the surgical procedures and
potential complications are discussed in the Suggested
Readings.

C5 PROGRESSIVE DISORDERS
C6
IN YOUNG ANIMALS
Breed-Associated Neuronal Abiotrophies
C and Degenerations

Neuronal abiotrophies and degenerative disorders have been
FIG 65.23 recognized in many breeds of dogs. Progressive neurologic
(A) Cervical myelogram of an 11-year-old Doberman/
Weimaraner cross with a chronic history of nonpainful dysfunction usually begins early in life. In disorders affecting
ataxia and hypermetria of all four limbs. Narrowing of the the entire spinal cord, clinical signs involving the rear limbs
C5-C6 disk space and thinning of the dorsal contrast are often noted early in the course of disease, with progres-
column over this site (in association with dorsal deviation sion to tetraparesis. Disorders that primarily affect white
and thinning of the ventral contrast column) can be seen. matter and result in UMN signs are most often seen in Rott-
(B) Dramatic resolution of this spinal cord compression in weilers, Afghan Hounds, Dalmatians, and Jack Russell Ter-
the traction view suggests a dynamic compression by a
bulging annulus fibrosus or ligamentum flavum. (C) Surgery riers. Disorders primarily affecting gray matter and causing
was performed to maintain traction on the spine at this site. LMN signs are seen in Alaskan Malamutes, Boxers, Brittany
Spaniels, German Shepherd dogs, English Pointers, and
Maine Coon Cats. The disorders are diagnosed on the basis
in predicting the site, severity, and nature of spinal cord of the typical clinical course, signalment, and lack of any
compression than other modalities. MRI also allows detec- definable etiology on screening blood tests, spinal radio-
tion of signal changes within the spinal cord parenchyma graphs, CSF analysis, advanced imaging, and other diagnos-
that may be associated with prognosis for recovery. tic testing. Diagnosis is confirmed by necropsy examination
in most cases. No treatment is available.
Treatment
The clinical course of untreated wobbler syndrome is typi- Metabolic Storage Diseases
cally chronically progressive, but in up to 25% of mildly A group of rare disorders characterized pathologically by
affected dogs signs will remain stable over time. Medical or accumulation of metabolic products in cells secondary to
surgical therapy can be used to attempt to relieve clinical a genetically based enzyme deficiency may result in signs