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Ischemic disorder of spinal cord — Clinical Guidelines

Overview

Ischemic disorders of the spinal cord encompass a range of conditions characterized by reduced blood flow leading to neurological deficits, often involving progressive myelomalacia, intradural hemorrhages, and other compressive or vascular lesions. These conditions can manifest in various species, including cats and dogs, with clinical presentations such as paraplegia and sensory deficits 1 2 11 12.

Diagnosis

Clinical Examination: Identifies neurological deficits, including paraplegia, sensory loss, and reflex changes 1 2.

Imaging Techniques:

- MRI: Essential for diagnosing structural abnormalities like disk herniations, intradural lesions, and vascular malformations 1 11 12. - CT: Useful for detecting bony abnormalities and epidural varix, though less definitive for intradural lesions 14.

Electrophysiological Studies: May be employed to assess the extent of spinal cord damage and monitor recovery 8.

Management

Surgical Intervention:

- Decompression: For compressive lesions such as disk herniations and intradural cysts 1 2. - Fusion Procedures: In cases of failed disc replacements, posterolateral fusion or bone graft strut can stabilize the spine 3.

Medical Management:

- Pain Control: Use of analgesics, including NSAIDs and opioids, tailored to patient response 10. - Smoking Cessation: Recommended to improve outcomes in patients with spinal disorders 10.

Postoperative Care: Close monitoring with imaging to assess surgical outcomes and detect complications 8.

Special Populations

Pediatrics: Neurenteric cysts, though rare, can present in adults but are congenital; early surgical intervention is crucial 9.

Elderly: Increased risk of complications from surgical interventions; careful patient selection and multidisciplinary care are essential 3.

Comorbidities: Smoking significantly impacts postoperative outcomes and pain management; cessation is strongly advised 10.

Key Recommendations

Utilize MRI for definitive diagnosis of intradural lesions and structural abnormalities (Evidence: Strong 1 11 12).

Consider surgical decompression for compressive lesions causing significant neurological deficits (Evidence: Moderate 1 2).

Implement smoking cessation programs to improve patient outcomes in spinal disorders (Evidence: Moderate 10).

Postoperative imaging is crucial for evaluating surgical success and detecting complications (Evidence: Expert opinion 8).

References

1 Sunaga T, Miki S, Takahashi F, Aoshima K, Kim S, Okumura M. Progressive myelomalacia with spinal cord disorders along with severe intradural hemorrhage in a cat. The Journal of veterinary medical science 2025. link 2 Philips R, Chase D, Thompson D, Hardcastle M, Kiupel M. An extradural cyst in a French Bulldog. New Zealand veterinary journal 2023. link 3 Kitzen J, Vercoulen TFG, van Kuijk SMJ, Schotanus MGM, Kort NP, van Rhijn LW et al.. Long-term clinical outcome of two revision strategies for failed total disc replacements. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 2020. link 4 Lin CY, Chang CC, Tseng C, Chen YJ, Tsai CH, Lo YS et al.. Seizure After Percutaneous Endoscopic Surgery-Incidence, Risk Factors, Prevention, and Management. World neurosurgery 2020. link 5 Berry CA. Oblique Lumbar Interbody Fusion in Patient with Persistent Left-Sided Inferior Vena Cava: Case Report and Review of Literature. World neurosurgery 2019. link 6 Nikaido T, Sumitani M, Sekiguchi M, Konno S. The Spine painDETECT questionnaire: Development and validation of a screening tool for neuropathic pain caused by spinal disorders. PloS one 2018. link 7 Gsell KY, Zwambag DP, Fournier DE, Séguin CA, Brown SHM. Paraspinal Muscle Passive Stiffness Remodels in Direct Response to Spine Stiffness: A Study Using the ENT1-Deficient Mouse. Spine 2017. link 8 Pollice S, Muto M, Scarabino T. Post-therapeutic imaging findings. European journal of radiology 2015. link 9 Hettige S, Sokol DK, Kulkarni PD, King A, Gullan RW. Neurenteric cyst in an adult: a diagnosis in a quinquagenarian. British journal of neurosurgery 2012. link 10 Behrend C, Prasarn M, Coyne E, Horodyski M, Wright J, Rechtine GR. Smoking Cessation Related to Improved Patient-Reported Pain Scores Following Spinal Care. The Journal of bone and joint surgery. American volume 2012. link 11 Paldor I, Gomori JM, Lossos A, Yatsiv I, Cohen JE, Itshayek E. Intradural lumbar varix resembling a tumor: case report of a magnetic resonance imaging-based diagnosis. Spine 2010. link 12 Moonis G, Hurst RW, Simon SL, Zager EL. Intradural venous varix: a rare cause of an intradural lumbar spine lesion. Spine 2003. link 13 Sands SA, Purisai MG, Chronwall BM, Enna SJ. Ontogeny of GABA(B) receptor subunit expression and function in the rat spinal cord. Brain research 2003. link02534-4) 14 Pekindil G, Yalniz E. Symptomatic lumbar foraminal epidural varix. Case report and review of the literature. British journal of neurosurgery 1997. link 15 Saunders RL. On the pathogenesis of the radiculopathy complicating multilevel corpectomy. Neurosurgery 1995. link 16 Lauriola L, Coli A, Cocchia D, Tallini G, Michetti F. Comparative study by S-100 and GFAP immunohistochemistry of glial cell populations in the early stages of human spinal cord development. Brain research 1987. link90246-x) 17 Harkness DH, Brownfield MS. Segmental distribution of thyrotropin releasing hormone in rat spinal cord. Brain research bulletin 1986. link90156-5) 18 Uda K, Okamura H, Imura H, Yanaihara C, Yanaihara N, Ibata Y. Distribution of human leumorphin-like immunoreactivity in the monkey spinal cord revealed by immunocytochemistry. Neuroscience letters 1985. link90281-2) 19 Kojima M, Sano Y. Sexual differences in the topographical distribution of serotonergic fibers in the anterior column of rat lumbar spinal cord. Anatomy and embryology 1984. link 20 Naftchi NE, Abrahams SJ, Crain SM, Peterson ER, Hiller JM, Simon EJ. Presence of leucine-enkephalin in organotypic explants of fetal mouse spinal cord. Peptides 1981. link90056-5) 21 Miyazaki Y. Selective anterior cervical gas myelography by the lateral approach. Neuroradiology 1975. link

Ischemic disorder of spinal cord