peer reviewed

Acute SpinAl cord

injurieS
Adam Moeser, DVM, and
Charles Vite, DVM, PhD,
Diplomate ACVIM (Neurology)

Acute spinal cord

injury is a major
cause of neurologic
dysfunction in dogs and
somewhat less so in cats.

Acute SpinAl cord inJurieS:

Step by Step
1. History: When a dog or cat presents with evidence
of acute spinal cord injury, obtain a detailed history
and ascertain whether trauma may have occurred.
2. Stabilization: Whenever spinal cord injuries
secondary to trauma are suspected, manipulate the
patient as little as possible. Evaluate the patient’s
overall stability first; then address neurologic deficits.
3. neurologic examination: The findings from a
comprehensive neurologic examination are the most
important part of the diagnostic evaluation.
4. differentials: If no trauma or obvious instability
has occurred, consider differentials, such as
intervertebral disk disease and fibrocartilagenous
embolism.
5. radiographs: Spinal radiographs are essential in
order to identify spinal instability prior to extensive
manipulation of the patient.
6. ct & Mri: Advanced imaging is valuable in
diagnosis of acute spinal cord injury. If severe
neurologic deficits are present, refer the patient to a
hospital with appropriate diagnostic capabilities.
7. treatment: Depending on diagnosis, pursue medical
management (indicated for patients with pain or
minor deficits) or surgery (indicated in patients with
severe neurologic deficits, vertebral instability, or
significant extradural compression).
8. Secondary damage: Be prepared for secondary
damage and initiate treatment if necessary.

38 Today’s Veterinary Practice May/June 2012

T
he most commonly encountered causes of ation of pulmonary and cardiovascular systems).
acute spinal cord injury in dogs are, in order Trauma patients may suffer significant damage to
of incidence:1-4 body systems that pose more immediate threats to
• Intervertebral disk disease (IVDD) their lives than neurologic deficits.
• Trauma (automobile trauma, gun shots)
• Infarction (fibrocartilagenous embolism). Neurologic Examination
• The neurologic examination is the first and most
In cats, the most common causes of acute spinal cord important tool used by the clinician to localize
injury recorded from a population of cats that had been the site of injury. Please refer to Chapter 3 of A
necropsied are, in order of incidence:5 Practical Guide to Canine & Feline Neurology
• Trauma (falling from windows, automobile trauma) (Dewey CW, Wiley-Blackwell, 2003) for more
• IVDD specifics on the neurologic examination. The
• Ischemic disease (infarction, fibrocartilagenous presence of certain examination findings will help
embolism [FCE]). localize the lesion (Table 1, page 40) and direct
further diagnostics.
PATIENT ASSESSMENT • However, it is not uncommon to find some discrep-
Stabilization ancy between neurolocalization based on the neuro-
Whenever spinal cord injuries secondary to trauma are logic examination and the actual injury localization.
suspected, it is important to manipulate the patient as • One study showed an incorrect neuroanatomic
little as possible. localization within the cervical cord in 12/26 dogs
• Transport: The use of a stretcher or board can be with cervical disk disease, mainly due to inconsis-
very helpful for transportation. The patient should tent withdrawal reflexes.6 In addition, incorrect
be restrained and possibly strapped to the board neuroanatomic localization from L4 to S3 can
during transport. occur due to spinal shock in cases of T3 to L3
• Overall Stability: When evaluating a patient with myelopathy (spinal cord disease).7
neurologic deficits due to suspect trauma, When assessing a patient with evidence of a myelopa-
evaluate the patient’s overall stabil- thy, the presence/absence of plegia and deep pain are
ity first (ie, evalu- very important indicators of prognosis regardless of the
etiology. Plegia and loss of deep pain are usually associ-
ated with severe lesions that are causing pathology to
a significant percentage of the white matter, while
patients that are only painful and ataxic likely have
less white matter involvement (Table 2, page
41). A theoretical progression of clinical signs
following progression of pathology would be:

Pain/ataxia/paresis Plegia Loss of

deep pain sensation

DIFFERENTIAL DIAGNOSIS
Intervertebral Disk Disease
IVDD is a major cause of acute spinal cord injury
in dogs; less so in cats. The intervertebral disk is
composed of an outer annulus fibrosis and an inner
nucleus pulposus (Figure 1, page 40). The majority
of the annulus and the entire nucleus is avascular; only
the peripheral parts of the annulus are innervated.

Types of IVDD
• Fibrous metaplasia is part of the normal aging
process in dogs and cats, which results in weaken-
ing of the annulus and fibrous collagenization of
the nucleus pulposus. This can lead to bulging of
the intervertebral disk and a Hansen Type II inter-
vertebral disk lesion (outermost layers of annulus
fibrosus remain intact).
• Chondroid metaplasia occurs within the nucleus
pulposus at an early age in chondrodystrophic

May/June 2012 Today’s Veterinary Practice 39

| AcuTE SPInAl corD InjurIES
TAble 1. examination Findings Related to
Spinal Cord lesion localization
lesion
localization Clinical Findings
C1 to C5 • Crossed extensor reflex × 4
• Neck pain
• Horner syndrome
• Proprioceptive deficits × 4
• Increased myotatic reflexes × 4
• Tetraparesis/plegia
• Increased tone × 4
• Upper motor neuron bladder
C6 to T2 • Absent cutaneous trunci reflex
• Neck pain
• Decreased thoracic limb tone/with-
drawal reflexes
• Pelvic limb crossed extensor reflexes
• Proprioceptive deficits × 4
• Horner syndrome
• Tetraparesis/plegia
• Increased pelvic limb myotatic reflexes
• Upper motor neuron bladder
• Increased pelvic limb tone
T3 to l3 • Absent cutaneous trunci near level of » CT and/or myelogram may be appropriate for
lesion
• Paraparesis/plegia
• Pelvic limb crossed extensor reflexes
• Back pain
• Proprioceptive deficits in pelvic limbs
• Increased pelvic limb myotatic reflexes
• Upper motor neuron bladder
• Increased pelvic limb tone*
l4 to S3 • Decreased anal tone/reflex
• Lower motor neuron bladder
• Decreased pelvic limb myotatic reflexes
• Lumbosacral pain
• Decreased pelvic limb tone/withdrawal may have decreased signal on MRI T2 weighted
reflexes
• Paraparesis/plegia
• Pelvic limb proprioceptive deficits
• Limp tail
*Potentially Schiff-Scherrington phenomenon if identified in thoracic limbs.
C = cervical; L = lumbar; T = thoracic
breeds, such as the dachshund.8 With chondroid
metaplasia, the nucleus pulposus becomes abnor-
mal and is no longer able to disperse forces evenly,
leading to herniation. This herniation can occur
acutely and cause a Hansen Type I intervertebral
disk lesion (complete perforation of annulus fibro-
sus with extrusion of nucleus pulposus into the
spinal canal). Since the nucleus pulposus is eccen-
trically placed more dorsally within the annulus,
the herniated material tends to herniate toward
the spinal cord.
• Traumatic noncompressive intervertebral disk
herniation occurs when the nucleus pulposus is
extruded and causes a concussive injury to the
40 Today’s Veterinary Practice May/June 2012
spinal parenchyma (Figure 2). In some cases this
extruded material causes a dural tear, which can
be found below the level of the dura mater.9,10
Imaging
• Plain radiographs can help determine the cor-
rect region of interest by identifying abnormali-
ties, such as narrowing of the intervertebral disk
space, mineral opacities within the canal/foramen,
and the vacuum effect (area of radiolucency at
the level of the affected intervertebral disk space
caused by loss of disk material).
» However, plain radiographs (without contrast) can-
not accurately diagnose IVDD with spinal cord
compression.
» The accuracy of identifying the correct site based
on plain radiographs alone is reported to range
from 51% to 61%, and advanced imaging is needed
for accurate localization and diagnosis of IVDD.11
• Computed tomography (CT) and myelogra-
phy have a sensitivity over 80% for localizing the
correct site, but magnetic resonance imaging
(MRI) remains the best imaging modality for cases
of IVDD (Figure 3, page 42).12,13
young and middle-age chondrodystrophic breeds
where IVDD is very high on the differential list.
» In older animals and nonchondrodystrophic
breeds, MRI should be recommended to the
owner as an option since most areas now have
a facility with MRI within a reasonable distance.
» MRI has been reported to have complete agree-
ment with surgical findings, with respect to the
site of disk extrusion.
» In cases of noncompressive traumatic interver-
tebral disk herniation, the affected disk space
images, along with mild extradural compression
seen at the level of the affected disk space.14,15
Treatment
Once spinal cord imaging is complete, a decision can
be made whether to pursue surgical decompression or
medical management.
Figure 1. Cross-sectional image of the interver-
tebral disk showing the annulus fibrosus and
nucleus pulposus.
 AcuTE SPInAl corD InjurIES |

percent or less of deep-pain negative dogs recover with

medical management alone.19
Surgical treatment for acute disk extrusions includes:
• Cervical IVDD: Ventral slot or hemilaminectomy
• Thoracic/Lumbar IVDD: Hemilaminectomy or
dorsal laminectomy.
• Modifications of the typical hemilaminectomy,
such as a pediculectomy and mini-hemilaminec-
tomy, can also be performed.

Prognosis
Indicators by disease type/presentation include:
• Acute Hansen Type 1 Disk Herniation/Intact
Nociception: Patients have an excellent progno-
Figure 2. Transverse T2-weighted MRI image sis with surgery. One retrospective study found
showing a right-sided intramedullary hyperin- that 96% of these patients were ambulatory within
tensity, along with a comparatively hypointense 3 months of surgery.19
nucleus pulposus at the C2 to C3 intervertebral
• Loss of Deep Pain Sensation/Lack of Noci-
disk space. These findings are consistent with a
ception: These patients have a more guarded prog-
traumatic noncompressive disk herniation.

TAble 2. Neurologic Function Related to

Medical Management Spinal Cord Tract
Conservative management typically consists of:1,2,16
• Strict cage rest for 2 to 6 weeks Function Tracts location
• Anti-inflammatory drugs Proprio- • Cuneate and gracili Periphery of the
• Analgesics ception fascicles white matter
• Physical therapy. • Dorsal/ventral/cranial
Alternative therapies, such as acupuncture, have spinocerebellar
been described, but not enough evidence is available • Spinocuneocerebellar
to determine their efficacy. Motor • Corticospinal Deeper within
A recent retrospective report describing the use of Skills • Reticulospinal the white matter
medical management for suspected thoracolumbar • Rubrospinal
IVDD reported a success rate of about 55% once dogs • Tectospinal
with episodes of relapse were factored in17; if dogs with • Vestibulospinal
only minor deficits (ie, pain) are included in the success Pin-Prick • Spinothalamic Deeper within
group, the success rate increases to 66%. A similar the white matter
Pain
retrospective study showed comparable results when
disk herniation was localized to the cervical region.18 Deep • Spinoreticular Very deep within
Conservative management is not an ideal choice for Pain the white matter
patients with severe neurologic deficits (severe paresis,
plegia, loss of deep pain) or those that have already
failed conservative management. However, if the client
cannot pursue surgery, conservative management is an
option for these patients.

Surgical Management
In patients that have severe neurologic dysfunction
at time of presentation, significant compression of
the cord may be present, which has the potential to
severely impair local blood flow and cause progres-
sive secondary damage to the cord. Candidates for
surgery include:
• Significant vertebral instability (luxation, fracture)
• Patients with significant neurologic deficits, such Histologic cross section of the cervical spinal cord of a
as severe paresis or paralysis dog showing the approximate location of certain ascend-
• Deep-pain negative dogs. ing and descending tracts. Note: Tracts are not depicted
The latter condition has a significantly worse prog- per actual size.
nosis if treated with medical management alone. Seven

May/June 2012 Today’s Veterinary Practice 41

| AcuTE SPInAl corD InjurIES

nosis. Decompressive with a lesion localized from the C1 to C5 spinal

surgery allows about cord after suffering suspected trauma; it is impor-
62% of deep pain tant to minimize cervical flexion in these dogs.
negative dogs with • CT is the gold standard for detecting vertebral
thoracolumbar disk fractures and instability, and should be recom-
extrusions to regain mended for any patient with suspected vertebral
nociception and abil- fractures or instability.24
ity to ambulate with- • While an MRI provides good evaluation of the
out assistance.20 spinal cord, a CT scan offers much better visualiza-
• Noncompressive tion of the vertebral column’s pathology.
Traumatic • In some patients with vertebral fracture(s) and/or
Intervertebral Disk luxations, both MRI and CT may be ideal. Figure
Herniation: One 5 shows an atlanto-axial luxation for which the CT
retrospective study allowed proper surgical planning.
Figure 3. Transverse T2-weighted reported that 46/48
MRI image at the level of the C3 dogs with this condi- Treatment
to C4 intervertebral disk space tion made significant Treatment of trauma patients with significant neuro-
showing a left-sided extradural
improvements and logic deficits ranges from rest to immobilization using
compression consistent with a
all were ambulatory external braces to surgical intervention/stabilization.
Hansen type I herniated disk.
with medical man- • Rest: Rest is appropriate for a patient with pain
agement.21 Prognosis and/or minor deficits and no evidence of signifi-
may be worse for patients that have lost deep cant instability of the cord.
pain sensation. Surgery is a potential therapy for • Stabilization: Cervical lesions need more rigor-
patients with suspected dural tears, and progno- ous stabilization due to the inherent mobility of
sis appears good based on limited reports.22,23 this region. When using braces and/or bandage
material to decrease motion, significant cutaneous
trauma lesions due to rubbing or moisture can occur, and
Common causes of trauma include: respiratory status can be compromised by tight
• Automobile accidents neck bandaging. Frequent bandage changes and
• Gun-shot wounds rechecks may be necessary.
• Vertical falls in cats, among others. • Surgery: Surgery may be indicated for patients
In cases of acute spinal injury related to trauma, sta- with significant neurologic deficits and instability.
bilization is the most important aspect of initial care. Once stabilized, these patients should be trans-
See Patient Assessment, page 39. ported to a veterinarian that is comfortable with
such procedures for evaluation and treatment.
Imaging
• Lateral and dorsal/ventral radiographs of the Prognosis
entire vertebral column can help identify any frac- According to available literature, prognosis for acute
tures (Figure 4) or luxations without manipulat- spinal cord injuries related to trauma seems to be
ing the patient excessively. more guarded than for other types of acute spinal cord
• Atlanto-axial luxations must be considered in dogs injuries.
• One report evaluating prog-
nosis for dogs with vertebral
fractures and/or luxations as
A b well as absent nociception
reported that 0/9 had return
of nociception.25 Therefore,
obvious vertebral instability
(ie, fracture, luxation), paraly-
sis, and no evidence of noci-
ception indicates a poor prog-
nosis.
• A better prognosis is indicat-
ed if patients with significant
deficits but intact sensation
receive surgical stabilization.
Figure 4. Lateral (A) and ventrodorsal (B) thoracic radiographs showing a
Unfortunately, these patients
pathologic compression fracture at T7; a CT confirmed these findings.
are often euthanized.

42 Today’s Veterinary Practice May/June 2012

 AcuTE SPInAl corD InjurIES |

A b C

Figure 5. Lateral T2-weighted MRI saggital image of cervical spinal cord in a dog with an atlanto-axial luxation (A);
transverse CT image of the atlas used for surgical planning and pin placement (B); 3D reconstruction of the CT (C)

Fibrocartilagenous embolism Treatment

FCE is encountered frequently in dogs; cats are also Treatment of FCE usually includes physical therapy
affected by it, but much less frequently. and rest. Different treatments, such as steroids, have
• An FCE occurs when material identical to the been attempted, but no significant positive association
nucleus pulposus of the intervertebral disk space has been found.28
forms an embolus that obstructs either arterial,
venous, or both types of vasculature within the Prognosis
spinal cord. • Prognosis is generally good, and most patients
• FCE commonly affects large- and giant-breed will show signs of significant improvement within
dogs, but may also affect small-breed and chon- 2 weeks,27,28 but maximal
drodystrophic dogs.14,15,26-28 Miniature schnauzers improvement may take
appear to be affected at a higher incidence than months.15 When patients
other small breeds.29 are given time to recover,
• Dogs typically present with a history of peracute
neurologic deficits that progress within a 24-hour
period.15,26,27 History often involves some form of
physical activity at the time clinical signs develop.15 SurGery: tiMe iS
• Patients are usually not painful at presentation oF tHe eSSence
and a substantial percentage will have asymmetri- Surgery should be
cal neurological deficits.15,26 performed as early as
possible in patients with
Imaging severe deficits in an
Diagnosis is usually made using advanced imaging. effort to minimize secondary damage from extradural
MRI is the best antemortem diagnostic tool, but CT compression.
and myelography can also be used to make a pre- Most papers regarding this subject show the
sumptive diagnosis. following trend: once the patient loses deep pain
• MRI will usually show an intramedullary hyperin- sensation, as more time passes, the prognosis
worsens. The recommended time frame for pursuing
tensity on T2-weighted images (Figure 6, page 44).
surgery varies but, for patients that have lost deep pain
• In some instances, lesions detected by MRI will
in the past 12 to 24 hours, most publications support
not be detectable since the changes may require
emergency surgery. As the time frame extends past
several days to develop.28
24 hours, the evidence supporting emergency surgery
• The main feature that helps differentiate an FCE becomes weaker and these patients may be able to
from other common causes of acute spinal cord wait until the morning for surgery without worsening
injury is the lack of extradural compression. A their prognosis.
herniated disk will have extradural compression. Similarly, patients that have become plegic in
the previous 24 hours are also considered surgical
Histopathology emergencies in order to preserve an excellent
Definitive diagnosis of FCE is made using histopa- prognosis, by intervening prior to development of
thology. Emboli found within the spinal cord vascu- extensive secondary damage to the spinal cord and
lature will be histologically identical to the nucleus loss of deep pain sensation (more guarded prognosis).
pulposus.

May/June 2012 Today’s Veterinary Practice 43

| AcuTE SPInAl corD InjurIES

SecondAry dAMAGe
The pathology that results secondary to a primary
spinal cord injury (IVDD, trauma, infarct) is often
more serious than the primary injury.1-4,30 Secondary
pathology can result from changes in the local ion con-
centrations, disturbances to blood flow and ischemia,
production of free radicals, and inflammation.1-4,30 The
chemical environment of an injured spinal cord may
also delay the regeneration of injured axons.31

therapeutic recommendations
Currently, treatment is aimed at relieving the insult
caused by the primary injury with:
• Surgery (if indicated)
Figure 6. Sagittal T2-weighted MRI image • Medical management (anti-inflammatory drugs
showing an intramedullary hyperintensity at the and analgesics).
level of C6 consistent with a FCE. Potential therapies for secondary injuries include:
• Calcium channel antagonists
• Free-radical scavengers (ie, vitamin E, selenium,
success rates as high as 84% have been cited.14 methylprednisolone)
• Negative prognostic factors may include lack of • N-methyl-D-aspartate (NMDA) antagonists
nociception, involvement of an intumescence (dis- • Opioid agonists and antagonists
puted in the literature), and intramedullary hyper- • Thyroid releasing hormone.2,3
intensity on (1) T2-weighted images of the spinal
cord that are longer than the length of two L2 or Free-radical Scavengers
two C6 vertebral bodies or (2) an intramedullary Most of these therapies are still being tested for
hyperintensity on transverse section that is greater efficacy, but the free-radical scavenger methylpred-
than 66% the height of the spinal cord.15,26-28 nisolone has been used with modest success to treat

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 AcuTE SPInAl corD InjurIES |

human patients. It is believed to exert a protective effect

through its free radical scavenging properties, which Adam Moeser, DVM, is a
may prevent further lipid peroxidation. In humans, second-year neurology resident
methylprednisolone may offer some benefit against sec- at University of Pennsylvania
ondary damage to the cord if used within 8 hours of the School of Veterinary Medicine.
primary injury.32 Limited studies have been performed He received his DVM from
in veterinary medicine, and mixed results have been University of Wisconsin –
seen in small numbers of dogs.22,23 Madison and completed a
As we understand more about the secondary damage rotating internship at the VCA
that occurs within the spinal cord following a primary Aurora/Berwyn veterinary hos-
insult, hopefully new and more effective treatments will pitals in the Chicago, Illinois, area.
become available. ■ Charles Vite, DVM, PhD,
Diplomate ACVIM (Neurology),
cT = computed tomography; FcE = fibrocartilagenous is an assistant professor in the
embolism; IVDD = intervertebral disk disease; MrI = mag- section of neurology and neu-
netic resonance imaging; nMDA = n-methyl-D-aspartate rosurgery in the Department of
Clinical Sciences at University
References of Pennsylvania School of
1. olby n. current concepts in the management of acute spinal cord injury. Veterinary Medicine. His clini-
J Vet Intern Med 1999; 13:399-407.
2. olby n. the pathogenesis and treatment of acute spinal cord injuries in
cal interests include epilepsy
dogs. Vet Clin North Am Small Anim Pract 2010; 40:791-807. as well as neurodegenera-
3. webb AA, ngan S, Fowler jd. Spinal cord injury i: A synopsis of the tive and neurodevelopmental processes. He also
basic science. Can Vet J 2010; 51:485-492. has specific interests in vestibular dysfunction and
4. webb AA, ngan S, Fowler d. Spinal cord injury ii: prognostic indicators,
standards of care, and clinical trials. Can Vet J 2010; 51:598-604. myotonia congenita. Dr. Vite received his DVM from
5. Marioni HK. Feline spinal cord diseases. Vet Clin North Am Small Anim Purdue University and completed a residency in
Pract 2010; 40:1011-1028. neurology at UPenn, followed by a fellowship in
6. Forterre F, Konar M, tomek A, et al. Accuracy of the withdrawal reflex for
localization of the site of cervical disk herniation in dogs: 35 cases (2004-
neuromagnetic resonance. He received his PhD
2007). JAVMA 2008; 232:559-563. from the same university.
(continued on page 84)

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May/June 2012 Today’s Veterinary Practice 45

| PracTice To PracTice
cOnTinuing eDucaTiOn
Many of the latest ocular diagnostic, treatment, and surgi-
cal recommendations are best presented by a specialist. A
great venue for continuing education in ophthalmology
is the ACVO Annual Conference, which offers a general
practitioner’s course that provides 8 hours of CE. After
attending the 2011 conference, I can attest that the board-
certified instructors provide helpful visuals and practical
advice. The ratio of attendees to speakers fosters discus-
sion with other practitioners and provides time to ask the
presenters specific questions.
You can also combine the ACVO general practitioner’s
course with general registration. The resident’s workshops,
research presentations, and exhibit hall provide additional
opportunities to pursue your interest in veterinary ophthal-
mology. The 2012 conference will be held October 17 to 20
in Portland, Oregon (acvoconferance.org).
Finally, another great way to obtain ophthalmic CE is to
see what courses your local veterinary school offers. You
can also visit the American Veterinary Medical Association’s
Meetings and CE Calendar (avma.org/meetings/calendar/
default.asp), which provides a complete list of CE oppor-
tunities across the country and is searchable by keyword.n
BNP = bacitracin/neomycin/polymyxin B; KcS = kerato-
conjunctivitis sicca; PDS = polydioxanone suture; STT = Pickerel and the practice team of Companion Animal
Schirmer tear test
References
1. Moore PA. Examination techniques and interpretation of ophthalmic
findings. Clin Tech Small Anim Pract 2001; 16(1):1-11.
(Acute Spinal Injuries continued from page 45)
7. Smith PM, Jeffery ND. Spinal shock-comparative aspects and clinical
relevance. J Vet Intern Med 2005; 19:788-793.
8. Ghosh P, Taylor TK, Braund KG. The variation of the glycosaminoglycans
of the canine intervertebral disc with aging; I. Chondrodystrophoid breed.
Gerontol 1977; 23(2):87-98.
9. Kent M, Holmes S, Cohen E, et al. Imaging diagnosis—CT myelography in
dog with intramedullary intervertebral disc herniation. Vet Radiol Ultrasound
2011; 52(2):185-187.
10. Poncelet L, Heimann M. Intradural vertebral disc herniation in a dog. Vet Rec
2011; 168:486A.
11. Lamb CR, Nichols A, Targett M, Mannion P. Accuracy of survey
radiographic diagnosis of intervertebral disc protrusion in dogs. Vet Radiol
Ultra 2002; 43:222-228.
12. Israel SK, Levine JM, Kerwin SC, et al. The relative sensitivity of computed
tomography and myelography for identification of thoracolumbar
intervertebral disk herniations in dogs. Vet Radiol Ultra 2009; 50:247-252.
13. Robertson I, Thrall DE. Imaging dogs with suspected disc herniation: Pros
and cons of myelography, computed tomography, and magnetic resonance.
Vet Radiol Ultra 2011; 42:S81-S84.
14. Risio LD, Adams V, Dennis R, et al. Association of clinical and magnetic
resonance imaging findings with outcome in dogs suspected to have ischemic
myelopathy: 50 cases (2000–2006). JAVMA 2008; 233:129-135.
15. Risio LD, Platt, SR. Fibrocartilaginous embolic myelopathy in small animals.
Vet Clin North Am Small Anim Pract 2010; 40:859-869.
16. Brisson BA. Intervertebral disc disease in dogs. Vet Clin North Am Small
Anim Pract 2010; 40:829-858.
17. Levine JM, Levine GJ, Johnson SI, et al. Evaluation of the success of
medical management for presumptive thoracolumbar intervertebral disk
herniation in dogs. Vet Surg 2007; 36:482-491.
18. Levine JM, Levine GJ, Johnson SI, et al. Evaluation of the success of
medical management for presumptive cervical intervertebral disk herniation
in dogs. Vet Surg 2007; 36:492-499.
19. Davis GL, Brown DC. Prognostic indicators for time to ambulation after
surgical decompression in nonambulatory dogs with acute thoracolumbar
disk extrusions: 112 cases. Vet Surg 2002; 31:513-518.
84 Today’s Veterinary Practice May/June 2012
2. Ollivier FJ, Plummer CE, Barrie KP. The eye examination and diagnostic
procedures. In Gelatt KN (ed): Veterinary Ophthalmology, 4th ed. Ames. IA:
Blackwell Publishing, 2007, pp 438-483.
3. Willis M, Bounous DI, Hirsh S, et al. Conjunctival brush cytology: Evaluation
of a new cytological collection technique in dogs and cats with a
comparison to conjunctival scraping. Vet Comp Ophthalmol 1997; 7:74-81.
4. Weigt A. General practitioners course: ocular pharmacology. ACVO Conf
Proc, 2011.
5. Martin CL. Prolapse of third eyelid gland (cherry eye). Ophthalmic Disease
in Veterinary Medicine. London: Manson Publishing, 2005, pp 206-209.
6. Morgan R, Duddy JM, McClurg K. Prolapse of the gland of the third eyelid in
dogs: A retrospective study of 89 cases (1980 to 1990). JAAHA 1993; 29:56-60.
Elizabeth Barfield Laminack,
DVM, practices at Companion
Animal Hospital in Athens,
Georgia. She received her
DVM from University of
Georgia and her undergradu-
ate degree in biology from
Reinhardt University. Dr.
Laminack continues to study
small animal ophthalmology at
the UGA Veterinary Teaching
Hospital and recently presented an abstract on
canine glaucoma at the Association for Research in
Vision and Ophthalmology (ARVO) Annual Meeting.
She wishes to thank Drs. Denise Weaver and Troy
Hospital for their support of her ophthalmic pursuits;
she also extends gratitude to her mentors, Drs.
Anthony Moore and Kate Myrna of UGA–VTH.
20. Scott HW, McKee WM. Laminectomy for 34 dogs with thoracolumbar
intervertebral disc disease and loss of deep pain perception. J Small Anim
Pract 1999; 40:417-422.
21. McKee WM, Downes CJ, Pink JJ, Gemmill TJ. Presumptive exercise-
associated peracute thoracolumbar disc extrusion in 48 dogs. Vet Rec
2010; 166:523-528.
22. Coates JR, Sorjonen DC, Simpson ST, et al. Clinicopathologic effects of a
21-aminosteroid compound (U74389G) and high-dose methylprednisolone
on spinal cord function after simulated spinal cord trauma. Vet Surg 1995;
24:128-139.
23. Siemering GB, Vomering ML. High dose methylprednisolone sodium
succinate: An adjunct to surgery for canine intervertebral disc herniation. Vet
Surg 1992; 21:406 (abstract).
24. Jeffery ND. Vertebral fracture and luxation in small animals. Vet Clin North
Am Small Anim Pract 2010; 40:809-828.
25. Olby N, Levine J, Harris T, et al. Long-term functional outcome of dogs with
severe injuries of the thoracolumbar spinal cord: 87 cases (1996–2001).
JAVMA 2003; 222:762–769.
26. Cauzinille L, Kornegay JN. Fibrocartilaginous embolism of the spinal cord in
dogs: Review of 36 histologically confirmed cases and retrospective study of
26 suspected cases. J Vet Intern Med 1996; 10(4):241-245.
27. Gandini G, Cizinauskas S, Lang J, et al. Fibrocartilaginous embolism in 75
dogs: Clinical findings and factors influencing the recovery rate. J Small
Anim Pract 2003; 44:76-80.
28. Nakamoto Y, Ozawa T, Katakabe K, et al. Fibrocartilaginous embolism of
the spinal cord diagnosed by characteristic clinical findings and magnetic
resonance imaging in 26 dogs. J Vet Med Sci 2009; 71(2):171-176.
29. Hawthorne JC, Wallace LJ, Fenner WR, Waters DJ. Fibrocartilaginous
embolic myelopathy in miniature schnauzers. JAAHA 2001; 37:374-383.
30. Jeffry ND, Blakemore WF. Spinal cord injury in small animals; 2. Current and
future options for therapy. Vet Rec 1999; 145:183-190.
31. Brosamle C, Huber AB, Fiedler M, et al. Regeneration of lesioned
corticospinal tract fibers in the adult rat induced by a recombinant,
humanized IN-1 antibody fragment. J Neurosci 2000; 20:8061-8068.
32. Bracken MB, Shepard MJ, Holford TR, et al. Methylprednisolone or tirilazad
mesylate administration after acute spinal cord injury: 1-year follow up. J
Neurosurg 1998; 89:699-706.