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Neck and back pain

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Abstract

Many diseases encountered in veterinary medicine cause spinal pain, including multiple neurological diseases and non-neurological conditions such as polyarthritis. Lesion localization is very important in cases of spinal pain, in order to ensure that the correct diagnostic tests are performed. This chapter considers clinical signs, lesion localization, pathophysiology, differential diagnosis, neurodiagnostic investigation, degenerative diseases, anomalous diseases, neoplastic diseases, nutritional diseases, inflammatory diseases, traumatic diseases, vascular diseases.

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Figures

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14.2 There are multiple origins of spinal pain, including ligaments, bone, nerve roots and spinal nerves, meninges, disc material and articular joints. Illustration created by Allison L. Wright, MS, CMI, Athens, Georgia, USA.
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14.3 A 9-year-old Schnauzer demonstrating severe neck pain with a stiff and flexed neck posture accompanied by poor weight bearing on the left thoracic limb, sometimes referred to as ‘nerve root signature’.
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14.4 Vertebral palpation. Palpation of the cervical vertebrae can be accomplished with one hand in small dogs. Pain may be exhibited by an increase in muscle tone associated with palpation, vocalization or a caudal ‘flicking’ of the ears. Palpation of the thoracolumbar vertebrae should be performed with one hand underneath the abdomen of the patient, so as to detect any increase in muscle tone in this region. Pain may also be noted as vocalization or the animal turning toward the examiner.
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14.5 Neuroanatomy of the spinal cord dorsal horn associated with pain transmission and modulation. Illustration created by Allison L. Wright, MS, CMI, Athens, Georgia, USA.
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14.6 Transverse T2-weighted MR images of the cervical spinal cord at the level of C4, the thoracolumbar spine at the level of L3 and the cauda equina. The size of the respective epidural spaces can be estimated based upon the presence of hyperintense fat (arrowed).
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14.8 Clinical approach to spinal pain. ANA = anti-nuclear antibody; CK = creatine kinase; CSF = cerebrospinal fluid; LE = lupus erythematosus; RhF = rheumatoid factor.
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14.9 Spondylosis in a 7-year-old Golden Retriever. Lateral radiograph showing marked ventral vertebral body spondylosis (arrowed). Other causes of back pain should be investigated as this osseous proliferation rarely causes neural tissue compression. Sagittal T2-weighted MR image showing spondylosis (arrowed) but there is no evidence of cord compression.
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14.10 Transverse CT image of the lumbar spine of a dog with dural ossification (arrowed). T2-weighted MR image of the same spinal region. The dural ossification is represented as a signal void (arrowed).
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14.11 Sagittal T2-weighted MR image of a dog with atlanto-occipital overlapping. The dorsal arch of C1 can be seen extending into the foramen (arrowed). 3D reconstructed CT image demonstrating the relationship between the dorsal arch of C1 (arrowed) and the foramen magnum. (Courtesy of Drs S Cerda-Gonzalez and C Dewey)
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14.12 Sagittal T2-weighted MR image of the caudal skull and cranial cervical spine of a dog with a Chiari-like malformation. Note the dorsal compressive soft tissue lesion (arrowed) at the level of C1–C2.
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14.13 Sagittal T2-weighted cranial MR image of a 6-year-old Cavalier King Charles Spaniel. There is evident hydrocephalus and marked replacement of the spinal cord parenchyma with fluid-filled cavities (arrowheads). Note the caudal displacement of the vermis of the cerebellum (arrowed) associated with occipital dysplasia of the calvarium. This is compatible with a Chiari-like malformation.
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14.14 Sagittal T2-weighted MR image of the brain of a dog with a Chiari-like malformation and a large quadrigeminal intra-arachnoid cyst (arrowed).
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14.15 Dorsal view of the caudal skull and cervical vertebrae demonstrating the margins for craniectomy and laminectomy performed for decompression of the caudal fossa.
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14.16 Transverse T1-weighted MR image of the spinal cord of a young Deerhound showing fluid-filled structures (arrowed) either side of the spinal cord at the level of the nerve roots.
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14.17 Transverse T2-weighted MR image of the dog in Figure 14.13 at the level of the second cervical vertebra. Note the large fluid-filled cavity within the parenchyma of the spinal cord (right arrow).
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14.18 Lateral deviation of the cervical vertebrae in relation to the skill and thoracic vertebrae, compatible with scoliosis, in a 6-month-old Cavalier King Charles Spaniel.
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14.19 The location of tumours (yellow) within the spinal canal is classified according to their location relative to the spinal cord and the dura mater. Illustration created by Allison L. Wright, MS, CMI, Athens, Georgia, USA.
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14.20 A 7-month-old Beagle exhibiting a stiff neck posture due to the inflammatory condition SRMA (sometimes called Beagle pain syndrome in this breed).
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14.22 Sagittal T2-weighted MR image of the cervical spinal cord of an 8-year-old West Highland White Terrier with severe neck pain due to GME. Note the multifocal hyperintense inflammatory lesions within the cord (arrowed). This is not specific for this disease. CSF analysis is always necessary to document the inflammatory nature of the condition.
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14.23 Lateral radiograph of an 8-year-old Airedale Terrier with lumbar pain. Gross irregular lysis and osseous proliferation of the vertebral endplates of L7 and S1 (arrowed) can be seen, which are compatible with discospondylitis.
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14.24 Sagittal T2-weighted MR image of the same region of the dog shown in Figure 14.23 . The bony detail is not as good as with radiography. A loss of signal is seen in the region of the osseous proliferation (long arrow) which is not specific for vertebral infection. However, in cases unresponsive to antibiotic therapy, MRI may help identify associated neural compression (short arrow). Sagittal T2-weighted and T1-weighted post-contrast lumbosacral MR images revealing pathology at the endplates compatible with discospondylitis. Note the hyperintensity within the disc and endplates (b) and contrast enhancement of the endplates and the soft tissues ventral to the lumbosacral junction (c).
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14.25 Scintigraphy can be performed to investigate for vertebral lesions, as demonstrated in this lateral view of the cervicothoracic spine of a 10-year-old Ibizan hound. The accumulation of the radioisotope within the body of the first thoracic vertebra (arrowed) is not specific for discospondylitis, and vertebral tumours can have a similar appearance.
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14.26 Dorsoventral fluoroscopic view of the lumbosacral vertebrae of a dog with discospondylitis. A needle (arrowed) is being directed to the disc space to obtain a sample for an aspiration study.
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14.28 Lateral radiograph of the lumbosacral spinal vertebrae of a dog which had discospondylitis at L7–S1 that required surgical stabilization. Note that the discospondylitis has nearly completely resolved.

Supplements

Behavioural response

Palpation of the neck of a Beagle with disc extrusion reveals a marked behavioural response indicative of pain. (See pages 252 and 253 of the Manual)

CSF flow study

Lateral and transverse views of an MRI CSF flow study showing the pulsatile movement of the CSF within the subarachnoid space. (See page 262 of the Manual)

Discospondylitis

(a) A Bull Terrier with discospondylitis demonstrating severe pain localized to the neck and marked motor dysfunction.

Discospondylitis

(b) Following 5 days of antibiotic therapy a major improvement in the posture, gait and comfort level of the dog can be seen. (b) Following 5 days of antibiotic therapy a major improvement in the posture, gait and comfort level of the dog can be seen. (See page 266 of the Manual)

Flexion and extension of neck

Following palpation of the cervical vertebrae, it can be useful to carefully flex and extend the neck as shown in this clip. However, this is not necessary and may be dangerous if pain is detected on palpation. (See page 253 of the Manual)

‘Phantom scratching’

A young Bichon Frise with syringomyelia demonstrating profound 'phantom scratching' behaviour. (See page 260 of the Manual)

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