The authors declare no conflict of interest.
Clinical Practice Review
Mechanisms of injury and emergency care of acute spinal cord injury in dogs and cats
Article first published online: 10 APR 2012
© Veterinary Emergency and Critical Care Society 2012
Journal of Veterinary Emergency and Critical Care
Volume 22, Issue 2, pages 160–178, April 2012
How to Cite
Park, E. H., White, G. A. and Tieber, L. M. (2012), Mechanisms of injury and emergency care of acute spinal cord injury in dogs and cats. Journal of Veterinary Emergency and Critical Care, 22: 160–178. doi: 10.1111/j.1476-4431.2012.00723.x
- Issue published online: 10 APR 2012
- Article first published online: 10 APR 2012
- Manuscript Accepted: 1 FEB 2012
- Manuscript Received: 27 DEC 2010
- hypertonic saline;
- neurologic trauma;
- polyethylene glycol;
- vertebral trauma
To review the literature in regards to the pathophysiology of acute spinal cord injury, and to describe current concepts in regards to patient assessment, diagnostic, and therapeutic measures with a special emphasis on emergency and critical care considerations.
Acute spinal cord injury occurs in 2 phases. The primary injury occurs at the time of initial injury and may include intervertebral disk herniation, vertebral fracture or luxation, penetrating injury, and vascular anomalies such as fibrocartilaginous embolic myelopathy. Secondary injury occurs following primary injury and is multifactorial encompassing numerous biochemical and vascular events that result in progression of injury.
The diagnosis is based on history and physical examination findings. A neurologic examination should be performed following initial patient assessment and stabilization. Further diagnostics to characterize acute spinal injury include radiographs and advanced imaging modalities such as myelography, computed tomography, or magnetic resonance imaging.
Initial treatment should focus on addressing the patient's cardiovascular and respiratory system. Supportive measures to support systemic perfusion are vital to minimizing secondary injury. Specific therapy toward minimizing secondary injury in veterinary medicine remains controversial, especially in regards to the utilization of methylprednisolone. Other therapies are either in need of additional research or have failed to document clinical difference.
The prognosis for acute spinal injury is varied and is dependent upon the presence of concurrent trauma, location, and type of primary injury sustained, and extent of neurologic impairment at the time of initial presentation. The etiology of the underlying trauma is of great importance in determining prognosis and outcome. Loss of deep pain is generally accepted as a poor prognostic indicator; however, even these patients can recover depending on their response to treatment.