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Pathophysiology of ivdh and spinal cord injury, and clinical implications
F. Forterre
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Veterinarians with a patient presenting with clinical signs of paresis and/or pain are reminded that intervertebral disc disease (IVDD) is but one differential for such signs, and are also encouraged to remember that such signs are almost always due to herniation (extrusion or protrusion) of the diseased disc, not just the presence of degenerative lesions within a still-contained disc. We thus distinguish the catch-all phrase “IVDD” from true herniation (IVDH). Clinical decision-making may be enhanced by consideration of some of the events transpiring in and around the spinal cord when a disc herniates.
Inflammatory Effects
Epidural inflammation occurs in the majority of dogs with IVD extrusion and may develop long before the onset of clinical signs. Inflammatory cytokines can be isolated from the extruded disc material and an epidural inflammatory response, ranging from acute invasion of neutrophils to formation of chronic granulation tissue might be present. The mononuclear inflammatory infiltrates consisted mostly of monocytes and macrophages and only few T and B cells. The severity of the epidural inflammation correlates with degree of the epidural hemorrhage and nucleus pulposus calcification which may both act as triggers of the lesion. Furthermore the degree of inflammation is statistically inversely correlated with the ability to regain ambulation. All these observations support the rationale of surgical treatment to remove the herniated disc material to achieve spinal cord decompression but also to alleviate the epidural inflammatory reaction.
Spinal cord blood flow
Alterations in spinal cord blood flow (SCBF) play an important role in spinal cord injury. Duration of compression-induced ischemia and intensity of blood flow recovery have an influence on the quality of neurological recovery after spinal cord injury. Therefore, maintaining adequate vascular perfusion, and decompressing the spinal cord are two important aspects of the clinical management of patients suffering from acute spinal cord injuries. [...]
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About
Affiliation of the authors at the time of publication
Department of clinical veterinary medicine- Vetsuisse Faculty, Bern, Switzerland
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