Simulation of acute spinal cord injury: effects on respiration

Treatment of traumatic cervical myelopathy with surgery, prolonged positive-pressure ventilation, and physical therapy in a dog

CASE DESCRIPTION

A 9-year-old dog was evaluated for traumatic cervical myelopathy after a surgical attempt to realign and stabilize the C2 and C3 vertebrae.

CLINICAL FINDINGS

The dog could not ventilate spontaneously and was tetraplegic; positive-pressure ventilation (PPV) was maintained. Myelography and computed tomography revealed spinal cord compression with subluxation of the C2 and C3 vertebrae and extrusion of the C2-3 intervertebral disk.

TREATMENT AND OUTCOME

Surgically, the protruding disk material was removed and the vertebrae were realigned with screws and wire. For PPV, assist control ventilation in volume control mode and then in pressure control mode was used in the first 6 days; this was followed by synchronized intermittent mandatory ventilation until 33 days after the injury; then only continuous positive airway pressure was provided until the dog could breathe unassisted, 37 days after the injury. Physical therapy that included passive range of motion exercises, neuromuscular electrical stimulation, and functional weight-bearing positions was administered until the dog was discharged 46 days after injury; the dog was severely ataxic and tetraparetic but could walk. Therapy was continued at home, and 1 year later, the dog could run and had moderate ataxia and tetraparesis.

CLINICAL RELEVANCE

Hypoventilation with tetraparesis in traumatic spinal cord injury can be successfully treated with PPV exceeding 30 days, surgery, and physical therapy.

Anesthetic considerations in the treatment of cervical myelopathy

BACKGROUND CONTEXT

The safe surgical treatment of patients with severe cervical spondylotic myelopathy involves a team approach incorporating special anesthetic considerations. This patient population is more vulnerable to perioperative complications. Advanced age, prolonged periods of immobility, multiple medical co-morbidities, and the risk of worsening neurologic injury mandate that the anesthesiologist pay special attention in the preoperative, induction, surgical, and recovery phases.

PURPOSE

To review the literature regarding the anesthetic management of patients undergoing surgery for cervical spondylotic myelopathy.

CONCLUSION

A basic understanding of the pathophysiology of cervical myelopathy as well as the nuances of the surgical treatment plan can help to ensure safe and effective patient management.