Discospondylitis

Re: Discospondylitis

Malcolm Ness — Thu, 06 Jun 2013 18:58:11 GMT

Patellar hyper-reflexia (so-called pseudo hyper reflexia) along with those other signs is consistent with a lesion either in the cranial lumbar spine or over the LS disc.

I would certainly keep up the meloxicam. Accurate localisation of the lesion followed by decompressive surgery (lumbar spine) or perhaps distraction - fusion of the LS if that turns out to be the sig lesion would carry a good prognosis for improvement but a guarded prognosis for full neuro resolution but that is academic if the owners have limited finances as neither could be done cheaply.

Re: Discospondylitis

John Flynn — Thu, 06 Jun 2013 18:54:18 GMT

Do you consider acute phase proteins to be potentially more reliable than haematology (although I appreciate there is more to haematology than "high neutrophil count", more so in a cat than a dog perhaps) in discospondylitis?

I was reminded recently how useful they can be in differentiating inflammatory from degenerative disease with what i suspect to be an immune-mediated poyarthritis dog with a sky-high CRP and completely unremarkable haematology - I gather quite a percentage of these dogs have an unremarkable haematology.

Re: Discospondylitis

Robin Grimmer — Thu, 06 Jun 2013 17:16:59 GMT

I should add a bit of history with this case. 12 yo DSH cat, was diagosed with 'arthritis' 4 years ago and has been on Metacam. However, has had progressive neuro signs of the HLs which have worsened recently. There has been marked muscle atrophy of the hind limbs. There is weakness, ataxia, proprioceptive deficits, exaggerated reflexes but intact deep pain, all of which indicates an UMN lesion, consistent with the radiological findings.

The owner can't afford too much more investigation, so am trying a month of Synulox.

Re: Discospondylitis

Malcolm Ness — Thu, 06 Jun 2013 16:57:42 GMT

I wouldn't rule out the disco dx on that basis - high neutrophil counts are an inconsistent finding in disco in dogs.

Re: Discospondylitis

Martin Atkinson — Thu, 06 Jun 2013 16:50:51 GMT

Should add that you would also expect a high neutrophil count as well if it is infective.

Re: Discospondylitis

Malcolm Ness — Thu, 06 Jun 2013 16:47:04 GMT

Difficult to be certain on these rads but, like Martin, I would tend towards degenerative rather than inflamm/infect disc disease here. The end-plates appear intact and there seems to be some remodelling of the adjacent parts of the vertebral bodies implying a long, slow disease process. There seems to be degenerative changes in the LS disc space as well.

Re: Discospondylitis

Martin Atkinson — Thu, 06 Jun 2013 16:24:04 GMT

Hmm...I'm no expert but I would have expected more destruction of the vertebral bodies themselves at the end plates if it was infective discospondylitis, seems more like an early ankylosing spondylitis to me. In answer to the OP though I have used amoxyclav for around 6 weeks successfully.

Re: Discospondylitis

Robin Grimmer — Thu, 06 Jun 2013 14:40:08 GMT

Lesion present L2/L3

Re: Discospondylitis

Malcolm Ness — Wed, 05 Jun 2013 16:42:07 GMT

Disco in cats appears to be much less common than in dogs.

I have seen a couple of cases with concurrent urinary tract infection and I think that there are some similar cases in the literature. Culture and sensitivity testing of urine and blood would be ideal to get a handle on what bugs you are dealing with. In dogs, we use amoxycillin/clav as first choice and change it only if lab results dictate - most of our (dog) cases and both of my cats stayed on amoxy/clav.

wrt duration - look for at least a month or 2 weeks beyond resolution of clinical signs whichever is longest.

I will be interested to see the rads.

Re: Discospondylitis

Anthony Dennison — Wed, 05 Jun 2013 16:21:50 GMT

I would go for clindamycin for good bone penetration, poss add in a combo also of metronidazole if single drug therapy isn't working. If it is discospondylitis and is in the bone, most textbooks recommend treatment for 6-8 weeks I think, but definately at least 1 month duration