Rabbit spinal lesion

Re: Rabbit spinal lesion

Marie Kubiak — Sat, 27 Sep 2014 18:28:03 GMT

The other problem with surgery is there aren't many people who would do it - us exoticos don't do spinal surgery, spinal surgeons don't touch bunnies. I have no idea if the equipment used for dogs would even be suitable for a <2kg patient.

In humans gastric innervation is T5-T9, I'm presuming there isn't huge variation from rabbits so given that in this rabbit the changes include this region I could speculate effects on prox GIT but it is only speculation!

Interesting re: steroids and application for disc disease, I generally fear them given the low tolerance of most exotics so wouldn't have thought of them.

Marie

Re: Rabbit spinal lesion

John Flynn — Sat, 27 Sep 2014 16:58:21 GMT

Thanks Maire for sharing those normal rads for comparison!

My limited grasp of disc extrusions (in dogs) is that patients with pain only or pain and mild proprioceptive deficits make a predictably reliable recovery and surgery would be a rarity should signs be very chronic etc. Given that surgery is likely to do some damage to spinal stability (and this bunny potentially may have a lack of spinal stability to begin with) if it is simply a "decompressive" type of surgery, and distraction-fusion-style procedures are likley to be pretty complication-heavy in a rabbit I would guess... then cage rest until things settle down sounds the most practical approach to me.

If there are congenital spinal instability issues (I'm not saying there are), then any spinal cord compression may be dynamic (like in "wobblers" or lumbosacral degenerative stenosis or something) and an MRI might need to be done in flexed and extended positions to pick up on such dynamic compression.

Re compression of GI nerves - do these exit from thoracic vertebral foramina?

I think NSAIDs are fine for discs being managed conservatively in dogs (personal opinion), bit I do think that steroids are more analgesic in some dogs with chronic nerve compression (such as degenerative lumbosacral stenosis)

Re: Rabbit spinal lesion

Marie Kubiak — Sat, 27 Sep 2014 15:09:48 GMT

[quote user="John Flynn"]hving never looked at spinal xrays from a rabbit before i really shouldn't be commenting...[/quote]

Please feel free, mammal neurology is one of the areas I am well out of my comfort zone with and all input is very gratefully received.

Rabbit thoracic spines always look a bit irregular to me but usually only the cranial bit and from T4 backwards they then appear more regular with even spacing. So this is definitely odd.

For comparison, these are 'normal' (though a bit small so detail may not be great)

My limited grasp of disc extrusions was that oedema and active reaction can be detected which then aids with determining significance and whether surgery is likely to help. To be honest I would expect this to be non-surgical- I'm assuming that given the chronicity changes are not likely to be acute and reversible. There may be some neuro compromise with mild HL ataxia (difficult to gauge in a hunched up, quiet rabbit in the hospital but O feels there is a subtle change at home) and apparent pain (or compression of GI nerves??) affecting demeanour and GI motility.

Glucocorticoids are generally contraindicated given the detrimental effects on GI function. Unless an immune-mediated component is present I am unsure how these would be of benefit compared to the safer NSAIDs available. I though glucocorticoids had been associated with negative outcomes with CNS trauma and were not recommended? Or is there a benefit I'm missing?

Marie

Re: Rabbit spinal lesion

John Flynn — Fri, 26 Sep 2014 23:04:23 GMT

hving never looked at spinal xrays from a rabbit before i really shouldn't be commenting...

nevertheless :

if there are no neurological issues noted, then presumably the presumptive lesion could, at worst, be a low-grade spinal-cord compression causing pain and thus anorexia etc.

Is the thoracic region of a rabbit generally mobile or not? how does this set of thoracic vertebrae compare to other rabbit rads?

Advanced imaging may demonstrated spinal cord compression, but is this likely to change anything? It still wouldn;t prove that this was the source of the clinical syndrome (I suspect significant spinal cord compression can be present without clinical signs?) perhaps more helpfully would be an absence of any spinal cord compression, but then that would jsut encourage to hunt further for another problem, so same resources for the MRI could be used for that "hunt" anyway?

If no neurological impairment, then I'd be surprised if surgery was the treatment of choice even if significant spinal cord compression demosntrated.

Antoher question out of interest: can you give rabbits prednisolone or other glucocorticoids?

Re: Rabbit spinal lesion

Marie Kubiak — Fri, 26 Sep 2014 21:24:40 GMT

I've been on holiday this week, but no panicked phone calls/emails from other vets as yet though which is usually a good sign. I'm sure I'll receive a call from the owner on Monday and will let you know how things are going. I offered advanced imaging before I went away but costs were off-putting for the owner and since she was not keen on surgical intervention then the imaging may not change management drastically anyway.

Marie

Re: Rabbit spinal lesion

Chris Allen — Fri, 26 Sep 2014 21:15:25 GMT

Totally curious here as to if there has been any updates?

Re: Rabbit spinal lesion

Marie Kubiak — Sat, 20 Sep 2014 19:33:31 GMT

[quote user="Evelyn Barbour-Hill"]

This is a genuine question, this is really not my field, but would trial therapy with NSAID be a reasonable alternative?

[/quote]

He's been on metacam for a couple of weeks, based on O's description that he seems uncomfortable, to no avail. Have also started tramadol and gabapentin in last 48hrs and will see if they bring any further benefit.

Marie

Re: Rabbit spinal lesion

Evelyn Barbour-Hill — Sat, 20 Sep 2014 18:08:17 GMT

[quote user="Marie Kubiak"]

Thank you. I have recommended MRI to see if there is anything further that can be done. We'll see if they go for it...

Marie

[/quote]

This is a genuine question, this is really not my field, but would trial therapy with NSAID be a reasonable alternative?

Re: Rabbit spinal lesion

Marie Kubiak — Sat, 20 Sep 2014 17:15:41 GMT

Thank you. I have recommended MRI to see if there is anything further that can be done. We'll see if they go for it...

Marie

Re: Rabbit spinal lesion

Evelyn Barbour-Hill — Sat, 20 Sep 2014 12:40:31 GMT

Not my field at all but I can't resist.... vertebrae from T4 to T9 all seem to show varying degrees of displacement and deformity. Not sure about T1-3.

If this were a cat or dog I'd be saying "There's your problem, squire....."

Re: Rabbit spinal lesion

Chris Allen — Sat, 20 Sep 2014 11:50:29 GMT

I'm only a student but there is definately something there, on DV almost reminds me of hemivertebra... Definate narrowing of intervertebral space as well.

Re: Rabbit spinal lesion

Kirsten Simpson — Sat, 20 Sep 2014 10:16:54 GMT

I agree that most of the cranial thoracic spine looks very odd! Higgeldy piggeldy and not lining up. Congenital problem? Narrowed disc spaces?

Re: Rabbit spinal lesion

Marie Kubiak — Sat, 20 Sep 2014 08:35:29 GMT

Any thoughts anyone? I'm contemplating MRI scan but am reluctant to suggest this without being more confident that it is the right thing to do. The rabbit belongs to a very intense owner who no doubt will be on the phone this morning and I'm still unsure which way to go!

Marie