Clinical reasoning in feline spinal disease: which combination of clinical information is useful?

Abstract

Objectives The aim of this study was to evaluate if a combination of discrete clinical characteristics can be used to identify the most likely differential diagnoses in cats with spinal disease. Methods Two hundred and twenty-one cats referred for further evaluation of spinal disease were included and categorised as follows: non-lymphoid neoplasia (n = 44); intervertebral disc disease (n = 42); fracture/luxation (n = 34); ischaemic myelopathy (n = 22); feline infectious peritonitis virus myelitis (n = 18); lymphoma (n = 16); thoracic vertebral canal stenosis (n = 11); acute non-compressive nucleus pulposus extrusion (n = 11); traumatic spinal cord contusion (n = 8); spinal arachnoid diverticula (n = 7); lumbosacral stenosis (n = 5); and spinal empyema (n = 3). Information retrieved from the medical records included signalment, clinical history and clinical presentation. Univariate analyses of variables (clinical history, breed, age, sex, general physical examination findings, onset, progression, spinal hyperaesthesia, asymmetry, ambulatory status and neuroanatomical location) were performed, and variables were retained in a multivariate logistic regression model if P <0.05. Results Multivariate logistic regression revealed that intervertebral disc disease most often occurred in middle-aged, purebred cats with a normal general physical examination and an acute onset of painful and progressive clinical signs. Ischaemic myelopathy occurred most often in older cats with a stable or improving, non-painful, lateralising, C6–T2 myelopathy. Spinal fracture/luxation occurred most often in younger cats and resulted most often in a peracute onset, painful, non-ambulatory neurological status. Concurrent systemic abnormalities or abnormal findings detected on general physical examination were significantly associated with feline infectious peritonitis virus myelitis, spinal lymphoma or spinal empyema. Conclusions and relevance This study suggests that using easily identifiable characteristics from the history and clinical examination can assist in obtaining a preliminary differential diagnosis when evaluating cats with spinal disease. This information could aid veterinary practitioners in clinical decision-making.

Thoracic vertebral canal stenosis in cats: clinical features, diagnostic imaging findings, treatment and outcome

“…Thoracic vertebral canal stenosis is poorly characterised despite being a common cause of spinal disease in the cat. 3 This study demonstrated TVCS to be most frequent in middle-aged to older male neutered cats presenting with a chronic, progressive, painful T3–L3 myelopathy. Imaging studies typically demonstrated dorsoventral spinal cord compression and ISI changes in the absence of a marked anatomical abnormality.…”

“…1,2 However, a more recent study indicated that non-lymphoid neoplasia and intervertebral disc disease were also common causes of spinal disease in cats. 3 Thoracic vertebral canal stenosis (TVCS) was recently documented to be among the 10 most common causes of spinal disease in the cat, 3 and a recent report described the successful surgical management of two cats with articular process hypertrophy causing TVCS. 4 However, there is little known about the clinical presentation, imaging findings and outcome of cats with this disease.…”

Clinical reasoning in canine vestibular syndrome: Which presenting factors are important?

“…This decision‐making process directs the clinician towards taking the most suitable action in a specific context and has been considered ‘critical and central to veterinary practice’ 11,12 . Previous studies have demonstrated the usefulness of clinical reasoning in a variety of common neurological presentations, including spinal disease and epilepsy in dogs and cats 13–16 . Although a recent study has evaluated associations between the clinical presentation, MRI findings and outcome in dogs with peripheral vestibular syndrome, 17 it is currently unclear if clinical reasoning can reliably be used to identify the most likely differential diagnoses in dogs with peripheral or central vestibular syndrome.…”

Vestibular syndrome in dogs: how to keep a level head

“…One of these new tools is clinical reasoning. The concept of clinical reasoning has been used in various disciplines of the human healthcare system for several decades, and it has recently found its way into veterinary medicine 2–4 . Although a strict definition of the concept does not yet exist, it can be explained as the process by which vets integrate multiple clinical and contextual factors, along with their own medical knowledge, to make decisions about the diagnoses, treatment options and prognoses of their patients 5,6 …”

“…The concept of clinical reasoning has been used in various disciplines of the human healthcare system for several decades, and it has recently found its way into veterinary medicine. [2][3][4] Although a strict definition of the concept does not yet exist, it can be explained as the process by which vets integrate multiple clinical and contextual factors, along with their own medical knowledge, to make decisions about the diagnoses, treatment options and prognoses of their patients. 5,6 In a paper summarised on p 226 of this issue of Vet Record, Harrison and colleagues provide a detailed overview of 239 dogs with vestibular syndrome, all retrospectively reviewed and statistically analysed for cues relating to signalment, disease progression and specific clinical signs and their association with the underlying diagnosis.…”