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

• Published in: Journal of feline medicine and surgery Vol. 22; no. 6; pp. 521 - 530
• Main Authors: Mella, Stephanie L, Cardy, Thomas JA, Volk, Holger A, De Decker, Steven
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01-06-2020
• Subjects: Animals; Cat Diseases - diagnosis; Cat Diseases - etiology; Cats - injuries; Clinical Reasoning; Diagnosis, Differential; Female; Male; Original; Retrospective Studies; Spinal Diseases - diagnosis; Spinal Diseases - etiology; Spinal Diseases - veterinary; Spinal Injuries - diagnosis; Spinal Injuries - etiology; Spinal Injuries - veterinary; intervertebral disc disease; Spinal disorder; neurology; feline infectious peritonitis; spinal lymphoma
• ISSN: 1098-612X; 1532-2750; 1532-2750
• DOI: 10.1177/1098612X19858447

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.