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1.
OBJECTIVE: To describe an intraoperative ultrasound imaging technique during dorsal laminectomy in 2 dogs with caudal cervical vertebral instability and malformation (CCVIM, "Wobbler syndrome"). STUDY DESIGN: Clinical case report. SAMPLE POPULATION: Two dogs with CCVIM. RESULTS: On neurologic examination there was tetraparesis with upper motor neuron signs in the thoracic limbs and lower motor neuron signs in the pelvic limbs in dog 1, and hyperreflexia of the rear limbs, normoreflexia of the right front limb, and hyporeflexia of the left front limb of dog 2. Both dogs had signs of marked cervical pain and radiographic signs of cervical spinal cord compression. Intraoperative ultrasonography of the spinal cord revealed protruding intervertebral disc at C5-6 (dog 1) and C6-7 (dog 2), and the parallel borders of the spinal cord and central canal after decompression. Continuous dorsal laminectomy (CDL) resulted in improvement over 16 months (dog 1) and 20 months (dog 2). CONCLUSIONS: Intraoperative ultrasonographic imaging of the cervical spinal cord after CDL was helpful in determining adequate decompression (postlaminectomy) of the spinal cord in relation to the ventral and lateral compressive component(s) and to image the protruding intervertebral disc. CLINICAL RELEVANCE: Intraoperative ultrasonography can be used to provide valuable information on the spinal cord and surrounding soft tissues for the neurosurgeon.  相似文献   

2.
Triple adjacent thoracolumbar disc protrusions causing moderate to severe spinal cord compression were diagnosed by magnetic resonance imaging in two German shepherd dogs with marked paraparesis and pelvic limb ataxia. Both cases were managed by selective hemilaminectomy, partial annulectomy and bilateral quadruple vertebral body stabilisation using novel canine locking fixation plates (SOP). The stabilisation of multiple vertebrae in the thoracolumbar spine was possible because the plates could be contoured with six degrees of freedom. Spinal pain resolved and neurological function improved in both dogs. Screw breakage was evident in one dog five months following surgery.  相似文献   

3.
Five young Shiloh Shepherd Dogs (4 males and 1 female) related by a common sire were studied because of progressive pelvic limb weakness and incoordination. All dogs had a spastic paraparesis and pelvic limb ataxia consistent with an upper motor neuron and general proprioceptive lesion between spinal cord segments T3 and L3. Proliferative lesions involving one or more of the articular processes from the 11th thoracic vertebrae to the 2nd lumbar vertebra were observed on radiographs of the thoracolumbar vertebrae. Dorsal compression of the spinal cord was identified during imaging studies at these sites. Abnormalities of the synovial joints and bony proliferation of the involved articular processes were identified at postmortem examination in 2 dogs. The articular processes and associated vertebral arches protruded into the vertebral canal, indenting the dorsal surface of the spinalcord. Degenerative joint disease (DJD) was identified histologically. A compressive myelopathy was diagnosed in the spinal cord. These dogs were affected by a compressive myelopathy as a consequence of vertebral process DJD that likely has a geneticcomponent. The DJD could have been caused by a primary vertebral malformation or an injury to the processes at a young age causing malarticulation.  相似文献   

4.
OBJECTIVE: To compare morphologic and morphometric features of the cervical vertebral column and spinal cord of Doberman Pinschers with and without clinical signs of cervical spondylomyelopathy (CSM; wobbler syndrome) detected via magnetic resonance imaging (MRI). ANIMALS: 16 clinically normal and 16 CSM-affected Doberman Pinschers. PROCEDURES: For each dog, MRI of the cervical vertebral column (in neutral and traction positions) was performed. Morphologically, MRI abnormalities were classified according to a spinal cord compression scale. Foraminal stenosis and intervertebral disk degeneration and protrusion were also recorded. Morphometric measurements of the vertebral canal and spinal cord were obtained in sagittal and transverse MRI planes. RESULTS: 4 of 16 clinically normal and 15 of 16 CSM-affected dogs had spinal cord compression. Twelve clinically normal and all CSM-affected dogs had disk degeneration. Foraminal stenosis was detected in 11 clinically normal and 14 CSM-affected dogs. Vertebral canal and spinal cord areas were consistently smaller in CSM-affected dogs, compared with clinically normal dogs. In neutral and traction positions, the intervertebral disks of CSM-affected dogs were wider than those of clinically normal dogs but the amount of disk distraction was similar between groups. CONCLUSIONS AND CLINICAL RELEVANCE: The incidence of intervertebral disk degeneration and foraminal stenosis in clinically normal Doberman Pinschers was high; cervical spinal cord compression may be present without concurrent clinical signs. A combination of static factors (ie, a relatively stenotic vertebral canal and wider intervertebral disks) distinguished CSM-affected dogs from clinically normal dogs and appears to be a key feature in the pathogenesis of CSM.  相似文献   

5.
O bjectives : To describe the clinical and magnetic resonance imaging features of cervical vertebral malformation-malarticulation in Bernese mountain dogs.
M ethods : Seven Bernese mountain dogs (four males and three females) were diagnosed with cervical vertebral malformation-malarticulation by magnetic resonance imaging. The following data were evaluated retrospectively: (1) abnormalities of the cervical vertebral column and spinal cord, (2) spinal cord compression, (3) intervertebral disc degeneration and herniation, (4) severity of clinical signs pretreatment and after treatment, (5) type of treatment and (6) outcome.
R esults : Spin echo T1-weighted and T2-weighted images disclosed multi-level, extradural compressive spinal cord lesions (ventral, dorsolateral or both) spanning from intervertebral disc spaces C3-4 to C6-7. In all seven dogs, T2-weighted images disclosed one or more intramedullary hyperintensities associated with extradural spinal cord compression. Surgery was performed in five dogs. Two dogs were managed medically. The prognosis for surgical or conservative management in Bernese mountain dogs was similar to cervical vertebral malformation-malarticulation in other breeds.
C linical S ignificance : Cervical vertebral malformation-malarticulation is an important differential diagnosis for young to middle-aged Bernese mountain dogs with a C1-5 or C6-T2 neuroanatomic localisation. Dorsolateral spinal cord compression associated with articular process hypertrophy was the most common feature of cervical vertebral malformation-malarticulation in the seven Bernese mountain dogs evaluated.  相似文献   

6.
Objectives : To evaluate the results of hemilaminectomy and vertebral stabilisation (+/? annulectomy) for the treatment of thoracolumbar disc protrusion. Methods : The medical records of dogs with thoracolumbar annular protrusions treated by hemilaminectomy and vertebral stabilisation were reviewed. Neurological function was assessed 24 hours following surgery. Long‐term follow‐up was by clinical examination or telephone questionnaire. Results : Twenty‐eight dogs fulfilled the criteria. Age ranged from 4 to 12·5 years (median 8 years, mean 7·7 years), bodyweight from 5·1 to 51·5 kg (median 28 kg, mean 27·1 kg), and duration of neurological signs before presentation from 48 hours to 104 weeks (median 5 weeks, mean 9·3 weeks). At presentation 22 dogs were ambulatory and six were non‐ambulatory. Myelography and/or magnetic resonance imaging (MRI) identified 31 thoracolumbar protrusions causing spinal cord compression. Unilateral hemilaminectomy was performed in 27 dogs and bilateral hemilaminectomy in one dog. Partial annulectomy was performed in 24 of 31 protrusions. Stabilisation was performed using vertebral body bone plates in 26 dogs and vertebral body screws and bone cement in two dogs. Internal vertebral venous plexus haemorrhage was recorded in nine dogs. A screw was inadvertently placed into an intervertebral disc in two dogs. Neurological examination 24 hours postoperatively revealed deterioration in pelvic limb motor function in 17 dogs. One dog was euthanatised at the owner’s request 6 days after surgery. Long‐term evaluation of 24 cases was performed 3 to 52 months following surgery (median 21 months, mean 23·9 months). Six dogs had improved from their preoperative status and one had deteriorated as assessed by the authors. Fifteen dogs had improved from their preoperative status and two were unchanged as assessed by owners. Clinical Significance : Hemilaminectomy and vertebral stabilisation are an effective treatment for chronic spinal cord compression due to thoracolumbar annular protrusion in dogs. A temporary deterioration in neurological function is not uncommon following surgery. Internal vertebral plexus haemorrhage and inappropriate vertebral body screw placement are potential complications.  相似文献   

7.
Congenital vertebral malformations are common in brachycephalic “screw‐tailed” dog breeds such as French bulldogs, English bulldogs, Boston terriers, and pugs. The aim of this retrospective study was to determine whether a radiographic classification scheme developed for use in humans would be feasible for use in these dog breeds. Inclusion criteria were hospital admission between September 2009 and April 2013, neurologic examination findings available, diagnostic quality lateral and ventro‐dorsal digital radiographs of the thoracic vertebral column, and at least one congenital vertebral malformation. Radiographs were retrieved and interpreted by two observers who were unaware of neurologic status. Vertebral malformations were classified based on a classification scheme modified from a previous human study and a consensus of both observers. Twenty‐eight dogs met inclusion criteria (12 with neurologic deficits, 16 with no neurologic deficits). Congenital vertebral malformations affected 85/362 (23.5%) of thoracic vertebrae. Vertebral body formation defects were the most common (butterfly vertebrae 6.6%, ventral wedge‐shaped vertebrae 5.5%, dorsal hemivertebrae 0.8%, and dorso‐lateral hemivertebrae 0.5%). No lateral hemivertebrae or lateral wedge‐shaped vertebrae were identified. The T7 vertebra was the most commonly affected (11/28 dogs), followed by T8 (8/28 dogs) and T12 (8/28 dogs). The number and type of vertebral malformations differed between groups (P = 0.01). Based on MRI, dorsal, and dorso‐lateral hemivertebrae were the cause of spinal cord compression in 5/12 (41.6%) of dogs with neurologic deficits. Findings indicated that a modified human radiographic classification system of vertebral malformations is feasible for use in future studies of brachycephalic “screw‐tailed” dogs.  相似文献   

8.
OBJECTIVE: To evaluate use of transcranial magnetic motor evoked potentials for assessment of the functional integrity of the cervical spinal cord in large-breed dogs with cervical spinal cord disease. DESIGN: Randomized, controlled, masked study. ANIMALS: 10 healthy large-breed control dogs and 25 large-breed dogs with cervical spinal cord diseases. PROCEDURE: Affected dogs were allocated to 3 groups on the basis of neurologic status: signs of neck pain alone, ambulatory with ataxia in all limbs, or nonambulatory. Transcranial magnetic stimulation was performed on each dog with the same standard technique. Motor evoked potentials (MEP) were recorded from electrodes inserted in the tibialis cranialis muscle. Following the procedure, each dog was anesthetized and cervical radiography, CSF analysis, and cervical myelography were performed. The MEP latencies and amplitudes were correlated with neurologic status of the dogs after correction for neuronal path length. RESULTS: Mean MEP latencies and amplitudes were significantly different between control dogs and dogs in each of the 3 neurologic categories, but were not significantly different among dogs in the 3 neurologic categories. A linear association was evident between MEP latencies and amplitudes and severity of neurologic deficits; the more severe the neurologic deficits, the more prolonged the latencies and the more decreased the amplitudes. CONCLUSIONS AND CLINICAL RELEVANCE: Transcranial magnetic MEP are useful to assess severity of cervical spinal cord disease in large-breed dogs. Impairment of the functional integrity of the cervical spinal cord was found even in dogs with neck pain alone.  相似文献   

9.
A bilateral and symmetrical neuronal vacuolation associated with spinal cord white matter degeneration and laryngeal neuropathy was observed in a 12-week-old male mixed-breed dog with a history of progressive pelvic limbs ataxia. On clinical examination, signs included inspiratory stridor, spinal ataxia, tetraparesis, and proprioceptive deficits more severe in the pelvic limbs. Examination of the larynx showed bilateral laryngeal paralysis and electromyography revealed fibrillation potentials restricted to the intrinsic laryngeal muscles. Clinical and pathological findings resembled the syndrome of neuronal vacuolation and spinocerebellar degeneration described in Rottweiler dogs. This is the first report of a similar disorder in a dog different from Rottweiler.  相似文献   

10.
Objective— To describe diagnostic findings, surgical technique, and outcome in dogs with thoracic spinal canal stenosis and vertebral instability secondary to congenital vertebral anomalies.
Study Design— Retrospective clinical study.
Animals— Dogs (n=9) with thoracic spinal canal stenosis.
Methods— Medical records (1995–1996; 2000–2006) of 9 dogs with a myelographic diagnosis of spinal canal stenosis and/or vertebral instability secondary to congenital vertebral anomaly that were surgically managed by vertebral stabilization with or without laminectomy were reviewed. Data on pre- and postoperative neurologic status, diagnostic findings, surgical techniques, and outcomes were retrieved. Follow-up evaluations were performed at 1, 2, and 6 months. Long-term outcome was assessed by means of clinical examination or owner telephone interviews.
Results— Spinal cord compression was confirmed by myelography, and in 2 dogs, dynamic compression by stress myelography. Eight dogs regained the ability to ambulate postoperatively. One dog with a partial recovery regained voluntary movement but did not become ambulatory.
Conclusions— Spinal cord injury secondary to congenital vertebral anomaly may have a good outcome when treated by vertebral stabilization with or without laminectomy. Adequate stabilization of the vertebrae and improved neurologic outcome were achieved in most dogs.
Clinical Relevance— Vertebral stabilization using positively threaded profile pins and polymethylmethacrylate with or without laminectomy is an effective treatment for spinal canal stenosis and vertebral instability secondary to congenital thoracic vertebral anomalies.  相似文献   

11.
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12.
OBJECTIVE: To evaluate progression of clinical signs and magnetic resonance imaging (MRI) findings in dogs with cervical spondylomyelopathy (wobbler syndrome) treated medically or surgically. DESIGN: Prospective cohort study. ANIMALS: 12 Doberman Pinschers. PROCEDURES: Neurologic examinations and MRI were performed before medical (n = 9) or surgical treatment (ventral slot, 3) and a minimum of 12 months later. RESULTS: Mean follow-up time was 14.5 months. Clinically, 2 dogs improved after surgical treatment and 5 improved after medical treatment. Magnetic resonance imaging of surgically treated dogs revealed adequate spinal cord decompression. Spinal cord signal changes were seen in 2 dogs before surgery, both of which had new signal changes at the same and adjacent sites during follow-up examination. One dog treated surgically developed 3 new areas of spinal cord compression. In the medically treated dogs, the severity of spinal cord compression at the time of follow-up examination was unchanged in 4 dogs, worse in 2 dogs, and improved in 3 dogs, but spinal cord atrophy was observed on transverse images. Four medically treated dogs had changes in spinal cord signal initially, but none developed new signal changes or compressions. CONCLUSIONS AND CLINICAL RELEVANCE: Medical and surgical treatment improved or stabilized the clinical condition of most dogs. Surgical treatment appeared to hasten the development of additional areas of spinal cord compression and lesions in dogs with preoperative cord changes; however, the clinical importance of these changes was not determined. The progression of pathologic MRI abnormalities was notably less in medically treated dogs, compared with surgically treated dogs.  相似文献   

13.
Spinal cord dysfunction secondary to spinal arachnoid cysts (SACs) has been reported previously in dogs. This retrospective study reviews the clinical signs, radiographic findings, and outcome after surgical resection of SACs in 14 dogs. Plain vertebral column radiographs and myelography were done in all dogs. Computed tomography (CT) was done in 7 dogs and magnetic resonance (MR) imaging in 3 dogs. Affected dogs were between 1 and 12 years of age, and 8 of 14 were Rottweilers. Abnormalities detected on neurological examination depended on the location of the SAC. Five dogs had bilobed or multiple SACs. SACs were located in the cervical vertebral column in 11 dogs and in the thoracic vertebral column in 4 dogs. All dogs had dorsally or dorsolaterally located SACs. Two dogs also had additional ventrally located SACs. Spinal cord compression secondary to intervertebral disc extrusion or protrusion was demonstrated at the site of the SACs in 2 dogs. Surgical resection of the SACs was completed in all dogs. Eleven dogs were available for follow-up. Five weeks postoperatively, 7 dogs improved in neurological function, with some residual ataxia and paresis in 6 of these dogs. Neurological function had deteriorated in 4 dogs. It was concluded from this study that Rottweilers have a higher incidence of SACs than other breeds of dog. Furthermore, bilobed or multiple SACs can occur commonly, and myelography effectively localized SACs in dogs. Surgical resection of SACs resulted in improvement in neurological function in the majority of treated dogs.  相似文献   

14.
Spinal arachnoid pseudocysts in 10 rottweilers   总被引：1，自引：0，他引：1  
Ten rottweilers presenting with spinal arachnoid pseudocysts were investigated. In six dogs, the lesions were localised dorsally at C2-C3; in three dogs, dorsally and ventrally at C5-C6; and, in one dog, dorsally and ventrally at C6-C7. Clinical signs were consistent with focal compression of the affected spinal cord segments. The animals showed ataxia of all four limbs, with truncal ataxia and marked hypermetria in cases of C2-C3 involvement, or ambulatory tetraparesis in cases of C5-C6 or C6-C7 involvement. Other than signs indicative of spina bifida in one dog, no abnormalities could detected on plain radiographs. Myelography was used to define the localisation and extent of the pseudocysts. Additional information was obtained using magnetic resonance imaging in five dogs. Five dogs underwent a dorsal laminectomy; in three cases, the pseudocyst was treated by marsupialisation and, in two, by durectomy.  相似文献   

15.
CASE DESCRIPTION: A 1-year-old female spayed Labrador Retriever was admitted for evaluation of a progressive gait disturbance characterized by tetraparesis and general proprioceptive ataxia in all limbs. CLINICAL FINDINGS: Neurologic examination suggested a dysfunction of the C6-T2 spinal cord segments, which was slightly worse on the right side. Discomfort was suspected upon lateral flexion of the neck. Two magnetic resonance imaging (MRI) examinations at a 3-week interval revealed an intramedullary fluid-filled cavitary lesion adjacent to C7, containing a blood clot. TREATMENT AND OUTCOME: Following unsuccessful initial conservative management, surgical marsupialization of the lesion was performed through a dorsal laminectomy, durotomy, and myelotomy at C6 and C7. Histologic evaluation including immunohistochemistry was diagnostic for a vascular anomaly. Initially, the dog was nonambulatory with tetraparesis and became tetraplegic after surgery; movement was regained 6 days later. Four weeks after the procedure, the dog was able to walk unassisted. One year after surgery, the dog was actively running and jumping, with mild residual ataxia in the pelvic limbs. CLINICAL RELEVANCE: The intramedullary vascular anomaly in this dog was successfully treated with a surgical marsupialization technique. The combination of MRI, histologic evaluation, and immunohistochemistry enabled lesion localization, evaluation of cavity content, and final diagnosis.  相似文献   

16.
Objective— To report clinical signs, diagnostic and surgical or necropsy findings, and outcome in 2 calves with spinal epidural abscess (SEA). Study Design— Clinical report. Animals— Calves (n=2). Methods— Calves had neurologic examination, analysis and antimicrobial culture of cerebrospinal fluid (CSF), vertebral column radiographs, myelography, and in 1 calf, magnetic resonance imaging (MRI). A definitive diagnosis of SEA was confirmed by necropsy in 1 calf and during surgery and histologic examination of vertebral canal tissue in 1 calf. Results— Clinical signs were difficulty in rising, ataxia, fever, apparent spinal pain, hypoesthesia, and paresis/plegia which appeared 15 days before admission. Calf 1 had pelvic limb weakness and difficulty standing and calf 2 had severe ataxia involving both thoracic and pelvic limbs. Extradural spinal cord compression was identified by myelography. SEA suspected in calf 1 with discospondylitis was confirmed at necropsy whereas calf 2 had MRI identification of the lesion and was successfully decompressed by laminectomy and SEA excision. Both calves had peripheral neutrophilia and calf 2 had neutrophilic pleocytosis in CSF. Bacteria were not isolated from CSF, from the surgical site or during necropsy. Calf 2 improved neurologically and had a good long‐term outcome. Conclusion— Good outcome in a calf with SEA was obtained after adequate surgical decompression and antibiotic administration. Clinical Relevance— SEA should be included in the list of possible causes of fever, apparent spinal pain, and signs of myelopathy in calves.  相似文献   

17.
OBJECTIVE: To describe a thermographic imaging protocol, identify normal thermographic patterns (ie, color map reflecting the skin temperature distribution) for various regions of interest (ROIs) of dog limbs, and evaluate effects of clipping the coat on thermographic patterns and limb temperature in healthy dogs. ANIMALS: 10 healthy dogs. PROCEDURES: Each dog was thermographically evaluated in the same room (ambient temperature, 21 degrees C) via ROIs that included cranial and caudal views of the body, full lateral body views, full views of the limbs, and views of various limb regions. After initial imaging, the coat was clipped on the forelimbs and hind limbs only. Each dog was then evaluated 15 and 60 minutes and 24 hours after clipping by use of the same protocol. RESULTS: For each ROI within a category (intact coat and each time point after clipping), mean temperatures were similar among the 10 dogs. Pairwise comparisons for 15 and 60 minutes and 24 hours established patterns of temperature stabilization among the 3 time points. Temperatures did not differ significantly between the left and right limbs. There was a mean success rate of 75% for use of image pattern analysis for recognition of similar thermographic patterns in the forelimbs and hind limbs. CONCLUSIONS AND CLINICAL RELEVANCE: Thermography can be a viable, noninvasive imaging modality that provides consistent images with reproducible thermal patterns in ROIs examined in healthy dogs. Although the coat had a predictable influence to decrease the mean temperature, thermal patterns remained fairly consistent after the coat was clipped.  相似文献   

18.
Cervical intervertebral disc protrusion in two horses   总被引：2，自引：1，他引：1  
Two horses with ataxia of all four limbs were found to have cervical intervertebral disc protrusion. Severe pelvic limb ataxia, proprioceptive deficits and spasticity were present in both horses with similar but less severe signs in the thoracic limbs. Cerebrospinal fluid analysis was within normal limits. Metrizamide myelography allowed definitive diagnosis in one case when a compression of the spinal cord was demonstrated at the level of the second intervertebral space. In the second case, an intervertebral disc protrusion between cervical vertebrae 6 and 7 was found at necropsy. Fiber degeneration with poor myelin staining characterized the spinal cords histologically.  相似文献   

19.
BACKGROUND: Adult dogs with degenerative myelopathy (DM) have progressive ataxia and paresis of the pelvic limbs, leading to paraplegia and euthanasia. Although most commonly reported in German Shepherd dogs, high disease prevalence exists in other breeds. OBJECTIVE: Our aim was the clinical and histopathologic characterization of familial degenerative myelopathy (FDM) in Pembroke Welsh Corgi (PWC) dogs. ANIMALS: Twenty-one PWCs were prospectively studied from initial diagnosis until euthanasia. METHODS: Neurologic examination, blood tests, cerebrospinal fluid (CSF) analysis, electrodiagnostic testing, and spinal imaging were performed. Concentrations of 8-iso-prostaglandin F2alpha (8-isoprostane) were measured in CSF. Routine histochemistry was used for neuropathology. Deoxyribonucleic acid and pedigrees were collected from 110 dogs. RESULTS: Median duration of clinical signs before euthanasia was 19 months. Median age at euthanasia was 13 years. All dogs were nonambulatory paraparetic or paraplegic, and 15 dogs had thoracic limb weakness at euthanasia. Electrodiagnostic testing and spinal imaging were consistent with noncompressive myelopathy. No significant difference was detected in 8-isoprostane concentrations between normal and FDM-affected dogs. Axonal and myelin degeneration of the spinal cord was most severe in the dorsal portion of the lateral funiculus. Pedigree analysis suggested a familial disease. CONCLUSIONS AND CLINICAL IMPORTANCE: Clinical progression of FDM in PWC dogs was similar to that observed in other breeds but characterized by a longer duration. Spinal cord pathology predominates as noninflammatory axonal degeneration. Oxidative stress injury associated with 8-isoprostane production is not involved in the pathogenesis of FDM-affected PWC dogs. A familial disease is suspected.  相似文献   

20.
Using a signal-averaging system, potentials evoked by stimulation of nerves in the limbs or tail of dogs were recorded through needle electrodes placed adjacent to the vertebral column. Cord dorsum potentials (consisting of a small triphasic wave followed by a large negative peak and a subsequent slow positive phase) were recorded at the level of the lumbar enlargement after stimulating nerves in the pelvic limb or tail, and at the cervical enlargement after forelimb nerve stimulation. Ascending volleys were recorded from appropriate levels of the spinal cord or from regions of the cauda equina. After forelimb nerve stimulation, a large slow potential, reflecting activation of an unidentified neuronal pool, was recorded at the level of the first cervical vertebra. Percutaneously recorded potentials were closely similar to those recorded directly from the dura mater, suggesting that the method accurately recorded spinal cord electrical events and, therefore, might be of use in studying clinical or experimental spinal cord disease.  相似文献   

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