Discospondylitis in a cat

This post will show you a cat that presented difficulties walking for several weeks without other expected signs of an infection. Is it that common to have an infection of the vertebral plates in cats? How different is discospondylitis in dogs versus in cats? How does it look to have an infection in the spine for a cat? How could you suspect the infection is in the spine? Why could a young cat refuse to jump or walk properly?

Discospondylitis is an infection of an intervertebral disc and its adjacent cartilaginous end plates and vertebral bodies. Discospondylitis is relatively common in dogs and it’s commonly from a bacterial infection and less often from a fungal microorganism. However, dyscospondylitis in cats seems to be less common as we can find scarce literature regarding this disease in the felines.

How does dyscospondylitis happens in cats?

Knowing the exact route of infection is generally not known on these cases. The most common suspected routes are haematogenous dissemination, migrant foreign bodies or direct extension of infected paravertebral structures.

In cats in particular, a previous history of a cat bite abscess and chronic gingivostomatitis, as well as the concomitant identification of endocarditis, are considered compatible with haematogenous spread. Other potential predisposing factors and infectious comorbidities include pyelonephritis, paraspinal abscess and respiratory tract infections.

Because the orgin of the infection is not always know, isolating the involving bacteria is not always easy neither. Ideally culture and sensitivity in order to isolate the organism will be the best way to find the right antibiotic, but it’s common to have negative results with urine and blood culture despites the animal having clear signs of infection.

The good news is that we know that the most common agents are  Enterococcus species, Clostridium perfringens, E coli and Staphylococcus species.

The arrival of these agents to the endplates produces an inflammatory response that leads to inflammation first but then destruction of the intervertebral disc and adjacent vertebral endplates. If the disease is not treated fast enough the infection can progress to spinal empyema or even spinal instability with secondary spinal cord compression.

So what will be the clinical presentation?

We will have a chronic presentation where the animal is not feeling that well,,,,Maybe not eating that well, a bit off color, but what is really important to recognize is that it will be painful!. And the pain might even be a bit diffuse as it’s possible to have more than 1 endplate affected. But one interesting thing is that Discospondylitis in cats has only been found in the thoracolumbar, lumbosacral and coccygeal vertebral column, with no reported instances of cervical discospondylitis.

ON this case, being a cat, the pain might not be as obvious as a dog right? SO here we have a patient that show pain because they’re not so keen to jump. Always ask these question to cat’s parents when you’re looking for signs of back pain: Is the cat now jumping in the chair before jumping on the table?

Interestingly, it seems that neurological deficits are a bit more common to be found in cats than in dogs including proprioceptive ataxia, paraparesis or paraplegia

ON THIS VIDEO you can see a cat that is weak. He walks a little bit and then decides to lie down. He’s actually tetraparetic: It’s clear the hind limbs are paretic but if you obsever carefully the front limbs are also paretic, even if the hoping seems normal. The spinal reflexes, withdrawal first and patellar after are normal.

How do we diagnose  discospondylitis?

Diagnosis of discospondylitis might not always be straight forward as adjunctive investigations, including haematology, serum biochemistry and urinalysis, do typically not reveal consistent abnormalities. Even CSF analysis is normal in a large number of canine and feline cases. Considering the variable and non-specific clinical presentation, imaging is critical in establishing a diagnosis of feline discospondylitis. What type of imaging, we could be lucky to see it on X-rays if it’s really advanced, otherwise we might need CT scan or even MRI.

SO How do you Treat discospondylitis? If many times you don’t have the bacteria involved on the infection?

The answer is that is difficult! Antibiotic treatment, even when it’s the right antibiotic, should be continued for at least 6 to 8 weeks.This should be broad-spectrum antibiotic, and pain relief. Fungal or algal discospondylitis has not yet been reported in cats, being a less described but possible aetiology of discospondylitis in dog. In fungal discospondylitis antifungals will be required. Amoxicillin–clavulanic acid or cephalosporins are considered reasonable standalone first-line antibiotics, with metronidazole, fluoroquinolones (such as marbofloxacin) and clindamycin being possible second-line antibiotics.

Overall, the outcomes are generally positive, with no long-term evidence of recurrence in cats with sustained antibiotic therapy for a median duration of 3 months.

Keep reading if you want to review the litterature.