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SPINAL FRACTURE & STERNAL LUXATION

 

PRESENTATION:  3 ½ year intact male Rottweiler presented for hind limb paralysis.

HISTORY:  The patient was hit by a car and apparently walked home, then became paralyzed in the hind limbs.

PHYSICAL EXAMINATION: The patient was dyspneic, non-ambulatory and painful in the ventral chest and thoracolumbar region. Thoracic auscultation revealed reduced lung sounds. Neurologic exam revealed deep pain present in both hind limbs with withdrawal reflexes intact with some motor function present. Hematuria was noted.

 

DIAGNOSIS: Thoracic radiographs revealed pneumothorax and a fracture of the sternum between the 5th and 6th sternebrae. Contrast cystogram revealed an intact bladder. Survey spinal radiographs and myelogram documented a fracture of the dorsal spinous process of T13 without significant deviation of the contrast column or displacement of the vertebral bodies of T13 and L1.

TREATMENT: A hemicerclage wire was placed to re-align the sternebrae. A temporary thoracostomy tube was used intraoperatively to resolve the pneumothorax. Conservative management of the T13 dorsal spinous process fracture was initiated with injectable and oral steroid anti-inflammatory drugs.

OUTCOME: Dyspnea resolved postoperatively. Neurologically, the dog gradually improved on both hind limbs and was walking by 6 weeks after the trauma.

 

DISCUSSION: HBC patients require thorough physical examination to identify all injuries. Twenty  percent of patients with aspinalfracture/luxation have a second one, therefore complete spinal  radiographs are indicated, using care to avoid excessive movement.

If vertebral displacement reduces the diameter of the spinal canal more than 80% in lateral and  VD views, there is generally irreversible cord damage. Neurologic exam is crucial to determine  prognosis, since radiographs only reveal the status of spinal displacement at the time they are  taken. Spinal cord displacement could have been much greater during the trauma. Radiographs  must be interpreted in conjunction with neurologic examination.

Myelography is indicated if survey radiographs and neurologic exam findings do not correlate or  if herniated IV disc or bone fragments in the spinal canal are suspected. Stable spinal fractures in patients with voluntary motor function can be managed conservatively with cage rest and anti-inflammatory drugs.

 

 

 

 

 


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