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.
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.
