Mary Allen
After serious accidents – be it collisions with cars or falls from a great height – there are often spinal injuries.
First aid
First aid at the scene of the accident and transport decide on the fate of the animals: careless handling can finally destroy the spinal cord. The patients should therefore be transported on a surface that is as firm as possible (e.g. a board), if necessary even secured with adhesive tape or plasters. After stabilization and before the first neurological examination, the caregiver should provide information as to whether the patient was still standing or walking at the scene of the accident, and whether there was paralysis, lameness, or pain.
Examination in the clinic
By carefully palpating the animal, the region of special interest. Then it can also be X-rayed for orientation already attached to its base. For the detailed examination, it will be placed on an examination table so that the more specific tests can be carried out unaffected by the fixation.
Animals that are still able to stand are first assessed while standing: the sense of balance, position of the limbs, position and posture reflexes, and the ability to coordinate can be determined in this way.
Before examining the reflexes, spontaneous movements, proprioception, and corrective reactions of the four limbs are checked. Finally, the animal can be carefully checked using the table edge probe or careful wheelbarrow driving. Defects found can be localized very well with the help of the reflex tests.
Localization
The outcome of the neurological examination is by far the most important criterion for determining the location of the neurological damage and the prognosis. The damage to the spine in the X-ray image can be significantly overestimated or underestimated. Especially after the loss of muscle tone, a spinal injury can spontaneously reduce and appear normal, even though the spinal cord is completely destroyed.
The X-ray examination of the identified defect should always be carried out in two planes. Sometimes the overlays are so unfortunate that the serious injuries can be overlooked, as shown in the dorsoventral view above of the same dog. In the neurological examination, this animal showed severe deficits.
If the neurological deficits match the severity of the radiologically determined spinal injury, the prognosis is so poor that further therapy is pointless. These include dislocations and fractures with significant displacement as shown in the next figure. The spinal cord is regularly completely severed in these animals.
If the pain fibers have not yet been severed, a significant dislocation can still be successfully treated if it can be stabilized.
Therapy
In many cases, a significantly less traumatizing fixation is sufficient. This Carthusian cat had fallen off the roof and – on closer inspection – had fractured the last thoracic vertebra at the caudal endplate and the dorsal vertebral joints. She was no longer able to stand, showed exaggerated hind limb reflexes, but still showed pain reactions. The internal stabilization with two crossed Kirschner wires, which were placed as posteriorly as possible in the vertebral bodies under X-ray control because of the discrete fractured fragments, was supported by keeping the patient in a narrow cage for 6 weeks.
The bone fragments lying in the spinal canal could be removed by carefully opening the vertebral arches.
The caudal vertebral endplate of the thoracic vertebra can still be identified as a linear fragment in the lateral control X-ray.
The cat recovered well. After four years, she shows a completely physiological function of the bladder, rectum, and hind limbs. She even goes for a walk on her beloved roof with great pleasure.
However, it is not absolutely necessary to treat every spinal injury surgically, as long as it is stable enough on the one hand and has a sufficiently good self-healing tendency on the other. For example, cats that fall from a great height often suffer from a sacrum-iliac dislocation if they sit on the buttocks. Very often the pelvis itself is not fractured. However, it is shifted 1-3 cm cranial, the sacrum acts like a wedge.
There are often even eruptions from the facies auricularis of the sacrum (circle). They do not interfere with neurological status or healing. A prerequisite for this therapy with absolute cage rest for 4-6 weeks is of course a good neurological status including full control of the anus and bladder.