MORE ABOUT GIZMO

He was evaluated by a primary care veterinarian the following day and placed on 5 mg Prednisone orally every 12 hours (tapering schedule) and 50 mg Gabapentin orally every 8 hours. He was relinquished to the Animal Welfare League of Alexandria on 2/20/21 and referred to BVNS Springfield on 2/22/21.

Neurological Exam

• Normal cranial nerves

• Normal thoracic limb spinal reflexes

• Normal thoracic limb proprioception and placing responses

• Intact cutaneous trunci reflex

• Upper motor neuron pelvic limb spinal reflexes with absent proprioception and placing responses

• Intact superficial pain perception in all limbs and tail

• Perineal reflex present

• Thoracolumbar kyphosis

• Unable to stand in the pelvic limbs

• Severe paresis in the left pelvic limb with only weak hip flexion noted and plegic in the right pelvic limb

• Discomfort noted with palpation near the cranial lumbar spine with PS: ¼

Physical Exam Findings

• Mild tartar

• Abnormal dentation

• Bilateral grade I medially luxating patellas

Neurodiagnostic Results

• MRI

  : Performed on 3/2/21 identified a traumatic ventral subluxation of L3 relative to L2 causing moderate canal stenosis, moderate external cord compression, intrinsic cord injury processes, and regional inflammatory myositis. Fractures were noted on the right 10th and 13th ribs. Left renal infarcts were also identified.

Diagnosis

1. Traumatic ventral subluxation of L3 relative to L2 causing moderate canal stenosis, moderate external cord compression, intrinsic cord injury processes, and regional inflammatory myositis.

2. Traumatic right 10th and 13th rib fractures.

3. Left-sided, chronic, renal infarcts.

Surgery Performed by Dr. Jarboe

• 2.0 SOP stabilization with 2.0 self-tapping 14 mm screws (plate spanning caudal L1 to cranial L4).

• A large callous was encountered at the L2-L3 junction, indicating a more chronic fracture than initially presumed.

Outcome The following day, Gizmo showed improved mobility in his pelvic limbs and improved comfort. At his 2-week post-op recheck, he was walking in the pelvic limbs with mild paraparesis and proprioceptive ataxia. By four weeks post-op, he was walking normally. His 8-week post-op radiographs showed continued alignment of the SOP construct. Gizmo found a forever home with the BVNS Neurologist who first evaluated him, Dr. Barker, and her wife Carolina.

Prognosis

• Fair to good with spine stabilization, given the presence of superficial pain perception and improving voluntary motor movement in the pelvic limbs.

Take-Home Points

1. Sedated radiographs can help identify fractures, bone infections, and some bone and soft tissue cancers.

2. Spine subluxations and fractures often carry a good prognosis with spine stabilization when some degree of voluntary motor movement exists.

3. Bladder management is key for a non-ambulatory dog to reduce detrusor muscle injury and urinary tract infections.

4. For spine trauma with inflammation, consider non-steroidal anti-inflammatory medication or anti-inflammatory doses of corticosteroids, rather than immunosuppressant doses.

5. Minimally displaced spine fractures with pain perception can sometimes be managed medically with strict exercise restriction, physiotherapy, bladder management, analgesia, muscle relaxants, and NSAIDs or anti-inflammatory corticosteroids.