Case Selection- Spinal
The following guidance is most likely familiar reading for most veterinary surgeons, however it may be useful to have it convenient for reference when considering referral of orthopaedic cases. These notes are guidance on the likely common cases and obviously the less common causes have to be considered.
Spinal cases present with symptoms relative to the degree of cord compression/ injury in order of severity : from mild back or neck pain, through ataxia +/- placing reflex deficits, to recumbancy with voluntary movements, to recumbancy with no voluntary movement +/- urinary/ faecal incontinence +/- loss of superficial pain sensation +/- loss of deep pain sensation. A general guide is seek early advice and or referral.
This is a very basic guide to examining a suspect spinal case:
If the dog is walking but ataxic test for placing reflexes: knuckle the paws over individually so the dorsal surface touches the ground and the dog should immediately return the foot to a normal position. Compare the legs with each other both front & back, and left and right.
With the dog standing place a piece of A4 paper under the foot and slide the paper and foot laterally– the dog should move the foot back to centre to maintain its balance. Compare each leg in turn.
Palpate the spine for evidence of pain. Dogs with these mild symptoms should be assessed carefully as may progress rapidly to the following.
If the dog is recumbent or unable to rise on the hindlegs support the dog in a standing position and test the placing reflexes as above. Observe for voluntary movements of the limbs, they may be very weak and seen when a familiar person comes to see the dog. If there is voluntary movement in a spinal case there will be deep pain sensation present. These cases need urgent investigation and surgery and usually have a good prognosis for return to function if dealt with quickly.
If the dog is recumbent or unable to rise on the hind legs and no voluntary movements are present it is important to test for conscious pain sensation. The most important thing to assess is that the dog is consciously aware of the pain– ie it must turn its head to look at the stimulus or cry out or try to bite you.
The most common mistake is that when a strong pain stimulus is given to the foot the leg will withdraw as a reflex– this is NOT evidence of conscious pain sensation– this actually occurs more strongly if the spinal cord is completely cut. Test for superficial pain sensation first– do this by gently squeezing the base of the nail with a pair of haemostats. In stoical dogs compare to another normal area to assess the dogs normal response to give an idea of the response to be expected. If conscious pain sensation is present there is no need to test for deep pain. If there is no response to superficial stimulus apply the haemostats to the bone and test more strongly. If either superficial or deep pain sensation is present in paralysed cases they need urgent investigation and surgery, and often have a good prognosis for return to function if dealt with quickly.
If the dog is recumbent or unable to rise on the hindlegs, has no voluntary movements of the affected area and has no conscious response to deep pain sensation the prognosis is much poorer and most likely hopeless if present for >24-28hrs.
The key thing with spinal cases is early referral to provide the best chance of success.
Telephone advice can be given to veterinary surgeons when you feel it may be helpful, on 028 38 352585