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12 December 1999
Exogenous Spinal
FOCAL POINT Trauma: Clinical
★ Accurate clinical assessment and
immobilization of animals with
spinal trauma are important for
Assessment and
successful patient management.
Initial Management
KEY FACTS
Washington State University
■ Animals that are suspected of
having an unstable vertebral
Rodney S. Bagley, DVM Anthony J. Cambridge, BVMS
segment should be rigidly Michael L. Harrington, DVM, MS Rebecca L. Connors, LVT
immobilized as quickly as Gena M. Silver, DVM, MS Michael P. Moore, DVM, MS
possible.
ABSTRACT: Spinal trauma is a common cause of spinal cord dysfunction in dogs and cats.
■ Clinical assessment should
When the spine is subjected to exogenous injury, the resultant impact often causes vertebral
be done cautiously to avoid
fracture or luxation. Because each spinal injury is unique, treatment guidelines must be indi-
iatrogenic damage to the spinal vidualized. This article reviews clinical assessment and management of spinal trauma.
cord.
S
■ When a nervous system injury is pinal trauma, a common cause of spinal cord dysfunction in dogs and
suspected, a complete neurologic cats,1–8 can occur from exogenous or endogenous spinal injury. Interverte-
assessment is mandatory to bral disk extrusion remains the most common endogenous cause, whereas
determine the location and automobile-related injury is the most common exogenous cause. Falls, trauma
severity of nervous tissue from falling objects, and projectile damage are also common. External impacts
damage. often result in vertebral fracture, subluxation, or luxation. This articles focuses
on the clinical management and treatment of small animals with exogenous
■ Because vertebral fractures spinal injuries that result in vertebral fracture or luxation.
and subluxations can be subtle
and visually difficult to assess, PATHOPHYSIOLOGY
good-quality, well-positioned The pathophysiologic changes that occur in the spinal cord after external impact
radiographs are essential. have been reviewed.1–7 Briefly, there are two major injuries: the primary mechani-
cal injury and the resultant pathophysiologic sequelae or secondary injury. The
■ Methylprednisolone sodium primary injury usually includes shearing and disruption of axonal processes, nerve
succinate should be administered cell bodies, and supporting structures (e.g., glial cells, vascular elements), resulting
as soon as possible after an in physiologic or morphologic disruption of nervous impulses. Any change in the
animal has sustained spinal vertebral canal diameter may cause spinal cord displacement, compression, and in-
injury. creased intraspinal pressure. Nervous impulses in this area may be disrupted be-
cause of increasing pressure applied to the axons and nerves or from ischemia
caused by alteration in spinal cord blood flow or hemorrhage. These increased
pressures set in motion numerous pathophysiologic consequences, including is-
Compendium December 1999 20TH ANNIVERSARY Small Animal/Exotics
bral disk disease have de- TABLE I raphy, however, may not be
compressive surgery within Grading Scale for Assessing appreciated from a single im-
48 hours of losing deep pain Treatment of Spinal Injuriesa age. Because of the strong
sensation, they have approxi- paraspinal musculature, ver-
mately a 50% or greater Grade Condition tebrae can be displaced acute-
chance of walking eventual- 8 Normal ly at the time of injury and
ly.14 In contrast, we have found 7 Pain only subsequently pulled back to a
that animals that lose deep more normal position. This
6 Paresis (walking)
pain sensation after suffering possibility should be consid-
spinal trauma have consider- 5 Paresis (not walking) ered in patients with verte-
ably less than a 50% chance 4 Paraplegia (urination and deep pain sensation bral trauma when clinical
of recovery. If deep pain sen- intact) signs appear worse than that
sation has been lost for 48 3 Paraplegia (urination absent and deep pain suggested by radiography.
hours or longer, there is vir- sensation intact) Disturbances to adjacent soft
tually no chance of func- 2 Paraplegia (deep pain sensation absent <48 hr) tissue (e.g., paraspinal muscle
tional recovery. Further- 1 Paraplegia (deep pain sensation absent >48 hr) disruption, hematoma) may
more, if deep pain sensation provide radiographic clues to
aFrom
is absent in an animal with least to most severely injured. the location of injury. The
100% or greater displace- degree of displacement of the
ment of the vertebral canal, vertebral canal on radiographs
the prognosis for walking is is less important in determin-
hopeless (Figure 3). ing prognosis than is the de-
gree of neurologic impair-
DIAGNOSTIC TESTING ment.
If a vertebral injury is sus-
pected, survey radiographs of CORTICOSTEROID
the affected area should be THERAPY
taken before continuing the Corticosteroid therapy is
examination. Vertebral frac- an important adjunctive ther-
tures and subluxations can be apy for humans and animals
subtle and visually difficult to with spinal trauma.15–24 Ideal-
assess. Thus good-quality, ly, corticosteroids are admin-
well-positioned radiographs istered as soon as possible
are essential.11,12 Initial radio- Figure 3A after a spinal injury, either
graphic assessment of obvi- before or during radiographic
ous displacements of the ver- evaluation. A multicenter
tebrae can be done while the study in humans also sug-
animal is awake and immo- gested that methylpred-
bilized. Sedation may be nec- nisolone sodium succinate
essary in some animals; how- (MSS) administered up to 8
ever, it may influence the hours after spinal trauma was
results of further neurologic beneficial. 16 Experimental
examination. Animals should studies in small animals have
be sedated only after deter- suggested that after spinal
mining the extent and severi- trauma, the time frame in
ty of the trauma. which MSS is helpful may be
Survey radiographs pro- Figure 3B
less (possibly as little as 1
vide a static record of the po- hour).15–24 This information
sition of the vertebrae. In- Figure 3—(A) Survey radiograph of a dog that lacks deep pain suggests that recommenda-
formation regarding how sensation in the pelvic limbs. There is greater than 100% dis- tions in human trials regard-
extensive the displacement placement of the vertebral canal L3-4. (B) Sagittal T2-weight- ing the benefit of MSS may
of vertebrae was at the time ed magnetic resonance image of the same area. The spinal be too long, thus emphasiz-
cord has been severed at this location.
of injury and before radiog- ing the need to administer
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pancreatitis associated with intervertebral disk disease in the and Ms. Connors are associated with the Department of
dog. JAVMA 180:1443–1447, 1982.
Clinical Sciences, Washington State University, College
27. Toombs JP, Caywood DD, Lipowitz AJ, Stevens JB: Col-
onic perforation following neurosurgical procedures and cor- of Veterinary Medicine, Pullman, Washington. Drs. Bagley
ticosteroid therapy in four dogs. JAVMA 177:68–72, 1980. (Neurology and Internal Medicine), Harrington (Neurolo-
28. Hoerlein BF, Spano JS: Non-neurological complications fol- gy), and Moore are Diplomates of the American College
lowing decompressive spinal cord surgery. Arch Am Coll Vet of Veterinary Internal Medicine. Dr. Silver is a resident in
Surg 4:11–16, 1975. neurology and neurosurgery. Dr. Cambridge is a resident
29. Siemering GB: High dose methylprednisolone sodium succi- in surgery. Ms. Connors is a neurology veterinary techni-
nate: An adjunct to surgery for canine intervertebral disc
cian.
herniation. Vet Surg 21:406, 1992.