Spinal Trauma

Re: Spinal Trauma

Mark Lowrie — Tue, 04 Jun 2013 09:10:09 GMT

[quote user="alex gough"]

I think the trial has finished now, but are you aware whether the Cambridge team would have taken on a case this bad when they were treating long term deep pain negative paraplegics with olfactory sheathing stem cells?

[/quote]

Hi Alex,

Yes this is the best option in these cases. I’m not sure if this was done in patients with complete laceration of the spinal cord but the theory is such that I am sure it could be attempted. However, this was a clinical trial and has not been rolled out as a commercially available technique. I too think the trial has now ended. I think this added a fantastic amount to the scientific literature but I really don’t see that this technique, as it currently stands, offering an option for spinal patients in the near future.

My main reason for sounding a little pessimistic was that although the study found an improvement in pelvic limb movement it was found that measures of long tract function (lateral stability, SSEPs, TMMEPs, and urodynamics) were not improved and hence this would suggest only an improvement in local intraspinal circuitry (e.g. spinal walking) rather than long tract axonal regeneration (i.e. restoration of brain control over hind limb motion).

Re: Spinal Trauma

Alex Gough — Mon, 03 Jun 2013 16:24:39 GMT

Mark, I think the trial has finished now, but are you aware whether the Cambridge team would have taken on a case this bad when they were treating long term deep pain negative paraplegics with olfactory sheathing stem cells?

Anthony, pubmed is free to anyone with internet access. Abstracts only but still a valuable resource.

Alex

Re: Spinal Trauma

Anthony Dennison — Mon, 03 Jun 2013 14:49:29 GMT

Thanks for all the advice Mark, much appreciated. Glad the radiographs were ok for you!

Unfortunately the kitten deteriorated over Saturday, became more dyspnoeic and wasn't urinating. The vet on call over the weekend said it was non-expressible. She was put to sleep on Sunday morning as she was getting worse rather than better.

With just a fracture of the dorsal comprtment she may have been ok, but would the rotation of the vertebra give a worse prognosis?

Re: Spinal Trauma

Mark Lowrie — Sat, 01 Jun 2013 09:09:13 GMT

[quote user="Anthony Dennison"]

With the damage to the dorsal process of T9 and the slight rotation seen on the DV, is this another lost cause, or would anti-inflammatory steroids, pain relief and cage rest see her through to a reasonable quality of life? Is my interest in neurology that is causing me to wait to see if there is any response to treatment cruel to the cat, and should I call the owners up in the morning and tell them that?

[/quote]

Provided the respiratory problem is stable (i.e. that the pneumothorax is not getting worse) then a conservative approach for the neurological injury may be suitable for this cat. You say the cat is paretic so if it has voluntary movement and deep pain sensation this is an encouraging signs.

It is difficult to see the radiograph well but to determine whether this is a stable or unstable fracture we use the ‘3 compartment rule’.

The three compartments are:

Dorsal compartment – contains the articular facets, dorsal laminae, lateral pedicles, dorsal spinous processes and supporting soft tissue structures.
Middle compartment - contains the dorsal longitudinal ligament, dorsal vertebral body and dorsal annulus fibrosus.
Ventral compartment – contains the lateral and ventral annulus fibrosus, nucleus pulposus and ventral longitudinal ligament.

If 2 or more compartments are involved then the fracture is considered unstable. It looks like you only have involvement of the dorsal compartment (you may be able to see this more clearly with the original radiographs) so there may be hope for this cat.

The other thing going for this cat is its age – the fact it is so young will mean the bones should heal well.

I would continue antibiotics due to the wounds but cage rest is the most important thing – very strictly for 6 weeks. I wouldn't use steroids but NSAIDs or other pain relief would be appropriate initially. I would also keep an eye on the neurological status to check it doesn’t deteriorate at all. But definitely worth giving time.

Re: Spinal Trauma

Mark Lowrie — Sat, 01 Jun 2013 09:05:59 GMT

[quote user="Anthony Dennison"]

no perceptible deep pain, hindlimb paralysis

[/quote]

You are right, this is a terrible prognosis. In fact I would go further and say it is no prognosis. You made the correct decision.

[quote user="Anthony Dennison"]

only option is euth

[/quote]

Absolutely. I wouldn’t even contemplate keeping this dog alive as there is obvious transection of the spinal cord. If you did and decided to repair the fracture, there is a very high likelihood of ascending descending myelomalacia. Best case scenario you would have a doubly incontinent dog, worse case scenario you would get involvement of the forelimbs and respiratory paralysis. So not one to do anything with at all. There are no studies on this as it has never bene done - hence the reason why Christopher Reeve (with no lack of money or determination) remained paralysed for life. If it is done the Nobel prize is a certainty.

Re: Spinal Trauma

John Flynn — Sat, 01 Jun 2013 08:25:19 GMT

I wouldn't contemplate waking the first one up with a radiograph like that and no deep pain. Could it be done? Who knows, but I think a set of wheels and a semi-permanent cystotomy tube would be inevitable if one tried...

Would you say that's most likely pulmonary contusion at the end of the trachea?

Second one, I think could come OK and would definitely give minimum of 24-72 hrs to decide whether to keep going or not as long as pain was controlled and able to nurse and manage comfortably enough.

Heart looks a little elevated off sternum on lateral view - could that be a bit of pneumothorax then?