Clinical Occurrences in the Neurorehabilitation of Dogs with Severe Spinal Cord Injury

Characterization of risk factors for early ambulation in paraplegic dogs with absent pain perception undergoing decompressive surgery for thoracolumbar intervertebral disk extrusions

Background

Current literature warrants surgical decompression in paraplegic dogs with absent pain perception (APP), but the rate of ambulatory dogs with APP following thoracolumbar (TL) IVDE surgery in a clinical setting remains unknown. Furthermore, the outcome of paraplegic APP French Bulldogs (FBs) is anecdotally considered poor. The aims of this study were threefold within a large population of TL-IVDE paraplegic dogs with APP undergoing decompressive surgery: (1) to characterize early spontaneous pelvic limb movement and ambulation following surgery; (2) to identify risk factors for the recovery of ambulation; and (3) to compare the outcome of FBs and Dachshunds presenting with APP.

Methods

A single-center, retrospective case series of dogs with paraplegia and APP diagnosed with TL-IVDE based on CT or MRI, all undergoing surgical decompression (hemilaminectomy ± durotomy). Two main groups were defined: ambulatory and non-ambulatory. These were further characterized depending on the presence of pain perception and spontaneous movement. The outcome was obtained at 4-8 weeks postoperatively. Statistical analysis was performed comparing ambulatory and non-ambulatory dogs and comparing rates of ambulation on FBs vs. Dachshunds.

Results

A total of 127 cases were included, with 77 out of 127 (60.6%) being ambulatory at recheck and 9 out of 127 (7.1%) being ambulatory despite APP. The remaining case distribution of non-ambulatory cases was: with APP (32 out of 127; 25.2%), with pain perception (5 out of 127; 3.9%), and with spontaneous movement (5 out of 127; 3.9%). Multivariate analysis revealed two negative factors for the recovery of ambulation: dogs undergoing hemilaminectomy alongside durotomy (p = 0.003) and dogs presenting with spinal shock (lower motor neuron signs with a lesion higher than the L3-L4 intervertebral disk) characterized by reduced/absent withdrawal reflex (p = 0.008). No difference was found between Dachshunds (n = 41, 73.2% ambulatory) and FBs (n = 33, 63.6% ambulatory) in terms of recovery of ambulation, with only 2 out of 33 (6.1%) FBs developing myelomalacia.

Conclusion

Early recovery of ambulation alone (60.6%) and ambulation alongside pain perception (53.5%) occurred in the majority of surgically managed TL-IVDE-affected dogs with APP. Negative prognostic factors for recovery of ambulation were durotomy performed alongside hemilaminectomy, and dogs presenting with spinal shock with reduced/absent withdrawal reflexes, the latter translating to a reduced/absent withdrawal reflexes with a lesion higher than L3-L4 intervertebral disk. Finally, no indications of a worse prognosis for recovery of ambulation or a higher rate of development of myelomalacia in FBs when compared to Dachshunds were found.

Gut feelings: gastrointestinal signs in French bulldogs undergoing spinal surgery

Introduction

The French bulldog (FBD) is a brachycephalic breed prone to several neurological conditions, of which intervertebral disc herniation (IVDH) is considerably prevalent. Gastrointestinal (GI) disease is a reported complication in dogs surgically treated for IVDH. The objective of this study was to describe GI signs and their outcome in FBDs surgically treated for IVDH.

Materials and methods

Data regarding the GI signs (vomiting, diarrhoea and regurgitation), their frequency and short-term outcome in FBDs surgically treated for IVDH (cervical, thoracolumbar or lumbar) between January 2017 and April 2023 were obtained from medical records at one institution. Categorical variables were compared using Fisher exact tests, and ordinal/continuous data between categorical groups using Kruskal-Wallis or Mann-Whitney tests.

Results

Ninety-seven FBDs were included for analysis. GI signs occurred in 74/97 (76.3%) FBDs while hospitalised, with 33.8% and 66.2% developing GI signs pre- and post-operatively, respectively. FBDs that developed GI signs had a mean of 4.9 episodes. Diarrhoea was the most common GI sign encountered (51/74) compared to regurgitation (38/74) and vomiting (22/74). Resolution of GI signs occurred within a mean of 2.2 days. Mean duration of hospitalisation post-surgery was 4.6 days in FBDs that developed GI signs versus 3.7 days in FBDs that did not (p = 0.033). Anaesthesia length was associated with developing GI signs (p=0.037). Neurological severity, neuroanatomical localisation and surgical procedure were not associated with development of GI signs (p = 0.42, p = 0.794 and p = 1, respectively).

Conclusion

GI signs were commonly encountered in FBDs surgically treated for IVDH and associated with length of anaesthesia and prolonged hospitalisation.

The Role of Early Rehabilitation and Functional Electrical Stimulation in Rehabilitation for Cats with Partial Traumatic Brachial Plexus Injury: A Pilot Study on Domestic Cats in Portugal

This prospective observational cohort pilot study included 22 cats diagnosed with partial traumatic brachial plexus injury (PTBPI), aiming to explore responses to an early intensive neurorehabilitation protocol in a clinical setting. This protocol included functional electrical stimulation (FES), locomotor treadmill training and kinesiotherapy exercises, starting at the time with highest probability of nerve repair. The synergetic benefits of this multimodal approach were based on the potential structural and protective role of proteins and the release of neurotrophic factors. Furthermore, FES was parametrized according to the presence or absence of deep pain. Following treatment, 72.6% of the cats achieved ambulation: 9 cats within 15 days, 2 cats within 30 days and 5 cats within 60 days. During the four-year follow-up, there was evidence of improvement in both muscle mass and muscle weakness, in addition to the disappearance of neuropathic pain. Notably, after the 60 days of neurorehabilitation, 3 cats showed improved ambulation after arthrodesis of the carpus. Thus, early rehabilitation, with FES applied in the first weeks after injury and accurate parametrization according to the presence or absence of deep pain, may help in functional recovery and ambulation, reducing the probability of amputation.

Spinal shock in severe SCI dogs and early implementation of intensive neurorehabilitation programs

Spinal shock is complex, paradoxical with sudden presentation, possibly leading to a guarded prognosis. Thus, it is suggested the need for early implementation of intensive neurorehabilitation. This prospective controlled blinded cohort study aims to understand the implication of spinal shock in neurorehabilitation of severe SCI dogs and the importance of its evaluation thought a spinal shock scale (SSS). 371 dogs were randomized by stratification according the presence of spinal shock in the SG (n = 245) or CG (n = 126). The SSS, a punctuation scale (0-7), was evaluated at admission and each 6 h for 3 days, each day for 15 days, each week for 6 weeks, each month until 3 months, followed by 3 monthly follow-ups. All dogs had similar land and underwater treadmill training with functional electrical stimulation. Observational dataset allowed an approximate level of power (1-β) of 0.90 and an α (Type I error) of 0.01, with a total of 11,088 SSS observations between two blinded observers and 18% of disagreement. 75% of the dogs were admitted in 24-48 h after injury, allowing early detection of spinal shock, and dogs admitted at 72 h with SSS ≥ 4 were not able to achieve ambulation. Regarding ambulation rate, there was a significant difference between groups, with 66.9% of ambulation in the SG and 97.6% in the CG. Also, there was a difference in regard to time until ambulation, with a mean of 31.57 days for the SG and 23.02 for the CG. The SSS estimated marginal means had an exponential decrease within the first 6 h, followed by a slower decrease, but always faster in spinal shock dogs diagnosed with non-compressive myelopathies. Thus, early intensive neurorehabilitation in dogs after severe SCI may benefit from SSS classifications at admission and during treatment to establish different therapeutic protocols according to each patient's needs, especially in deep pain negative dogs.