Coco is a nine-year-old, spayed female Pomeranian from Rockhampton. Dr Marvin Kung had spoken to the referring vet who said she had a history of right thoracic limb lameness for several weeks and had presented unable to bear weight on her pelvic limbs. Dr Kung recommended she be flown to Brisbane Veterinary Specialist Centre (BVSC) immediately.
Her neurological condition deteriorated prior to travel to the point where she developed proprioception deficits in her thoracic limbs along with poor bladder function. By the time Coco arrived at BVSC, she was non-ambulatory, laterally recumbent and unable to maintain herself in a sternal recumbency.
Neurological examination revealed normal cranial nerve function. She was painful on direct palpation of her cervicothoracic junction, and also painful on lumbosacral palpation. She had superficial sensation present in all limbs. She was unable to wheelbarrow and could hop moderately well in the left thoracic limb, but poorly on her right. Her paw placement reflex was markedly delayed in both thoracic limbs with the right worse than the left. She had good withdrawal reflexes and voluntary motor function in both her thoracic limbs.
Her pelvic limbs had poor withdrawal reflexes which was worse in the right. Her patella reflexes were normal to mildly reduced bilaterally. There was good tail tone, and slightly reduced anal tone.
The thoracic limb signs were consistent with a spinal cord lesion in the cervical region with upper motor neuron (UMN) signs to both thoracic limbs, but a lesion in this location did not tie in with the lower motor neuron (LMN) signs seen in the pelvic limbs. One of the differentials for the findings would be two separate lesions; one at the L4-S1 region and another at the cervical region of the spinal cord.
To confirm these neurological examination findings and to further refine the localisation a contrast enhanced CT of Coco’s entire spine was obtained. This study showed evidence of multiple extradural compressions of the spinal cord over intervertebral disc spaces. The most significant ones were at C6-C7 and L7-S1 (see Figures 1 to 3).
Coco had a history of right thoracic limb lameness for several weeks and had presented unable to bear weight on her pelvic limbs.
Coco’s serious neurological diagnosis was explained to the owners and they agreed that delicate surgery was the only option. It was important to relieve Coco of the pain and discomfort as soon as possible, so Coco underwent immediate surgery to decompress both the C6-C7 and the L7-S1 disc protrusions.
A ventral slot surgery was performed at C6-C7 and a large amount of firm disc material was retrieved. A dorsal laminectomy was then performed at L7-S1 to allow removal of the protruded disc in that area. The surgery was complex. Foraminotomy was not required as there was adequate decompression post removal of the disc protrusion at L7-S1. Coco’s pain management started as soon as possible and was maintained with a balanced and carefully designed protocol prior to, during and after surgery. Pain control is of paramount importance for spinal cases and this also helps the rehabilitation process.
Coco recovered well from surgery and commenced a tailored and intensive physiotherapy and rehabilitation program at BVSC the following day, and in time was able to walk in the hospital’s enclosed grassed area. Coco had rapid and marked neurological improvement after surgery and was able to stand and walk 5 – 10 steps just days after surgery. She went home after a short stay in hospital since her recovery was so rapid, and she continued to improve at home. She is now pain free and active.
Good communication and early intervention enabled BVSC to be well prepared for Coco and to ensure she had the best possible care upon arrival and throughout her stay at the hospital.
Dr Marvin Kung BVSc MANZCVS Dip ACVS-SA, originally from Malaysia, is one of the key board-certified surgeons at Brisbane Veterinary Specialist Centre. He is highly trained and adept at all areas of small animal surgery but has a special interest in surgical oncology and spinal surgery. Dr Kung has performed many delicate spinal surgeries and with his meticulous approach to surgery, and specialised individual patient care, has established his high reputation.
Dr Kung is a member of the Australian and New Zealand College of Veterinary Scientists in Small Animal Surgery, a Diplomate of the American College of Veterinary Surgeons and a registered specialist with the Queensland Veterinary Surgeons Board. His special interests in neurosurgery (especially surgery for spinal disease) and surgical oncology are supported by the facilities, equipment and staff at BVSC.