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Treatment of traumatic cervical myelopathy with surgery, prolonged positive-pressure ventilation, and physical therapy in a dog

Sean D. Smarick VMD, DACVECC1, Helena Rylander DVM, DACVIM2, Jamie M. Burkitt DVM, DACVECC3, Nancy E. Scott MS, DVM, DACVECC4, Jacqueline S. Woelz MS5, Karl E. Jandrey DVM, DACVECC6, Janet Aldrich DVM, DACVECC7, and Beverly K. Sturges DVM, DACVIM8
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  • 1 Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, CA 95616.
  • | 2 Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, CA 95616.
  • | 3 Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, CA 95616.
  • | 4 Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, CA 95616.
  • | 5 Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, CA 95616.
  • | 6 Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, CA 95616.
  • | 7 Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, CA 95616.
  • | 8 Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, CA 95616.

Abstract

Case Description—A 9-year-old dog was evaluated for traumatic cervical myelopathy after a surgical attempt to realign and stabilize the C2 and C3 vertebrae.

Clinical Findings—The dog could not ventilate spontaneously and was tetraplegic; positive-pressure ventilation (PPV) was maintained. Myelography and computed tomography revealed spinal cord compression with subluxation of the C2 and C3 vertebrae and extrusion of the C2-3 intervertebral disk.

Treatment and Outcome—Surgically, the protruding disk material was removed and the vertebrae were realigned with screws and wire. For PPV, assist control ventilation in volume control mode and then in pressure control mode was used in the first 6 days; this was followed by synchronized intermittent mandatory ventilation until 33 days after the injury; then only continuous positive airway pressure was provided until the dog could breathe unassisted, 37 days after the injury. Physical therapy that included passive range of motion exercises, neuromuscular electrical stimulation, and functional weight-bearing positions was administered until the dog was discharged 46 days after injury; the dog was severely ataxic and tetraparetic but could walk. Therapy was continued at home, and 1 year later, the dog could run and had moderate ataxia and tetraparesis.

Clinical Relevance—Hypoventilation with tetraparesis in traumatic spinal cord injury can be successfully treated with PPV exceeding 30 days, surgery, and physical therapy.

Abstract

Case Description—A 9-year-old dog was evaluated for traumatic cervical myelopathy after a surgical attempt to realign and stabilize the C2 and C3 vertebrae.

Clinical Findings—The dog could not ventilate spontaneously and was tetraplegic; positive-pressure ventilation (PPV) was maintained. Myelography and computed tomography revealed spinal cord compression with subluxation of the C2 and C3 vertebrae and extrusion of the C2-3 intervertebral disk.

Treatment and Outcome—Surgically, the protruding disk material was removed and the vertebrae were realigned with screws and wire. For PPV, assist control ventilation in volume control mode and then in pressure control mode was used in the first 6 days; this was followed by synchronized intermittent mandatory ventilation until 33 days after the injury; then only continuous positive airway pressure was provided until the dog could breathe unassisted, 37 days after the injury. Physical therapy that included passive range of motion exercises, neuromuscular electrical stimulation, and functional weight-bearing positions was administered until the dog was discharged 46 days after injury; the dog was severely ataxic and tetraparetic but could walk. Therapy was continued at home, and 1 year later, the dog could run and had moderate ataxia and tetraparesis.

Clinical Relevance—Hypoventilation with tetraparesis in traumatic spinal cord injury can be successfully treated with PPV exceeding 30 days, surgery, and physical therapy.

Contributor Notes

Dr. Smarick's present address is Allegheny Veterinary Emergency Trauma & Specialty, 4224 Northern Pike, Monroeville, PA 15146.

Dr. Rylander's present address is Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI 53706.

Dr. Scott's present address is Veterinary Medical and Surgical Group, 2199 Sperry Ave, Ventura, CA 93003.

The authors acknowledge Dr. Christian Robison of Pacific Veterinary Emergency Service for initial emergency management and Dr. Nicholas Macy of Santa Cruz Veterinary Hospital for initial surgical management, referral, and providing images.

Address correspondence to Dr. Smarick.