Introduction
Vertebral fractures and luxations (VFLs) are the leading causes of neurologic dysfunction in small animal patients. This frequently results from severe external trauma, such as vehicular accidents or animal attacks. These injuries account for a substantial number of cases presenting with neurologic impairments suggestive of spinal cord dysfunction, occurring in approximately 6% of such cases [1]. The pathophysiology of VFL comprises both mechanical damage and secondary injury mechanisms, including ischemia, inflammation, and excitotoxicity, which collectively contribute to spinal cord damage and neurological deficits [2].
Pain and neurologic deficits are consistently associated with VFL. Neurologic injuries result from compression or contusion of neural tissue, while pain can arise from neural compression, direct mechanical injury, or instability of mesenchymal tissues [3]. The spectrum of spinal cord injury varies widely, with tissue destruction being inevitable after impact and the severity ranging from mild to severe. Chronic compression can lead to demyelination, progressive axonal damage, and neuronal and axonal death [4].
The primary aim of treating animals with VFL is to preserve the function of the surviving neural tissue. This often requires surgical decompression and skeletal stabilization to prevent further trauma, in addition to physiotherapy and rehabilitation [5]. Surgical intervention is particularly important within the first few hours post-injury to ease the extent of secondary damage and improve outcomes [6]. However, in cases with minor neurologic abnormalities or where surgical facilities are unavailable, conservative therapy can sometimes adequately restore function if the vertebral column remains naturally stable [7].
Given the high incidence of concomitant injuries in animals experiencing severe external trauma, an in-depth and ordered assessment of all body systems is crucial. Life-threatening injuries to the respiratory and circulatory systems must be addressed urgently, as they can be rapidly fatal [8]. Early recognition of potential VFL is vital to avoid aggravating neurological injuries, with careful handling and stabilization techniques being crucial to prevent further damage [9]. In many cases, securing the animal to an external splinting device, such as a plank of wood or a stretcher, is recommended to minimize movement and additional trauma.
Case History
A 2-year-old male shorthair cat was presented to the small animal unit of the Veterinary Teaching Hospital, Usmanu Danfodiyo University, Sokoto, Nigeria. The owner reported that the cat had been unable to walk, experiencing incessant urination, reduced appetite, and exhibited general weakness (Fig. 1). The symptoms were observed for about 4 days following an attack by a newly acquired dog in the household. Further history from the owner indicated that the attack was quite severe, with the cat being shaken vigorously by the dog.
Figure 1.
Tom on presentation.
Physical Examination
Upon presentation, the cat was weak and recumbent, unable to stand or move its hind limbs. The perineal region was notably wet, possibly due to urine incontinence, and there was an open wound on the abdominal region, indicative of trauma from the dog attack (Fig. 2). The recorded vital parameters are: Temperature; 36.7°shashC, Pulse; 86 beats per minute and Respiratory rate; 25 cycles per minute.
Figure 2.
Wet and Soiled perineal area.
A detailed neurological examination shows no response to painful stimuli (needle pricking) in the hind limbs and anal region (Fig. 3), indicating a significant neurological problem; this signifies a severe spinal cord injury.
Figure 3.
Physical examination.
An X-ray of the vertebral column was performed, which revealed fractures involving the fourth, fifth, and sixth lumbar vertebrae. The radiographic images showed clear disruptions in the continuity of these vertebrae, with displacement of bone fragments and potential compression of the spinal cord (Fig. 4).
Figure 4.
X-r)ay showing the affected part of the lumbar vertebrae.
Laboratory tests, including a complete blood count (CBC) and serum biochemistry, were conducted to assess the overall health status of the patient. The CBC results showed mild anemia, possibly due to internal bleeding. Serum biochemistry indicated elevated creatinine levels, suggestive of potential renal impairment, possibly aggravated by the inability to control urination.
Case Management
The management of vertebral fractures in a cat involves both symptomatic management and surgical intervention, although the latter was not feasible in this case due to the lack of necessary facilities and the severity of the injuries. Symptomatic treatment included administering Neurobion®, a vitamin B complex, to support nerve strength and possibly aid in neural repair, along with analgesics to manage pain and alleviate symptoms. The goal of this treatment was to stabilize the patient’s condition and provide supportive care. However, despite these efforts, the patient’s condition continues to deteriorate. The patient shows significant neurological deficits, such as paralysis, and fecal and urine incontinence, indicating severe spinal cord injury. These symptoms, coupled with the lack of response to needle pricking in the hind limbs and anus, suggested profound loss of sensory and motor functions below the level of the fracture (fourth, fifth, and sixth lumbar vertebrae).
Notable atrophy of the hind limbs and continued fecal incontinence, which were signs of progressive neurological damage were also observed. This progressive deterioration is common in severe spinal injuries, especially when effective intervention is delayed or the damage is extensive. Given the ethical responsibility to alleviate suffering, the patient’s condition and prognosis were discussed with the client and other clinicians. Considering the expected poor quality of life and the lack of improvement, the decision to euthanize the patient was made in consultation with the client. Euthanasia was performed using a high dose of Sodium pentobarbitone, ensuring a painless and humane passing for the cat (Fig. 5).
Figure 5.
Tom-cat after euthanasia.
Discussion
The possibility of recovering neurologic functions in cases of VFL in small animals depends heavily on the initial severity of the injury and the timely administration of appropriate treatment. When peripheral pain perception is retained, the chance of regaining useful neurologic functions is generally favorable, irrespective of the treatment method employed [1].
However, predicting the extent of neurologic recovery and the timeframe for regaining maximum function can be challenging. Studies have shown that if complete transection of the spinal cord has not occurred and decompression is performed within the first 6 hours of the injury, patients without pain perception have a guarded to poor prognosis, though recovery is not entirely impossible [2,10]. Early surgical intervention can significantly influence outcomes, yet in cases where facilities or resources are limited, conservative management must be considered carefully.
In this particular case, the initial conservative treatment with Neurobion® and analgesics was aimed at managing symptoms and stabilizing the patient’s condition. Unfortunately, the patient’s condition deteriorated, demonstrating that the extent of neural damage was too severe to be managed with a conservative method alone. The lack of improvement, coupled with the onset of additional symptoms such as hind limb atrophy and fecal incontinence, indicated a poor prognosis.
Given the development of symptoms and the limited resources available for advanced surgical intervention, euthanasia was deemed the most humane option to prevent further suffering. This decision aligns with ethical veterinary practice, emphasizing the importance of quality-of-life considerations in patients with severe, debilitating conditions [3,11].
Client communication and consent are crucial in the decision-making process. It is important to always involve pet owners in discussions about prognosis and treatment options, ensuring they understand the potential outcomes and can make informed decisions regarding their pet’s care. In this case, the client’s consent to euthanize the patient was obtained after thoroughly discussing the expected poor prognosis and potential for recovery.
Effective pain management is critical in cases of spinal injuries. Multimodal analgesia, incorporating medications such as NSAIDs, opioids, and adjunctive therapies, can help improve patient comfort and outcomes [12]. However, in this case, despite the administration of analgesics, the patient’s neurologic and overall condition worsened, further justifying the decision to euthanize.
