Hemilaminectomy - key physical exam findings and how to assess deep pain: One of the most common referrals to a specialist hospital is for intervertebral disc disease. If you are not particularly interested in the neurological examination (I won't judge) and just want to refer the patient on, here are a few things that are useful to record/be aware of; 1 - Note whether the patient is ambulatory 2 - If there is no voluntary motor function, check for pain sensation. It is very common for vets to mistake withdrawal of the limb with a pain response. My tip, is to hold a towel behind the patients head, then have a separate observer observe the patient's head while you inflict the painful event (usually squeezing the toes until there is a response). Ask the observer to tell you when they think you are inflicting pain (they should not be able to see what you are doing as this can bias the test). If you are inflicting pain and the observer can't tell from watching the patients head for a response, there is loss of pain sensation, even if the patient withdraws the limb.
Loss of superficial pain is when they don't respond to a toe squeeze, deep pain when they don't respond to a haemostat placed across the digits. Loss of deep pain reduces the prognosis for IVDD spinal decompression via hemilaminectomy from around 90% to 60-70% so it is an important prognostic indicator. 3 - Do not give steroids 4 - Opioids can affect our neurological examination. Ideally they should be wearing off when they arrive to us. This is a judgement call however, as there may be severe pain necessitating opioid administration. 5 - Refer early. We would rather see the patient when they are ataxic, than when they have lost deep pain due to subsequent deterioration.
If you are interested in neurology, here are the links to two excellent articles with tips for performing a neurological examination.
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