The key things to know about spinal fractures are;
1 - Stabilise the spine prior to imaging and utilise advanced imaging (CT) versus radiographs.
There is the primary insult to the spinal cord and then a secondary insult. Everything possible needs to be done to prevent secondary injury, to preserve remaining neurons. These dogs can certainly start with pain sensation (in which case 85-90% of them will recover with stabilisation) and then subsequently loose pain sensation (prognosis closer to 5% with stabilisation). It is very important not to contribute to secondary injury. If a dog has been in a traumatic incident and has neurological deficits or spinal pain, strap them to a back-board (you can use anything for this - just something that is going to reduce movement of the spine) and then perform advanced imaging. If you perform radiographs in-house then you need to be very careful not to induce further injury. Furthermore, radiographs are not nearly as sensitive for spinal fractures (i.e they can be missed on radiographs). If they are missed, and there is ongoing instability of the spine, then deterioration and loss of nociception is possible.
2 - Do not give glucocorticoids. There is no evidence that administration helps in dogs with spinal injury, and there is a risk of inducing side effects - GI bleeding was noted in 90% of cases in one paper.
3 - 45-83% will have concurrent injuries - check for abdominal pain, signs of concurrent fractures (14-48%), signs of thoracic trauma (low SP02, dyspnoea, shock, shallow respirations, muffled lung sounds, crackles etc - 15-35% will have pulmonary injury). It is important to perform a full clinical examination and further imaging (if safe and the patient is stable) to assess for other injuries.
4 - Patient's can present as grade 1 neurological injury ie. pain only with no neurological deficit. Be careful, as without stabilisation these can progress to higher grades of injury. Any trauma case that presents with spinal pain should be assessed for a vertebral fracture.
5 - Grade 5 neurological patients due to spinal fractures, have a very poor prognosis <5%. Grade 5 dictates that deep pain nociception has been lost. A point of note is that this is not the same for grade 5 patients with IVDD, and these have a much greater prognosis for recovery (60-70% + in several studies).
6 - The neurological signs of one lesion may mask another lesion. Generally LMN signs will mask UMN signs. This may confuse the neuroanatomical localisation.
Comments