Managing acutely paralyzed patients with disc herniation or spinal sord injury (Proceedings)


Managing acutely paralyzed patients with disc herniation or spinal sord injury (Proceedings)

Presenting new drugs and procedures that have been very helpful and leading to recovery (from laser, to electromagnetic resonance, to hyperbaric oxygen (chambers that do not cost and arm and a leg).

Spinal cord associated acute disc herniation and paralysis, spontaneous or secondary to trauma

Most (80%) of disc herniation that lead to acute paralysis occur at T11-L3, then L4-S3,. The Area most protected T1-T10, by the dorsal longitudinal ligament. Second most common is C2-C6 but cases have been reported at C7-T10 but rarely.

Initial care begins with history

Gotten with the phone call coming into the practice by the owner or person trying to help the acutely paralyzed dog at the scene. IF the paralysis was due to trauma instruct the responders/owner to transport on a flat solid surface if at all possible, right from where the pet is laying, keeping them in one plane in horizontal lateral recumbency. Duck tape the head and pelvic area and several other points between. Rarely breathing may stop if the herniation of disc or injury has occurred at the cervical-vertebral region. Then in these cases mouth to nose (snout) (MS ) ventilation (rescue breathing) is life saving and must be done immediately and continued en route. Some years ago I had a small poodle fall down some stairs once and stopped breathing soon after it came to rest at the bottom of the stairs. The owner was a physician and he began mouth to snout ventilations approx 8-10 times a minute and he had a neighbor drive the dog and him, continuing to perform the MS rescue breathing. The dog arrived with profound spastic paralysis but with deep-pain sensation. Following iv placement, anesthesia, hand bagging to get the radiographs and do a myelogram that should a ruptured C4-5 space and cord compression. She was placed on an anesthetic ventilator, taken to surgery and a slot and ruptured disc removal was accomplished. The remained on a ICU ventilator (old Puratian-Bennett) for 5 days and began bucking the ventilator more all the time. The dog was able to be off the ventilator shortly after that she made a complete neurologic recovery.

Initial neuro-exam

Should be done to determine. location, degree of problem and prognosis, and provide a baseline to log progress should treatment be performed. The neuro exam will involve the following:
1. gate (not done in the paralyzed patient)
2. Postural reactions (proprioceptive positioning = sensory & motor).
3. paw recognition; assesses ascending pathways (dorsal spinocerebellar tract)
4. surface receptor, periph & spinal N, brain stem, cerebellum, cerebral cortex
5. assesses descending upper motor neuron pathways (cortico and rubro [opposite side] and reticulospinal pons/medulla area [same side] tracts.
6. returning cord white matter (lateral and ventral funiculi)
7. assesses reflex pathway and muscle tone (passive manipulation of each limb = normal, hypo, hypertonia)
8. spinal reflexes: (hyporeflexia= lower motor neuron, hyper reflexia =upper)
     extensor thrust Femoral N + L4-5 segments (hyperextensor thrust = upper)
     patellar reflexes ( Femoral N + L4-5 segment (hyperpatella reflex = upper)
     biceps and triceps reflexes Radial N + C7-T2 segments

ON ADMISSION if the animal is not immobilized and history reveals possible acute intervertebral disc herniation – or acute back injury, teat all of these as if they all had just fractured and place the animal in lateral recumbency and IMMOBILIZATION CONTINUE using cardboard, tape, duct tape, similar to how it is described lately. Working with Cardboard and Tape, MANUFACTURE THE SPINE BOARD. It stabilizes the spine, Stabilizes clots, Helps decrease pain. Allows radiographs as x-ray beams to go through it.

PERFORM A HISTORY, PHYSICAL EXAM, NEUROLOGICAL EXAM AND SCORE INJURY beginning with level of consciousness. Caution is advised with cases that also have other injuries, are in shock and in cases where the acute paralysis has just occurred or is very recent (hours) as some spinal cord shock, contusion, and decreases in spinal cord blood flow due to vasospasm can provide injury scores that are going to be worse and location indications that may change over the course of the next few hours.