Case of the Month
Axel, a 10 year old male, neutered Whippet Hound, presented for falling and stumbling on all 4 feet. Axel has arthritic knees, and has a problem with his kidneys called glomerulonephritis, but otherwise has been healthy. 4 days prior to coming in he was seen to stumble and fall down, and the stumbling and falling was becoming progressively more frequent.
On physical exam Axel was bright and alert. He had mild dental tartar, and some recession of his gums. His heart and lungs were normal, as was palpation of his abdomen. He had some swelling of his knees due to disease of his cruciate ligaments which caused him to have arthritis. He had paresis (partial paralysis) of all 4 legs, with his left front most severely affected, causing him to have a very ataxic (stumbly) gait. He showed some pain with palpation of his caudal cervical spine (his neck in the area right before his shoulders). On examination of his cranial nerves he also had some slightly decreased function resulting in slow blink reflexes.
The possible reasons for Axel’s problem are localized to his neck or brain, because of all 4 legs being affected. The problem with his facial nerves may or may not be associated with the problem with his legs – a possible red herring. The possibilities include, in order of probability, a ruptured disc in his cervical spine (neck), a tumor in his cervical spine (neck), a tumor in his brain, or less likely meningitis.
Axel was referred to a neurology practice, Dogwood Veterinary Referral Hospital, in Ann Arbor. Dogwood is owned by two veterinary neurologists, Dr. Jared Galle, and Dr. Andrew Isaacs. Dr. Isaacs saw Axel and kept him there in order to perform a CT scan on his neck first, his brain if needed, and to possibly do a spinal tap to check for meningitis.
The CT scan was done in the morning, and a ruptured intervertebral disc at C5-C6 was diagnosed. There are seven cervical (neck) vertebrae (even in a giraffe!), so the problem was located right where he was painful in the part of his neck by his shoulders. Dr. Isaacs recommended surgery since there was so much material pressing on the spinal cord that medical therapy wouldn’t be able to help very much. Also, taking care of the problem sooner rather than later would make the surgery easier, and the prognosis much better. Also, Dr. Isaacs assured Axel’s family that in his experience dogs are much more comfortable after surgery than they were before. The owner consented to surgery, so Axel went straight to surgery from the CT unit without having to be woken up from anesthesia.
The surgery, called a ventral slot decompression, lasted over two hours. Axel had had some chronic disease in that area, likely from a bulging disc, then an acute (sudden) problem from the disc actually rupturing. There was more scar tissue than Dr. Isaacs had hoped, but he was able to clean out a lot of material from around the spinal cord. Axel did well through the surgery, and was kept comfortable with IV pain medication.
Axel went home the next day. At first he was very weak and sleepy, mostly because of the pain medication he was on. Axel’s instructions included cage rest for 10 days, which would decrease the possibility of inflammation and/or bleeding around the spinal cord, and medication for pain and swelling of the tissues around the spinal cord.
Axel was rechecked at the time his sutures were removed, 10 days after surgery. His neck had healed beautifully, and he was able to walk much better. He has continued to improve and now is back to normal playing with his “sister” and barking and carrying on whenever one of his “people” come home, and at mealtime.