Fibrocartilaginous embolism

benny

Ben at the clinic yesterday, now a healthy and sprightly teenager of 13!

Benny, a very fit and active 10 year old, had been playing ball down near his home on Throsby Creek,  when all of a sudden he turned and collapsed.  He was absolutely unable to use either of his back legs. With difficulty his owners Alison and Alan carried him to the car – luckily, he didn’t seem to be too painful – and brought him straight up to us where by that time he had some function back in his left leg but still couldn’t stand up. His right leg was paralysed.

We gave Ben something to settle his agitation and established that there were no unstable fractures and actually not a lot of pain. We gave him pain relief anyway. He was “knuckling” (ie bearing weight on the top of his foot on his right hind leg) and he lacked a “withdrawal” reflex on this foot – both signs that localised the problem to the lower spine. The good thing was that he could still feel pain if we squeezed his toes hard enough – this indicated that there was still some function in his spine and still hope in sight.  We didn’t know at this stage if we were dealing with a “slipped disc”, a tumour , a spinal “stroke” or vascular accident or some other pathology, and with the nearest advanced imaging facility 2 hours away we kept him overnight on a morphine drip and made some appointments for the next day in Sydney.

A CT scan in Sydney failed to reveal any significant spinal cord compression, which suggested a syndrome,  likely given his breed and the running around at the time of injury, where a very small piece of disc material comes loose and hits the spinal cord with high speed, causing bruising and swelling. Alternatively this disc material could end up in the blood stream and cause a blockage (embolism) of the blood flow to a small area of the spinal cord.

This was GOOD NEWS. Ben was sent home and told to REST.   Alison and Alan made a sling to support his body while he went outside several times a day to walk. Ben went from strength to strength. Within a week he was up and walking, using his stiff R hind leg as a sort of prop to propel himself along. We got him a boot and that seemed to make him a little more aware of where his foot was. Alison and Alan did physio daily, massaging, flexing and extending the leg, and within a fortnight of the accident he had started to put weight on his R foot as well.  All in all in took about 4 weeks for Ben to walk without scuffing his toes.

Fibrocartilaginous embolism can affect any dog although about half are giant breeds. Most are young adults 3-6 years of age, and most damage the lumbar area of their spinal chord. Unlike in Benny’s case damage can progress over 24 hours but it stops getting worse after that. Most patients make a significant if not full recovery over the next 4 – 6 weeks.

If we had had access to an MRI scanner 3 years ago we may have seen the lesion that caused Ben’s problem. Without access to advanced imaging we can never be sure of what has happened, but treatment of rest and physio, even if there was a disc rupture, is very reasonable as long as there is no pain.

The good news is it rarely happens twice!

 

 

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