Chloe Lacroix

Background

Prior to her first visit to us, Chloe, a 14 year old Miniature Long-Haired Dachshund had previous spinal surgery – T12-13 in New York at the Animal Medical Center in 1999, and C3-4 at the Royal Vet College in 2002. Mrs Lacroix had been manually expressing Chloe’s urinary bladder for some time three times daily and was accustomed to this procedure and to daily physiotherapy.

Condition on Presentation (1) 

Chloe originally presented at Fitzpatrick Referrals on 25^th May 2004 for assessment of acute pelvic limb paresis. At the time of presentation she was proprioception negative on both pelvic limbs. Withdrawal reflex was weaker on the right and she was unable to stand.

Diagnosis

On this occasion, myelography revealed a centralized compressive lesion at L4-5 with cord swelling to L3-4. There was some residual cord compression evident at T12-13.

Surgery (1) 

A hemilaminectomy was performed on the right side from L3-4 to L4-5 and decompression was achieved. Two days postoperatively, Chloe was able to walk, but dragged the right pelvic limb. The prognosis for recovery was guarded, but it was hoped that she would recover sufficiently to enable her to have a good quality of life. Chloe went to a local hydrotherapy pool to aid recovery as Fitzpatrick Referrals did not have a rehabilitation centre at the time and happily regained full mobility.

Condition on Presentation (2)

Chloe presented as an emergency on 31^st January 2009 for recurrence of spinal pain. On the day of presentation clinical signs in terms of neurologic dysfunction were difficult to ascertain as conscious proprioception deficits were a permanent feature for the pelvic limbs. The owner reported that the left pelvic limb was generally a more significant problem than the right There was pain evident on deep digital pressure application to the thoraco-lumbar junction and to the cranial cervical spine.

Diagnosis

The owner elected for MRI scan of the entire spine. Every disc had undergone degeneration. Protrusion was evident at C2-C3 but dorsal rim fluid signal was still apparent at this site such that we were reluctant to contemplate surgery unless pain or neurogenic function became intractable associated with this. The major MRI finding was massive inter-vertebral disc herniation at T12-T13 on the left, which was the side opposite to that operated on at the same inter-vertebral junction in 1999. Moderate protrusion was also evident at T13-L1 and at the lumbo-sacral junction.

Surgery (2)

A left-sided hemilaminectomy was performed from T12 to L1 and a large volume of extruded and chronic fibrous material was removed from the inter-vertebral disc at T12-T13. A smaller volume was removed from the inter-vertebral disc at T13-L1. Because instability associated with bilateral facetectomy at T12-T13 would be likely to impair functional outcome and also because a dynamic component of impingement of the spinal cord at these two sites would possibly influence outcome, particularly in the presence of chronic axonal degeneration, ancillary support was provided using pins and polymethylmethacrylate internal fixation from T12 to L1. Postoperative radiography revealed satisfactory alignment and stability. 

Rehabilitation

Chloe stayed with us until 3^rd February 2009, whereupon she was returned home to confinement and subsequent physiotherapy. Physiotherapy, acupuncture and hydrotherapy were scheduled at our rehabilitation centre for a period of six weeks. At this stage Chloe was ataxic and her owner was advised to concentrate on pad stimulation, bounces and weight transfer exercises. She returned for regular physiotherapy treatments including trigger point release and passive mobilisation exercises. The goals for the rehabilitation team were to relieve pain sufficiently to enable the removal of non-steroidal anti-inflammatory treatment, identification of treatment points for acupuncture, including cervical and thoraco-lumbar, that could result in prolonged analgesia with regular acupuncture sessions and perhaps improved spinal cord blood flow. It was felt that it would be possible to gain a greater level of function than preoperatively depending on the compensatory capability of the spinal cord. The aims of hydrotherapy were to promote muscle mass and coordination and the aims of physiotherapy were to maintain joint range of motion and mobility whilst contributing to proprioceptive feedback.

By the beginning of March 2009 Chloe was doing well, mobilising independently but was still ataxic. She showed some deep pain bilaterally and proprioception was improving at this stage. The owner was shown further mobilisation exercises and encouraged to try walking her on different surfaces. Stepping over poles and weaving exercises were also recommended to the owner in an effort to try and improve ataxia and strengthen generally.

A course of acupuncture treatments appeared to be helping reduce any pain and discomfort and improve function and mobility generally.

Condition on Presentation (3)

Chloe re-presented on 9^th July 2009 for reassessment as while the owner was away a large swelling had become apparent over the caudal and lateral aspect of the right calcaneus which constituted either a hygroma or a haematoma and was treated symptomatically. At the same time Chloe became inactive and unable to use the pelvic limbs whereas previously she had been overactive, However, when she came to see us, she appeared to be managing to stand up and was walking reasonably well.

Rehabilitation 

The owner was shown by our physiotherapy team how to employ transcutaneous electrical stimulation on an ongoing basis to improve muscle mass and hydrotherapy continued at our rehabilitation centre twice weekly to maintain fitness and attitude. She also continued to have a variety of nutritional supplements. The owner was aware that none of these measures were curative and the best that we could hope for was for Chloe to be comfortable and happy.

Chloe has continued to come for hydrotherapy sessions weekly for the past two years and she has done remarkably well. She works hard in the pool and constantly kicks her hind legs when encouraged by pad stimulation. She is now 14½  years old.