Intervertebral disc disease is very common in the patients we see at North Coast Veterinary Specialist and Referral Centre (NCVS) and,without advanced imaging, our job would be made that much more difficult. Zoe, a 9 year old Miniature Dachshund presented for acute onset hindlimb ataxia of three days duration.
Examination revealed caudal lumbar pain with segmental reflexes normal, patellar and withdrawal reflexes and a reduced perineal reflex. Neurolocalsiation was L4 -S3 spinal cord segments. A CT scan was performed revealing a large mineralised density within the vertebral canal over the L6/7 intervertebral disc space, an uncommon location. A dorsal laminectomy was performed over this space and a large amount of disc material retrieved. Recovery has been rapid with improved ambulation the day after surgery.
Ninety percent of disc extrusions in small dogs occur within three spaces either side of the thoracolumbar junction, but as you can see not exclusively. This case demonstrates the importance of a complete neurological exam; if the perineal reflex for example was missed neurolocalisation based on the limb reflexes could have been misinterpreted as T3-L3 spinal cordlesion and the diagnosis would have been missed. The neurological exam and its interpretation are of critical importance to understanding neurological disease. The single most reliable prognostic indicator in paraplegic dogs is the presence (Grade IV/V) or absence (Grade V/V) of deep pain sensation (conscious perception, not withdrawal) as outcomes are strongly correlated with grade. Grade IV /V still have an extremely good prognosis with > 90% of dogs expected to walk again. Conversely Grade V/V is generally less with 50% if presented < 24 hours and < 5% after 48 hours of injury.
The NCVS surgery team welcome any queries and/or questions regarding disc disease and are happy to run through a neurological exam at any time.