ºÚÁÏÉç

Holly Smith, Head Neurology and Rehabilitation RVN and owner of Worm  

Worm, a five-year-old miniature dachshund, came to ºÚÁÏÉç Small Animal Referrals last August following an acute onset of back pain and difficulty walking.

At that point Worm was bright, alert and responsive. Physical examination was within normal limits. However neurological examination revealed mild ambulatory paraparesis, proprioceptive ataxia in the pelvic limbs and thoracolumbar kyphosis.

Postural reactions were reduced in both pelvic limbs. Spinal reflexes were intact in all four limbs. The thoracic limbs were normal. Cranial nerves assessment was normal. However, spinal hyperaesthesia was detected on palpation of the thoracolumbar region. These findings are consistent with a T3-L3 myelopathy.

Given the mild nature of the clinical signs, conservative treatment was elected in the first instance. Worm was started on medical treatment for pain and a period of strict cage rest, which meant he was confined to his crate and only taken to the garden on a lead.

After a period of four to six weeks, Worm was comfortable, and his neurological examination was normal. At that point he could gradually increase his exercise and stop his medication. Worm had recovered well from this episode of back pain and myelopathy.

A few weeks later it was noticed that Worm was “wobbly” on his pelvic limbs again, seemed uncomfortable and not himself.

Admission as an inpatient     

Worm returned to the ºÚÁÏÉç in October, when he was assessed by the Neurology and Neurosurgery Service again. He was paraplegic, with intact nociception (paralysed back legs, could still feel them). He was an inpatient for four days.

MRI of the thoracolumbar spine identified an intervertebral disc extrusion at T12-T13 intervertebral disc space, which was pressing on the spinal cord. A hemilaminectomy was performed.

Pain was managed pre and postoperatively with opioids (methadone), along with a non-steroidal anti-inflammatory drug and a nerve pain medication.
Initially Worm’s bladder was checked regularly to see if he could urinate by himself, and pain scores carried out to ensure he was comfortable. He regained the movement in his back legs the same evening as his surgery and was able to wag his tail! Worm recovered well postoperatively.

Worm had to have strict cage rest again for at least four weeks after his surgery. It was important that he didn’t try to run, jump up or climb stairs, which could cause him pain and possible deterioration. He was back to going to the garden on a lead for a change of scene and the toilet, three to four times a day for five to ten minutes only.

Physio, hydro and K-laser treatment      

During his recovery Worm had laser, physiotherapy and hydrotherapy. The exercises improve strength and balance while maintaining a positive muscle memory, so the body doesn’t remember abnormal as normal, instead of returning to normal function.

Laser was used on his back to help the wound heal and give extra pain relief. These are short sessions and comfortable for him. He had to wear “doggle” eye protection during the sessions.

Physiotherapy exercises include massage, passive range of motion on his back legs. We then incorporated active/assisted exercises, which involved supported standing, rhythmic stabilisation (wobbling) on a wobble cushion and foot slides on a textured surface or wobble cushion. Worm was a good boy for his physiotherapy and enjoyed the attention!

In hydrotherapy he used the underwater treadmill to improve his walking. This helps with strengthening, by walking against the resistance of the water. With someone in the treadmill every session, they could also help make sure he was placing his feet properly, practising and improving proprioception. This was not Worm’s favourite thing to do and some bribery with treats was needed!

Worm has made a full recovery from his intervertebral disc extrusion and hemilaminectomy surgery. This doesn’t mean it might not happen again and therefore he is kept a close eye on and isn’t allowed to climb stairs or jump. There are a lot more ramps in his house now!