Apple’s Lucky Escape
Apple is a 1 and ½ year old Russian Blue cat referred to Northwest Veterinary Specialists for management of a spinal fracture. She had been missing for a few days but this was not unusual.
On this occasion Apple was found in the evening by her owner, trying to get home using her front legs but dragging her back legs. The local veterinary surgery saw Apple and immediately identified a spinal injury, confirming fracture of the spine with radiographs. Apple was monitored carefully and kept comfortable with a combination of pain killers and then referred to Northwest Veterinary Specialists for assessment and management.
On arrival Apple was settled and comfortable. She was clearly unable to stand on her pelvic limbs and showed only weak movement in the right pelvic limb although there was sensation in both feet. Her tail was flaccid with no sensation. Any attempts at movement were obviously very painful. Spinal fractures are of course extremely serious injuries and it is difficult to predict the outcome. The location of the fracture, degree of instability and neurological status all affect the management decisions, with patients showing no pain sensation in the limbs having a much poorer prognosis. In Apple’s case radiographs showed a fracture of all stabilising components of the spinal column at the L6-7 vertebral junction (close to where the lumbar spine attaches to the sacrum and pelvis). The fractures were extremely unstable with marked deviation but fortunately the spinal canal is quite roomy at this level and the spinal cord has terminated, with only peripheral nerves present in the neural canal. This means that quite severe displacement at this level may carry a better than expected prognosis.
Apple was admitted and following assessment by our anaesthetist Matthew Gurney she was anaesthetised. Following anaesthesia muscles supporting the spinal column relax and great care must be exercised to avoid causing further trauma when moving the patient. After further radiographs Apple was prepared for surgery and taken to the operating theatre. An incision over the fracture, down the midline of her back allowed careful dissection of the muscles away from the spinal column and sacrum on both sides. With the vertebrae exposed the fracture was visible with the spinal canal exposed by fracture of the articular processes. With great care, threaded pins were driven into the vertebral bodies of L6 and into the sacrum and pelvis. Once all the pins were in position they were encased in medical bone cement which is initially mixed as a liquid but which hardens to form a rigid column incorporating the pin ends and preventing any movement at the fracture site. The vertebral column was held in the correct position until the cement had hardened. Post-operative radiographs show satisfactory positioning of the implants and good alignment of the fracture.
Apple made an excellent recovery following surgery and was making attempts to walk on the following day. Within a week she was ready for discharge, walking well and using a litter tray normally. Apple was kept at home in a large cage for 6 weeks and allowed out for short supervised walks several times a day. Six weeks post injury radiographs obtained under sedation confirmed good progression of healing of the fracture and Apple was given increased freedom. Tail sensation and function was showing steady positive improvement. Twelve weeks following her injury Apple was returned to normal activity.