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Neurology Case Study: Bobby

02 March 2018

Meet Bobby (far right of photo) who was an unforgettable patient that was in recently for a recheck with JJ one of the surgeons in our Neurology team.

Bobby was referred to the Neurology & Neurosurgery Service after being knocked down by a car in 2017 when he was 8 months old. Bobby was paraplegic due to a double vertebral fracture (L1-L2 and L4-L5) however had deep pain sensation and normal spinal reflexes.

To gain the best outcome a multidisciplinary approach from the Neurosurgery, Surgery, Imaging and Anaesthesia teams was planned and his case was then discussed by all the specialists involved.

CT & MRI Conclusions

CT and MRI were used in combination in this case and showed:

CT conclusions:

  • Traumatic, severe, comminuted compression fractures of L1 and L4 with secondary marked narrowing of the canal at caudal aspect of L1 and L4, more severe for the L1 fracture. L1-L2 right sided subluxation. Thoracolumbar kyphosis likely secondary to the spinal injury.
  • Bilateral severe pulmonary contusions.
  • An incidental finding of non-obstructive mineral gastric foreign bodies.

MRI conclusions:

  • Comminuted compression fractures of L1 and L4 with intracanalar dorsal displacement of the fracture fragments (worse at L1) and secondary narrowing of the dimensions of the vertebral canal.
  • Evidence of cord compression at L1, severe, ventral and no obvious lateralisation. Evidence of intramedullary hyperintensity just cranially to the L1 fracture site.
  • Suspicion of mild cord compression at L4. Possible very subtle intramedullary hyperintensity at cranial and mid L4.

After investigations, Bobby was moved to the surgical theatre to stabilise the spinal cord. Two locking bone plates were used (LCP / 2.0 screws) and fixation was made from T13 to L2 and from L3 to L5 on the left side. The left 13th rib was luxated to increase the safer position of the plate.

Given Bobby's age and the potential stress in the L2-L3 intervertebral space, it was decided to remove both bone plates once the bone had healed. He regained voluntary movements after surgery and he was discharged 4 days later. Bobby recovered the capability to walk during the first week after surgery. A final X-ray was performed recently at his last re-check post plate removal.

The great news is Bobby is back to normal. JJ says 'Thank you so much for giving us the opportunity do our best; this is a great example of multidisciplinary team work that gives the best outcome for the pet. Bobby's owners were a delight to work with and we are so pleased with the outcome'. 

 

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