A 13-week old female intact Cavalier King Charles Spaniel presented to the Cornell University Hospital for Animals Emergency service with a one day history of trauma following being hit by a car. Following the accident, the dog was immediately taken to a veterinary emergency and critical care center. She was treated overnight for shock and cerebral edema. No improvement was observed, and the patient was referred to Cornell.
Initial assessment at Cornell revealed voluntary motor function in all limbs, absent proprioceptive positioning in the pelvic limbs, decreased withdrawal reflexes in the pelvic limbs, decreased patellar reflex on the right, absent patellar reflex on the left, and lumbar discomfort on palpation. Problems included T3-L3 and L4-S3 myelopathy and hypoxemia. No free fluid was found during both A (abdominal) and T (thoracic) FAST scans.
A full body CT scan was performed, revealing injuries to the face, cranium, thorax and cervical and lumbar vertebrae. There were comminuted minimally displaced fractures of the right frontal bone, maxilla and bony orbit. A fluid dense material (presumed to be hemorrhage) was present intracranially and intranasally. A gas pocket was also seen intracranially (pneumocephalus). Thoracic views showed a moderate generalized and asymmetric patchy airspace lung pattern. At the C3 vertebra, fissure fractures were present through the right pedicle and both caudal articular processes. The L4 vertebral body had a comminuted fracture that was mildly dorsally displaced into the vertebral canal with suspected compression of the spinal cord.
The next day, the patient was induced under general anesthesia for surgical repair of the L4 vertebral fracture using cortical screws and polymethyl-methacrylate (PMMA). Post-operative CT was subsequently performed to confirm the placement of the implants. She remained in the hospital on maintainance therapy and pain managment for five days postoperatively. She was subsequently discharged with a fair to good prognosis. Recheck appointments showed continued neurologic improvement.
This presentation will explain diagnostic imaging findings along with medical and surgical management. A discussion of spinal fracture stabilization and prognosis for polytrauma will also be discussed.