King is a 12 year old mixed breed referred to BVNS for the inability to get up. King’s story started 9 years ago when he was rescued by the current owners after surviving being dragged behind a truck on a highway.When referred King was unable to get up when laying on his side and once assisted to rise he would cross over his back legs, knuckle them and was drunk and weak on the back legs. He was also stiff in his low neck and taking little short steps on the thoracic limbs. King had been examined 1 year ago for back pain and the current problem started 2 months ago. He had not been able to get up for the last 5 days and his symptoms were unresponsive to medication. Examination supported a neck problem and MRI showed a tumor was severely pressing on the spinal cord. There was a concern that surgery may not remove all of the tumor, the tumor would come back, or that King would never regain the ability to walk, even with surgery. Below is a summary of the case:
• Unable to rise when laying on his side, progressive weakness and ataxia of pelvic limbs (PL), short strided and crossing of the thoracic Limbs (TL)
Low cervical spinal cord disease evident:
1. Pelvic limbs were weak, long strided, high stepping, circumducting and had poor proprioception,
2. Thoracic limbs are short strided,
3. Neck held in a persistently flexed position.
Owners opted for surgery knowing that prognosis was good for a return to function but potentially poor for maintenance of long term function. Post-operative MRI shows reduction of tumor to microscopic disease and biopsy showed synovial myxoma. Five days after surgery King was stronger, playful and much improved from presurgery status. Biopsy revealed the tumor to be a synovial myxoma which is a slow growing benign tumor and the prognosis is thought to be good.
Take Home Points:
1. Patients with low cervical spinal cord are short strided on the TL, hold their head flexed and are long strided, weak and ataxic on the PL. Neck pain is not always obvious or present.
2. Surgery can be effective at rapidly improving clinical signs and producing good long term outcomes even when there is severe compression from a tumor.
3. Performing a MRI after surgery and while still under anesthesia is useful in assessing decompression, tumor resection, and prognosis.
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