Plus-Hex CLINICAL
Patient signalment
Species Breed Age Sex Weight
Dog
Body condition score 4 / 9
Presentation
French bulldog 3 years, 9 months Male, neutered 13.8 kg
The patient presented with acute-onset pelvic limb weakness( ambulatory paraparesis) but no loss of bladder or bowel control. The clinical history noted that the patient was aggressive when in hospital for brachycephalic obstructive airway syndrome surgery 2 years previously. This surgery was performed to improve the patient ' s airway, a procedure commonly carried out on brachycephalic breeds such as French bulldogs [ 1 ].
Assessment
The patient ' s clinical presentation of pelvic limb paraparesis represents grade 2 on the modified Frankel grading system [ 2 ]. This grading system consists of five categories: grade 1 relates to the least severe clinical presentation seen with spinal cord injury, where there is spinal hyperaesthesia but no neurological deficits; grade 5 is the most severe presentation, where the patient is paraplegic with absent pelvic limb nociception. This grading system is used to provide universal categorisation of the varying clinical presentations of thoracolumbar( TL) intervertebral disc disease( IVDD).
A brief neurological examination was performed, as a comprehensive clinical assessment proved challenging due to the patient ' s temperament.
The assessment included observations of:
• Patient mentation
• General posture and gait
• Reaction to postural changes
• Cranial nerve and spinal reflexes
• Spinal palpation.
This examination identified an inability to maintain a normal posture and gait due to the pelvic limb paraparesis, weakened spinal reflexes and delayed hindlimb proprioception, as well as loss of the cutaneous trunci reflex following spinal palpation at the lower TL region. These results indicated a T3 – L3 myelopathy.
Client consent was subsequently obtained for spinal imaging and surgical intervention, if appropriate and required. The client also completed an additional magnetic resonance imaging( MRI) patient safety questionnaire at this time.
Treatment
Following the patient ' s admission, a pre-anaesthetic examination was performed. Premedication consisting of an intramuscular( IM) injection of 0.2 mg / kg methadone( Comfortan, Dechra) and 15 μg / kg medetomidine( Sedator, Dechra) was administered. This provided adequate sedation for placement of an intravenous( IV) catheter. The patient was then transferred for MRI induction.
Propofol( PropoFlo Plus, Zoetis) was administered to effect by a veterinary surgeon( VS) to induce anaesthesia. The patient ' s airway was secured by tracheal intubation with a size 5 endotracheal tube placed using a laryngoscope. A semi-closed rebreathing anaesthetic system was then attached. A 50:50 mix of oxygen and air was provided as well as isoflurane( IsoFlo, Zoetis), the inhalant anaesthetic agent used in this case. Intravenous fluid therapy( IVFT) of Hartmann ' s solution was administered at 4 ml / kg / hour.
A pre-MRI checklist was performed before entry into the MRI room, ensuring no metal was present, as this can interfere with image quality and / or potentially damage the machine. The patient underwent MRI of the spine, which confirmed TL IVDD at the disc space between lumbar vertebrae L2 and L3. The client was contacted to confirm their consent for surgery. The patient was transferred for theatre preparation.
The surgical site was clipped and scrubbed with chlorhexidine( Vetasept 2 % Surgical Scrub, Animalcare Ltd) diluted 50:50 with water. Once this was completed, an erector spinae plane( ESP) nerve block was performed with bupivacaine( Marcaine 0.5 %, MercuryPharma). An arterial catheter was placed and the patient was moved through to the operating theatre.
The IVFT of Hartmann ' s solution was continued and a ketamine( Anesketin, Dechra) constant-rate infusion( CRI) was started at a rate of 10 μg / kg / min, with an initial 200 μg / kg bolus. A final skin preparation was performed with a second scrub of 50:50 chlorhexidine solution followed by the application of an alcoholbased chlorhexidine spray( Hydrex, Ecolab). Cefuroxime( Zinacef, Sandoz) at 22 mg / kg was administered IV 30 minutes before surgery, and repeated every 90 minutes thereafter. Paracetamol( Paracetamol, BBraun) was administered IV at 15 mg / kg as further adjunctive analgesia, and 1 mg / kg maropitant( Vetemex, Virbac) and 1 mg / kg omeprazole( Omeprazole, Sandoz) were administered IV.
Volume 40( 3) • June 2025
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