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Hawksmoor News

May Case Study – Joshua

may1Name:                  Joshua

Breed:                  Staffordshire Bull Terrier

Age:                     7 years old

Condition:          Severe Disc Herniation Lumbar Spinal Region (L1-L2) and Left sided (L1-L4) Continuous Hemilaminectomy performed in June 2014.

 

Joshua has been attending the centre for Hydrotherapy treatment since September 2014 following the surgery to his Lumbar spinal region after a severe disc herniation was diagnosed.

The “herniated disc” is a common back injury in people who take a fall or strain their backs. Likewise, dogs can suffer from herniated vertebral discs that can lead to severe pain or paralysis. Though these spinal injuries in dogs can be serious, there are effective treatments, such as physical rehabilitation, such as swimming and surgery.

Between each pair of vertebrae there sits an intervertebral disc, which you can compare to a jelly donut. “An outer fibrous ring called the annulus fibrosis is like the cake donut, and it is filled with a dense, shock-absorbing material called the nucleus pulposus, which is like the jelly.”

If the “jelly” becomes calcified and hard, it loses its shock-absorbing capacity. Pressure or trauma can cause the calcified material to bulge or explode into the nearby spinal canal, which houses the spinal cord, a process called herniation. The resulting pressure on the spinal cord can result in clinical signs ranging from pain to complete loss of feeling and function of the limb.

Classically, there are two types of disc herniation: “disc extrusion” occurs when the nucleus pulposus explodes into the spinal canal and “disc bulging” is when the nucleus pulposus protrudes into the spinal canal.

The clinical signs stemming from the disc herniation depend upon the location of the injury; a disc injury in the lower back can cause problems only in the hind limbs, whereas an injury in the neck can cause dysfunction in all limbs. With spinal injuries, neurological function is lost in a specific order, and the chance for recovery is greatly influenced by seeking prompt medical attention.

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The above pictures demonstrate a simplified diagram of spinal disc herniation.

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The above picture demonstrates an MRI of the spinal cord and a herniated disc is highlighted.

Joshua had surgery to deal with this spinal disc herniation classed as a “Hemilaminectomy”. This type of surgery is quite traumatic for the patient.

A hemilaminectomy is a procedure where the surgeon approaches the spinal column.  After determining the correct disc space a high speed drill with a bur is used to remove the lamina (vertebral bone) on either the right or left side of the vertebral bodies.  The removal of the bone allows the surgeon to visualize the spinal cord and the disc which facilitates removal of the disc material.  Once the spinal cord is decompressed it can begin the process of healing.

The spinal cord will require some time to heal.  The healing process for every dog is different and can take several days to weeks to be complete.  Many dogs can have a complete recovery and return to normal function.

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Joshua after his surgery recuperating at home.

When Joshua first attended the centre he was assisted in with the use of a sling to support his hind limbs, he was “hand standing” a lot and unable to support his weight through the hind limbs. He was knuckling over a lot and in particular struggling with placement of the right hind limb.

A gait analysis was not completed on this first session as Joshua was struggling so much with his limb placement.

Initial measurements were taken as follows –

 

Limb Measurement
Left Fore 21cm
Right Fore 20cm
Left Hind 30cm
Right Hind 31cm

 

These first measurements demonstrated that Joshua’s muscle mass was fairly even but he had marked muscle atrophy present in the hind limbs which was obvious during palpation and he was taking most of his weight through the fore limbs.

Deep pain reflexes were very slow especially in the right hind and the proprioception reflex in both hinds was also very reduced.

Following the assessment it was decided that Joshua would benefit the most from aquatic treadmill hydrotherapy in order to support his weight whilst also retraining his gait pattern to build equal muscle mass and encourage further hind limb usage.

Joshua was fitted with a help up harness in order to assist him on the front and back end and reduce any damage to his hind limb feet. He was then showered and taken into the treadmill with the hydrotherapist for his first session. Initially the water was filled to 12 inches and the speed was started at 0.1 miles per hour and increased to 0.3 miles per hour very slowly.

 

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Joshua in the treadmill on his first session being supported by Becky.

 

Joshua continued to attend the centre 1-2 times per week initially and progressed well during his sessions. His owner purchased a help up harness for use at home and so they could exercise him whilst supporting him also.

After 10 sessions Joshua was re measured as follows –

 

Limb Measurement
Left Fore 24cm
Right Fore 24cm
Left Hind 33cm
Right Hind 33cm

 

These measurements demonstrated that Joshua had built up his muscle mass in all 4 limbs and was even on his hind and fore limbs. He was also able to walk without the hind end of the harness on when walking at home, entering the centre and whilst walking in the treadmill which was a great result.

Whilst in the treadmill Joshua’s water level was maintained at 12 inches and the speed gradually increased to 0.5 miles per hour. He also had a step introduced to keep his fore limbs static so he could focus on engaging his hind limbs throughout his sessions. Initially Joshua coped with the step well but after a while he refused to walk on this, so it was removed.

Unfortunately for Joshua he suffered a burn to his back and so had a break from hydrotherapy from late November 2014 to February 2015.

Joshua returned to hydrotherapy on 10th February 2015 as his burn had now healed well.

Joshua was re assessed on his return to hydrotherapy and measurements taken as follows –

 

Limb Measurement
Left Fore 25cm
Right Fore 25cm
Left Hind 36cm
Right Hind 34cm

 

This demonstrated that he had maintained himself well with exercise at home whilst he was unable to attend hydrotherapy which was great for Joshua.

We started Joshua back in the treadmill again as he was walking well with some degree of ataxia (wobbling) still present.

The water level this time was filled to 9 inches and the speed up to 0.4 miles per hour. The time that he has completed has slowly been increased and he now manages 3 sets of 2 minutes 30 seconds with rest periods between.

Joshua copes very well with his sessions and enjoys wetting his dad and Becky as much as possible!!

Recently Joshua was re measured as follows –

 

Limb Measurement
Left Fore 23cm
Right Fore 23cm
Left Hind 35cm
Right Hind 35cm

 

These measurements showed that Joshua had reduced his muscle mass on the fore limbs and become even on the hind limbs meaning he was now taking less weight through the fore limbs, a great result for Joshua.

We have just introduced Joshua to the incline on the treadmill in order to engage his hind limbs whilst re training his gait pattern and building adequate muscle mass in the hind limbs. So far Joshua is responding well to the incline and although tired initially after his sessions he copes well with exercise at home.

Joshua on his holidays with his dad last year.

Joshua on his holidays with his dad last year.

We are really pleased with Joshua’s progress at the centre and he is a lovely dog to treat.

He always enters the centre with a smile on his face and works so hard to please during his sessions.

We really hope that Joshua continues to progress well and is soon back to his old self.

Well done Joshy, keep up the cracking work and build those buns of steel!!

Well done Joshy, keep up the cracking work and build those buns of steel!!