What are spinal fractures and luxations?

Spinal fractures are broken bones that occur in one or more of the vertebrae of the spinal column. They may be complete (separating the vertebra into two pieces) or incomplete (only extending part of the way through the vertebra) and displaced (out of alignment) or non-displaced (maintaining natural alignment). Because the vertebrae surround the spinal cord, fractured vertebrae have the potential to cause significant spinal cord and/or nerve damage. 

Spinal subluxations and luxations are partial or complete dislocations occurring between two vertebrae. These result in a loss of normal alignment that causes compressive injury to the spinal cord and its associated spinal nerves. 

What causes spinal fractures and luxations in dogs?

Spinal fractures and luxations/subluxations are most commonly caused by major trauma, such as a vehicle collision, fall from a height, or fight with another animal. It is also possible to see this type of injury without a traumatic incident in patients who have abnormal weakening of one or more of their vertebrae due to a bone tumor or bone infection. 

What are the clinical signs of a spinal fracture or luxation?

Patients who have a spinal fracture or luxation usually show signs of being in significant pain, especially if any pressure is exerted along the injured portion of their spine. Usually, other signs of trauma, such as wounds, “road rash,” broken and bleeding toenails, and lameness, are also present. They may be unable to stand up, or may have variable degrees of difficulty walking. 

How are spinal fractures and luxations diagnosed?

When a patient is brought to the hospital following a suspected or witnessed trauma, they are first triaged by the veterinarian to determine the status of their circulatory and respiratory systems and search for signs of internal bleeding. Oxygen and IV fluids are often administered to help normalized vital functions, and interventions are performed to stop any ongoing internal or external bleeding. Once this is done, a complete neurologic and orthopedic evaluation is performed. Findings consistent with a spinal fracture or luxation include pain on spinal palpation, decreased voluntary movement in the limbs and/or tail, decreased or absent reflexes, decreased sensation, and decreased bladder and anal tone. 

Once stabilized, x-rays are taken of the patient’s chest, abdomen, and spine to evaluate for the presence of internal injuries. Careful study of the spinal x-rays allows for definitive diagnosis of most spinal fractures and luxations. It is important to keep in mind that at the instant of injury, there may have been greater displacement of bone fragments than is present afterward, so injuries to the spinal cord and nerves may be more severe than expected based on the current position of the bones. 

Further detailed information about both the bone fragments and the status of the spinal cord and associated nerves can be acquired with the use of a CT scan or MRI, but these procedures are only possible in patients who are stable enough to undergo general anesthesia. 

How are spinal fractures and luxations treated?

The treatment of a spinal fracture or luxation depends on the location and characteristics of the injury. Non-displaced fractures, especially those of the thoracic vertebrae (which are surrounded by a number of stabilizing structures), often heal uneventfully with strict confinement, supportive/nursing care, and pain medication. X-rays are taken every four to six weeks to monitor the healing process and determine when physical activity can be resumed. 

Displaced or unstable fractures and luxations are best treated surgically. This typically involves making an incision down the center of the back over the injured area, precisely re-aligning the fragments, and securing them in place with screws, pins, wire, and/or bone cement. 

What are the potential risks and complications of surgery for spinal fractures?

Any surgery immediately adjacent to the spinal cord and nerve roots carries the potential for damage to these delicate structures. This risk is minimized through the use of magnification and very precise and careful manipulations. There is also a risk of intra-operative hemorrhage, as large blood vessels run along either side of the spinal cord. Following surgery, possible complications include infection, implant breakage, and compression of the spinal cord and/or nerves by scar tissue. Proper incision care and post-operative activity restriction will help to minimize these risks. 

What is the post-operative care for a spinal fracture?

Most patients remain hospitalized for at least two to three days after surgery to closely monitor their neurologic function and to provide the intensive nursing care they need as they begin to heal. During this time, patients are given intravenous fluids and injectable pain medications and antibiotics to ensure they remain well-hydrated and comfortable until they begin to eat, drink, and take oral medications. Patients are kept on thick bedding, and those who have decreased mobility are rotated from one side to the other regularly to prevent pressure sores and respiratory problems from developing. Patients are carefully assisted to an outdoor area several times each day to allow them to use the bathroom. Those who have impaired bladder function will have a urinary catheter placed or will have their bladder expressed through the application of gentle pressure several times daily. Careful attention is paid to keeping incontinent patients clean in order to prevent skin infections and discomfort. 

Once a patient is eating, drinking, and comfortable on oral pain medications, they will be sent home. Instructions specific to the patient’s current neurologic status will be provided to enable optimal at-home care. For most patients, this includes strict confinement to a kennel or large crate with plenty of soft bedding except for brief trips outside to use the bathroom. A padded belly sling will typically be sent home to assist the pet in standing up and support them while walking. If bladder function is abnormal, the owner will be taught how to catheterize or express the bladder of their pet on a regular schedule. 

Recheck appointments will be scheduled at two, four, eight, and twelve weeks after surgery. At two weeks, the stitches will be removed and a physical rehabilitation therapy program will be initiated. This typically involves once or twice-weekly appointments with one of our physical rehabilitation technicians, as well as daily at-home exercises. A program like this has been shown to improve comfort and accelerate healing. At the four, eight, and twelve week rechecks, x-rays will be taken to monitor the progress of bone healing and ensure that the implants are intact. Bone healing is usually complete by three to four months after surgery, and at each recheck, the surgeon will determine how much physical activity can be safely added into a patient’s daily routine. 

What is the prognosis for spinal fractures?

The prognosis for spinal fractures depends on the severity of the initial injury to the spinal cord and associated nerves. In patients who do not have neurologic abnormalities on their initial physical exam, as well as those who have only mild deficits (such as weakness and decreased reflexes), the prognosis with prompt and appropriate treatment is very good to excellent. Most of these patients will make a full recovery. Patients who have lost the ability to use one or more limbs, but who are still able to feel pain in those limbs, have a fair prognosis for recovery of function, although some degree of weakness and/or incoordination may persist long-term. Most of these patients will recover bladder and bowel function, if those were initially impaired. Patients who are unable to feel pain below the injury on their initial physical exam have a poor prognosis for recovery of mobility and bladder/bowel function, as loss of sensation is associated with very serious spinal cord damage. Some of these pets may be able to adapt to life in a customized wheelchair, but long-term incontinence management can become very challenging, and quality of life may be diminished to an unacceptable degree. 

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