Written by a Medical Acupuncture for Veterinarians course graduate. Signed release obtained from client/author. A201705

Abstract
This case study focuses on a young canine patient with acute hind limb paralysis. Intervertebral
disk disease (Type I, Grade 4) was suspected and non surgical management of the neurologic
spinal cord injury was pursued. Functional neurologic recovery and ambulation were
accomplished with a multimodal medical treatment plan, including electroacupuncture (EA),
low-level laser therapy, and oral glucocorticoid medication.

History and Presentation
Zephyr is a 9 year old, female, spayed Dachshund who first presented on January 16,
2018 with acute onset of bilateral hindlimb lameness. She was normal the night before, with no
known trauma. Zephyr has had two previous episodes of hind end lameness which resolved
quickly with pain management, Carprofen and Tramadol, from her previous veterinarian. No
diagnostic imaging was performed at that time.

Physical Examination and Clinical Assessments
Upon presentation, Zephyr’s vital signs were within normal limits. Musculoskeletal examination
revealed moderate pain on myofascial palpation of the thoracolumbar junction; thoracolumbar
kyphosis; bilateral hind limb non weight bearing lameness with bilateral hind limb motor
function absent. Femoral pulses were strong and synchronous with normal temperature of all
distal limbs. Neurological examination revealed normal cranial nerves; bilateral forelimb
conscious proprioception (CP) normal, bilateral hindlimb CP absent; bilateral forelimb reflexes
normal, bilateral hind limb increased patellar reflexes with crossed extensor reflex (Upper Motor
Neuron (UMN) signs); bilateral hind limb superficial pain absent; bilateral hind limb deep pain
present. Perianal examination revealed normal anal sphincter tone. Urogenital examination
revealed normal size and tonicity bladder on palpation. Spinal radiographs were performed and
found to be unremarkable, with no calcified intervertebral disks, spondylosis, narrowed spinal
disk spaces, fractures, luxations or masses noted.

Medical Decision Making
Referral for consultation with a veterinary neurologist for advanced diagnostic imaging and
possible surgery was discussed and declined due to financial constraints. Acupuncture was
recommended for somatic afferent stimulation of spinal structures, decreasing sympathetic tone
and increasing parasympathetic balance to promote healing and nerve growth. 7 EA performed at
local trigger points releases motor units of muscles thus decreasing traction on affected spinal
cord segments. 3 Low-level laser therapy was recommended to decrease inflammation and
provide analgesia by decreasing degeneration of the motor nerves, increasing metabolism in the
nerve cells, promoting remyelination and axon regeneration. 6

Differential Diagnoses
The primary rule out for Zephyr was Intervertebral Disk Disease (IVDD). Other rule outs for
hind limb paralysis include spinal fracture, luxation, neoplasia, embolism and/or inflammation.

Putative Diagnosis
IVDD was suspected as a putative diagnosis based on physical exam findings, breed and history.
In order to definitively diagnose IVDD, a myelogram, Magnetic Resonance Imaging (MRI) or
Computed Tomography (CT) is necessary. As a chondrodystrophic breed, Dachshunds are
predisposed to age related intervertebral disk degeneration and subsequent acute dorsal disk
extrusion/protrusion causing compression of the overlying spinal cord. This is referred to as
Type I Hansen’s IVDD. 2 Based on normal spinal radiographs and neurologic exam findings with
normal forelimbs and paralysis of hind limbs with UMN signs, the injury was localized to spinal
cord segments T3-L3. Being non-ambulatory with deep pain intact, this was suspect Grade 4
IVDD. 2

Acupuncture Treatments
Acupuncture using Hwato 0.2 x 25mm needles was performed on the following points: GV 20
(Bai Hui) activates the trigeminal nerve (n.) and is parasympathomimetic, treating
stress/agitation. GV 14 activates the cervical thoracic spinal nerves (nn.), a homeostatic point
that treats back pain. GV 4 activates cranial lumbar spinal nn., a homeostatic point that treats
lumbar pain and provides pelvic analgesia. Bilateral BL 18-23 and BL 52 activates the mid
thoracic to lumbar spinal nn. near the site of injury; associated with the most lateral branch of the
dorsal primary ramus of their related spinal n. BL 40 activates the tibial n. and is the hind limb
master point, treating pelvic limb paresis. ST 36 activates the fibular n. and is
parasympathomimetic, treating pelvic limb dysfunction. KI 1 activates the tibial n. and treats
neuropraxia of the pelvic limbs. Bafeng points activate the digital nn. for peripheral pelvic limb
nerve stimulation. 7 EA was performed, with pairs of acupuncture points on the ipsilateral side
connected with an electrode and given a frequency of 3 Hz alternated with 100 Hz for 3 seconds
each, over a period of 20 minutes. 3 The other acupuncture sites were stimulated by the insertion
of a needle. Acupuncture and class IV laser therapy were recommended daily for 4 days, then
twice weekly for several weeks, then twice monthly. Additional medical treatments included
exercise restriction, Methocarbamol, Prednisone (1 mg/kg tapering dose) and Gabapentin.

IMG_0724[1]  IMG_0727[1]

Outcomes & Discussion
Zephyr received EA and laser therapy on January 16, 18, 23 and 24. Upon recheck examination
on January 18, Zephyr still had bilateral hind limb CP absent, however improvement of
superficial pain was noted especially on the left side. On January 23, Zephyr had a recovery of
ambulation/motor function, however bilateral CP was still absent on the right hind and
delayed/absent on the left hind. On January 24, Zephyr had improved with left hind CP normal
and right hind CP mildly delayed but present. At the six weeks follow up exam, on March 9,
Zephyr demonstrated normal ambulation and CP with no recurrence of symptoms. With
Zephyr’s spinal cord injury, the larger myelinated fibers responsible for CP and intermediate
voluntary motor fibers had been affected, with retention of some small fibers mediating deep
pain. 2 If small groups of axons survive the injury, they could promote neural input to higher
centers. Peripheral n. stimulation from EA decreased the inflammatory cascade and increased
oxygen perfusion and blood circulation to the site of injury, while also increasing sensory input
to the distal limbs. 3 As seen in Hayashi’s study, EA combined with standard medical treatment
(and laser therapy) was effective in recovering ambulation in an animal with IVDD. 3
Acupuncture is a useful tool that should be integrated into medical and pre/post surgical
treatment of neurologic spinal cord injury cases to promote neurologic function recovery. 4,8

References
1. Coates JR. Intervertebral disk disease. Vet Clin North Am Small Anim Pract 2000.
2. Cote, Etienne. Intervertebral disk disease. Clinical Veterinary Advisor. Elsevier-Mosby,
2011.
3. Hayashi AM, Matera JM, Pinto AC. Evaluation of electroacupuncture treatment for
thoracolumbar intervertebral disk disease in dogs. J Am Vet Med Ass 2007.
4. Janssens LAA. Acupuncture treatment for canine thoraco-lumbar disk protrusions / a review
of 78 cases. Vet Med Small An Clin 1983.
5. Longworth W, Mccarthy PW. A Review of research on acupuncture for the treatment of
lumbar disk protrusions and associated neurological symptomatology. The J Altern Compl
Med 1997.
6. Robinson, Narda. “An Emerging Standard of Care for Thoracolumbar Intervertebral Disk
Disease in Dogs”, CuraCore, curacore.org, Sept. 12, 2015.
7. Robinson, Narda. Interactive Medical Acupuncture. Teton NewMedia, 2016.
8. Still J. Acupuncture treatment of thoracolumbar disc disease: a study of 35 cases. Comp Anim
Pract Acupuncture 1988.
9. Wheeler SJ, Sharp NJH. Thoracolumbar disc disease. Small animal spinal disorders.
Diagnosis and Surgery. Elsevier-Mosby, 2005.


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