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Written by a Medical Acupuncture for Veterinarians Course Graduate. Author’s name available upon request. Signed release obtained from client/author.

MiniMarch20

Abstract

There was successful use of acupuncture and laser therapy to return a hindlimb paraplegic dachshund to full function in 14 days without spinal decompression surgery.

History Presentation

A 15-year-old, 12-pound spayed miniature Dachshund presented on emergency with an acute onset of bilateral hindlimb paralysis and fecal incontinence. No injuries or signs of weakness, previous to onset of paralysis, had been observed by the owner.

Physical Exam and Clinical Assessment

Upon exam, the dog was able to bear weight only in the forelimbs, exhibiting a kyphotic spinal posture with bilateral hindlimbs flaccid and dragging behind the dog. She was painful to spinal palpation from L-3 through L-6. She did not have control of her bowels and was dribbling urine from what palpated to be a full, difficult to express bladder. Her cranial nerve and forelimb reflexes were intact and normal. Bilaterally in the hindlimbs, she had no conscious proprioception or patellar/crossed extensor reflexes, but she did have deep pain and a mild amount of rectal tone. She was able to partially move her tail. Her myofascial exam revealed pain in the distal thoracic and lumbar spine, as well as myofascial constriction over the scapula where she had a scar from a previous dog bite wound. The remainder of the physical exam was unremarkable for a dog of her age. Based on the neurological examination, she was diagnosed with a suspected intervertebral disc lesion in the region of L-4- through S-3 spinal segments.

Medical Decision Making

Based on financial constraints, the owner initially elected euthanasia, but eventually consented to one week of pro-bono treatment, including acupuncture and laser therapy, to see if there was any improvement. Radiographs and further diagnostics were not performed, and the dog was treated for a suspected intervertebral disk injury in the region of L-3 through S-4.

MiniMay2016

Acupuncture Treatment

The dog was started on carprofen 12.5 mg PO q 12 hours for three weeks, Gabapentin 25 mg PO q 12 hours for two weeks. She received a laser treatment (Class IIIb laser delivering 12 joules/cm2) once every 24 hours over her entire spine and hips daily for seven days. She also received hindlimb massage and passive range of motion/assisted walking every three hours for the first 10 days. She received 20-30 minute dry needle acupuncture treatments, every two-three days for the first week, using 0.16mmX20mm seirin needles placed in GV-14 (cervicothoracic nerves), Bai Hui (mid-caudal lumbar spinal nerves), bilateral Ba Fengs, K-I1 and K-I3 (tibial nerve), BL-54 (sciatic nerve), and BL-60 (fibular and tibial nerves). The goal was to stimulate peripheral nerve function to regain muscle control, as well as neuromodulation of the central nervous system in order to decrease pain and restore nerve function. Acupuncture and laser treatments were decreased to once weekly for the next four weeks after the first seven days of treatment.

Outcomes, Discussions

Within four days of treatment, the dog was able to weight bear and stand when the hindlimbs were placed, regained a bilateral withdrawal reflex, and control of bowels and urinary bladder. Within 12 days, she was able to walk with assistance from a sling from lateral support.  Although she never regained conscious proprioception in the hindlimbs, she was able to ambulate, tail wag, and have normal urinary and bowel control 14 days from presentation and returned to full function by day 45. On average, for a dog with an intervertebral lesion in the region of L-4 through S-3 with conventional treatments of cage rest and steroids or NSAIDS, it takes between 30-60 days to see mild improvement from hindlimb paralysis. The progress that this dog made in 14 days is astounding. Because multiple treatments were performed simultaneously and a definitive diagnosis was never reached, it is impossible to determine whether acupuncture alone or a combination of acupuncture, laser, massage, and conventional pain medication resulted in this remarkable recovery. Regardless, the combination of acupuncture and other therapies in the acute phase of a spinal injury is worth serious consideration when surgery is not an option or when the patient is stable enough for spinal decompression surgery to be delayed. Combination therapy that includes acupuncture and laser treatment should be considered in the perioperative period.

References:

(1)   Robinson NG.    Nonsurgical options for IVDD?  Keeping hope, and dogs, alive.  Veterinary Practice News.  May 23, 2011.  Accessed at http://www.veterinarypracticenews.com/vet-practice-news-columns/complementary-medicine/non-surgical-options-for-ivdd-keeping-hope-and-dogs-alive.aspx on 03-07-13.

(2)   Joaquim JG, Luna SP, Brondani JT, et al.  Comparison of decompressive surgery, electroacupuncture, and decompressive surgery followed by electroacupuncture for the treatment of dogs with intervertebral disk disease with long-standing severe neurologic deficits.  J Am Vet Med Assoc.  2010;236(11):1225-1229.