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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/4966.

Abstract:

Acupuncture was performed on a French Bulldog as part of a treatment for paresis and ataxia of her pelvic limbs secondary to congenital malformation of the thoracic spine causing compression of her spinal cord.  Her stance improved from crossed rear legs to a more stable wide stance, and she was able to climb stairs and became more active.  On neurological exam, her conscious proprioception improved.  

History/Presentation:

Izzy is a 9-year-old female/ spayed French Bulldog who was obtained by the current owner at 9 months of age.  She has had episodes every few years of severe paresis and ataxia in her pelvic limbs, and decreased proprioception was reported. Pain was not always detected, but she recovered within days with rest and metacam, although her gait remained ataxic and proprioception is delayed.  In the last 6 months, she is having difficulty going up and down the few stairs she has previously been capable of, and is more ataxic.  She is tipping forward when eating. The only medications she is taking are dasuquin supplements and heartworm prevention.

Physical Exam:

Izzy is bright, alert, hydrated with a body condition score of 4.5/9.  She walks with her weight bearing off of her pelvic limbs, and swings her feet.  When sitting, or standing for more than a few seconds, her pelvic limbs cross.  Her medial thigh adductor muscles, – gracilis, pectineus, and sartorius are very tense, as are her lateral cervical neck muscles. Along her back thoracic and lumbar erector spinae muscles are tense.  Thoracic limb reflexes, proprioception and placing are all normal.  Pelvic limb reflexes are normal, but proprioception and placing are greatly delayed, there is no crossed extensor reflex. She does not demonstrate pain on palpation.  Radiographs of her spine show abnormally shaped vertebral bodies and spondylosis in the thoracic region.

Clinical Assessment:

Thoracic spinal cord compression causing decreased sensation in rear legs and muscular contraction in compensation in the medial pelvic muscles and cervical neck.

Medical Decision Making:

Goals for acupuncture were to increase nerve conduction from spinal nerves to the pelvic limbs, and to loosen tense muscles, thus increasing comfort and mobility. Relaxing / decreased sympathetic tone points were used to allow her to tolerate acupuncture with less stress.

Acupuncture Treatment: Dry Needling and Class IV Laser:

Hwato GV 20, GV14, Bai Hu.   Decrease sympathetic overstimulation and relax for acupuncture, stimulate spinal nerve transmission.  Days 1, 5, 22, 43

Serin 20 ga bilateral in mid-belly of tense muscles of cervical neck bands, medial thighs. Reduce tension in muscles. Days 1,5, 22, 43.  BL 17-23 bilateral Days 1, 5 only

Serin 18 ga Bafeng bilaterally. Increase spinal nerve conduction. Days 1, 5 and 43.

Post acupuncture laser of lateral and medial thigh, spinal muscles, and cervical muscles.

Homecare – gentle massage and heat of lateral cervical and medial thigh muscles.

Outcome Decisions and References:

Immediately post acupuncture Izzy had a wide based stance, which looked more stable.  When lasering her cervical muscles, her head would drop in a very relaxed state.  Before her second treatment on day 5, her conscious proprioception was greatly improved, and her stance was wider and more stable. According to the owner, Izzy started voluntarily doing a set of three steps, and was more mobile.  She did well for 2 weeks, then was no longer doing stairs and was tipping forward when eating.  Her spinal muscles were much less tense after the first two treatments, so those points were not repeated.

As this is a chronic, congenital issue, full recovery is not expected, however, Izzy has been slowly deteriorating in the last few months so the improvements seen can be attributed to the acupuncture and laser.  Her conscious proprioception is better than it was when we started, most likely due to the Bafeng and Bai Hui points.  Her wide based stance, while not normal, is more stable, and may be due to improved proprioception, but the relaxing of the medial thigh adductors were likely a large part as well.  Her improved mobility is likely due to her increased stability as well as reduced neck tension, which can be attributed to the dry needling in the muscle bellies as well as the laser treatments.  As she has not demonstrated pain we did not have her on any medications when we started acupuncture, however, as she ages I expect we will use non-steroidal anti-inflammatories, gabapentin, and / or amantadine.  We will also continue massage and heat, as well as work on exercises to increase her coordination and hopefully decrease muscular compensation.

Izzy’s response to therapy has been gratifying, especially her wider based stance giving her more stability.  For dogs with pelvic limb arthritis, I will continue to focus on the palpation and if needed treatment of the adductor muscles.  I am surprised how well she and other dogs tolerate the Bafeng points, as most dogs resist palpation close to the toes. We are working on the best interval for acupuncture to maintain mobility.

For conventional references on diagnosis and management of hemivertebrae causing paresis and ataxia, I used Dewey (1.) pages 350-357, and the key to neuroanatomic localization on page 39 and Westworth and Sturges (2.) Unfortunately, the only treatments recommended were anti-inflammatory doses of glucocorticoids and surgery.  I used the Canine Point Mini Manual from Medical Acupuncture for Veterinarians to determine point selection, along with a VIN search.

 

  1. A practical guide to canine and feline neurology, 2nd edition, Dewey, 2008,
  2. Congenital Spinal Malformations in Small Animals, Westworth, D and Sturges, B Veterinary Clinics of North America Small Animal Practice 40 (2010) 951-981