Written by a Medical Acupuncture for Veterinarians course graduate. Author’s name available upon request. Signed release obtained from client/author. 4366
Abstract: Lucy is a 9-year-old female spayed longhaired dachshund that was treated with three treatments of acupuncture for a presumptive diagnosis of thoracolumbar intervertebral disk disease. Acupuncture treatments utilizing dry needling only were provided at presentation, 4 days later, and two weeks later. Treatments provided relief of muscle tension, spinal cord analgesia, and improved proprioception following spinal cord injury.
History and Presentation: Lucy is a 9-year-old female spayed longhaired dachshund that first presented in October 2016 for a stiff gait and scuffing of her hind toes of two days duration. She was painful during palpation of the thoracolumbar back and had mildly delayed proprioception of the left hind foot. Radiographs showed calcified vertebral disks at L2/L3 and narrowed vertebral disks at T11/T12 and T12/L1. She was placed on restricted activity, leashed walks only, Tramadol 4 mg/kg three times daily and Prednisone 0.5 mg/kg once daily. Her back pain and proprioceptive deficit was resolved at her recheck appointment 1 week later. She presented again for back pain in July 2017. The owners stated he had two similar episodes of back pain with no neurologic deficits described by the owner in the preceding 8 months that were treated at home with activity restriction.
Physical Examination and Clinical Assessments: Lucy was BAR with normal vital parameters. She weighed 12.7 lbs with a body condition score of 6/9. She was ambulatory in all 4 limbs.
She was again painful to back palpation between T10-L4, with mildly delayed hind proprioception in both hind feet. Cranial nerve exam was normal, while the panniculus reflex was decreased beginning at L3 and patellar reflex was mildly hypertonic. Myofascial examination revealed heat and fascial restriction over the lumbar back. There were tight bands in the thoracolumbar longissimus muscle bilaterally, as well as the triceps brachii and deltoid muscles.
Medical Decision Making: Due to the sensitivity in the thoracolumbar region of her back, points were selected cranial and caudal to the suspected lesion along the inner bladder line for the first treatment. Treatments also focused on trigger points in the thoracic limbs, suspected to be caused by increased weight bearing in the cranial half of her body. The second acupuncture treatment was performed 4 days after the first to both encourage the owner to bring Lucy in for recheck examination to monitor her condition more closely and to allow treatment of points closer to the suspected site of the compressed spinal cord once Lucy’s back was more comfortable.
Differential Diagnoses: Differentials for Lucy included intervertebral disk disease, thoracolumbar myelopathy, diskospondylitis, spinal neoplasia. Lucy has no known history of trauma to her back.
Definitive (or Putative) Diagnosis (or Diagnoses): Presumptive diagnosis of intervertebral disk disease in thoracolumbar spine due to appearance of previous radiographic studies and breed predilection
July 3: dry needle 0.16 mm coated needles for 20 minutes GV 14; SI 9, 11; TH 10 and local triceps trigger points; GB 21; BL 11, 18, 27, 40; LR 2
July 7: dry needle 0.16 mm coated needles for 20 minutes GV 14; Bai Hui; SI 9, 11; TH 10 and local triceps trigger points; GB 21; BL 11, 13, 18, 25, 52; ST 36; LR 2
July 23: dry needle 0.16 mm coated needles for 20 minutes GV 14; Bai Hui; SI 9, 11, 12; LI 10, 15; GB 21; BL 11, 21, 23, 40; ST 36
Outcomes, Discussions, and References: Acupuncture as an adjunctive treatment resulted in faster control of Lucy’s back pain than tramadol and activity restriction alone. Her previous episodes of back pain would result in obvious pain and stiffness for at least 5-7 days as described by the owners. After the first acupuncture treatment, Lucy did not appear as stiff to her owners and she was more willing to interact. Then after the third acupuncture treatment, Lucy seemed more energetic and her old habits of digging holes in the backyard and playing with the cat had returned. The owners stated they had not known Lucy was in significant pain between her obvious episodes but that they had not noticed she had stopped many of her normal behaviors. K. Cheng describes in Acupuncture in Medicine that acupuncture communicates with the spinal cord to induce its own recovery and improves proprioception through stimulation of damaged or unused nerve pathways. In the short-term, it also relieves muscle tension in tight or painful muscles when these muscles have been used in an abnormal compensatory function.