Epidemiological and Clinical Studies in Cats with Thoracolumbar Vertebral Fracture and Luxation and Its Management

Background: Thoraco-lumbar spinal trauma frequently results in neurological dysfunction of varying degrees in domestic cats. The consequences may be permanent disability or death depending on severity and segment of spinal cord affected. Assessment of primary damage to spinal cord is important to prevent secondary damage and complications arising from neurological deficit. Since assessment of neurological dysfunction and its treatment in spinal trauma in cats is an evolving field, the present study was undertaken with an objective to record and associate epidemiological data and clinical examination findings at the time of presentation with clinical outcome on 60th post-treatment day in cats with thoracolumbar vertebral fracture and luxation, for a better clinical approach in this condition. Methods: 24 affected cats were assessed epidemiologically and clinically at the time of presentation. All the cats were treated either conservatively or surgically based on extent of neurological dysfunction and severity of injury on radiographic evaluation. Post-treatment observations was then correlated with epidemiological data and clinical findings to assess the clinical outcome. Result: In the present study, sub-adult semi-domicile cats were most affected and major cause was automobile accident. Presence of concomitant injuries (30%) affected recovery. Thoracolumbar spinal cord segment (T3-L3) was most affected (71%). Among 16 cats with unstable vertebral fractures, 5/6 cats recovered after surgical treatment and 2/10 cats recovered after conservative treatment. Survival and recovery was poor when degree vertebral canal displacement was more than 70% (10 cats). All 7 cats with grade 1 or grade 2 and one cat with grade 3 neurological dysfunction recovered after conservative treatment. 5 cats with grade 3 and 2 cats with grade 4 neurological dysfunction recovered after surgical treatment. Selection of surgical treatment provided better recovery in cats with unstable vertebral fractures and greater degree of neurological dysfunction.

Percutaneous kyphoplasty for the treatment of distal lumbosacral pain caused by osteoporotic thoracolumbar vertebral fracture

Background Kyphoplasty has been demonstrated to be minimally invasive and effective in treating osteoporotic vertebral fracture patients with back pain over the level of the fractured vertebrae. Rare studies have reported on thoracolumbar vertebral fracture patients presenting with distal lumbosacral pain (DLP). Whether kyphoplasty had a favorable therapeutic benefit for these patients remains unclear. Purpose To evaluate the therapeutic efficacy of kyphoplasty in treating osteoporotic thoracolumbar vertebral fracture (OTVF) patients with DLP and assess the clinical significance of focal tenderness to palpation in these patients. Material and Methods Thirty-two OTVF patients who only complained of DLP were treated by kyphoplasty. The vertebral heights, local kyphotic angle, Visual Analogue Scale (VAS), and Oswestry Disability Index (ODI) scores were assessed preoperatively, one day after surgery, and at last follow-up. All patients were evaluated regarding their degree of satisfaction with kyphoplasty. In addition, we compared the therapeutic efficacy of kyphoplasty in patients with and without focal tenderness to palpation. Results All patients successfully underwent kyphoplasty without complications. The vertebral heights, local kyphotic angles, VAS, and ODI scores were all significantly improved after kyphoplasty and maintained at last follow-up in our patients ( P < 0.001). At last follow-up, all patients expressed satisfaction with kyphoplasty. No significant differences in these parameters were detected between patients with and without focal tenderness. Conclusion The possibility of thoracolumbar vertebral fractures in elderly patients complaining of DLP should not be neglected. Kyphoplasty presents a superior benefit in treating OTVF patients with DLP. The absence of focal tenderness does not influence the clinical efficacy in these patients.