History

  • Signalment: 2-year-old male intact Pug named Bosley
  • Presenting Complaint: Bosley presented to the MissionVet Specialty & Emergency Neurology Department for evaluation of chronic progressive non-ambulatory paraparesis
  • History: 
    • Bosley started having difficulty walking in February or March 2018 when he was around 8 months old
    • Signs started with ataxia and dragging pelvic limbs
    • He was not apparently painful
    • Treatment with steroids helped, but signs were progressive
    • He lost the ability to walk in the Fall of 2019

Neurological Exam:

  • Mentation was alert and appropriate
  • Non-ambulatory paraparetic with spastic movement in the pelvic limbs when supported
  • Postural testing in the pelvic limbs was abnormal including absent knuckling (both 0) and absent hopping in the pelvic limbs (both 0)
  • Postural reactions in the thoracic limbs were normal
  • Thoracic limb reflexes were normal
  • Cranial nerve exam was normal
  • No apparent spinal pain with deep palpation at any level

Neuroanatomical Localization: T3-L3 myelopathy

Differential Diagnoses

  • Intervertebral Disk Disease (IVDD)
  • Meningitis (autoimmune vs infectious)
  • Neoplasia
  • Diskospondylitis
  • Trauma
  • Congenital Malformation

Diagnostics

Spinal Radiographs (taken May 2018):

Congenital Vertebral Spinal Malformation Case Study - Spinal Radiograph with annotation of T5-T8

Several mid thoracic hemivertebrae resulting in severe kyphosis of the T5-8 spine

MRI (performed October 2019):

Congenital Vertebral Spinal Malformation MRI

Severe spinal cord compression caused by hemivertebrae, most significant at T7-8

Congenital Vertebral Spinal Malformation MRI Spinal Cord Cross Section at T7-8 MRI of a Normal Spinal Cord Cross Section

Treatment

  • Treatment Options:
    • Decompressive surgery with spinal stabilization. (Owners elected to move forward with this option.)
    • Continued medical management with steroids, wheelchair, etc.
  • Prognosis:
    • Guarded due to length of time affected and severity of clinical signs, however, it is unlikely he would have any improvement without surgical decompression.
  • Treatment (performed October 2019):
    • Surgical decompression via dorsal laminectomy over T5-7 with stabilization using threaded pins and PMMA.
Post-Op Radiographs showing good placement of pins

Post-Op radiograph showing good placement of pins

Post-Operative Outcome

  • 2-Weeks Post-Op: Patient was weakly ambulatory with marked proprioceptive ataxia – still on steroids.
  • 8-Weeks Post-Op: Patient was strongly ambulatory with moderate proprioceptive ataxia – still on steroids.
  • 12-Weeks Post-Op: Patient remained strongly ambulatory with mild proprioceptive ataxia. Steroids were discontinued 2 weeks prior to this exam.