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Neurological assessment of veterinary patients recovering from severe thoraco-lumbar spinal injuries.

Dir Sir, Patients with moderate to severe lesions of the thoracolumbar spine often have a protracted recovery time in the hospital before they can be discharged. This situation is often seen with herniation of degenerated discs in chondrodystrophic breeds or in patients with spinal trauma. The long-term care of these patients is often delegated to veterinary technicians or to the nursing staff of the hospital. It is important to determine the neurological status of the patient on a daily basis in order to monitor improvement of the patient and to determine if any deterioration has taken place. The parameters that are important in the recovery of severely affected patients are the return of deep pain perception (DPP), voluntary motor activities and voluntary micturition. The author has developed an assessment system for paralyzed patients (Table 1), that was found simpler to use and more appropriate than the standard classification system. The original classification system that is used to determine the status of a patient presenting with clinical signs of degenerative disc logical recovery in the first two to four weeks (2, 4). Once the first signs of recovery are noted, there will usually be a progressive return of function, unless there is something hindering the recovery, such as remaining or new pressure on the spinal cord, infection, or permanent partial damage to the cord. In the experience of the author, the return of these functions will not always be in the same order, especially voluntary micturition, mainly due to the fact that males suffer more from upper motor neuron spasms causing dysuria. It is however important to monitor the progression in each individual. It is also very important to identify any deterioration of a patient, especially in chondrodystrophic breeds with disc herniation, as further herniation is a well known complication after surgical decompression (4, 5). Because of the protracted recovery of many patients, it helps if one of the nursing staff can do the daily assessment. If different clinicians are involved, it is also helpful if there is an easy scoring system to follow the progress of each patient. Based on observations of over 320 cases, the author has developed an easy scoring system, whereby a member of the nursing staff can do an evaluation and assign a score to each patient. It then becomes easy to follow the progress of each patient and to identify any problems that may arise. The scoring system is based on the following events: