Spinal Case of the Month
Spinal Case of the Month: Neuro-Oncology
On the 1st January 2017 Malcom, a 6 year old male Boxer, presented to us as an emergency having struggled to use his left hind limb for approximately 6 weeks. His problem had progressed to the left front limb, leaving him very much impaired and unable to use the left side of his body.
By doing a neurological examination, we localised Malcom’s problem to the lower region of the spinal cord. We suspected that a lesion was blocking the nerve impulses originating in the brain from reaching the limbs.
Malcom was anesthetised on the day of presentation and underwent an 1.5 Tesla (high field) magnetic resonance imaging (MRI) scan. This revealed the presence of a left sided lesion at the cervical vertebrae 5 and 6, (see image below, dogs have 7 cervical vertebrae). The lesion was located on the side of the spinal cord at the level of the meninges (the layer of tissue around the spinal cord) and the nerve root exiting the spine.
According to recent reports, the lesion that we saw seems to more commonly affect Boxer dogs than other breeds and is usually a form of benign cancer, meaning that it does not spread to other parts of the body. But because of the location of the mass, near delicate nervous structures, there was local damage to the spinal cord and symptoms, such as those that affected Malcom.
After careful discussion with Malcom’s owners, considering that the lesion could be approached surgically and potentially removed to prolonged Malcom’s life for at least a year, we agreed to perform the spinal surgery.
Malcom had surgery on the 3rd January and we used a technique called a ‘cervical hemilaminectomy’ and fluoroscopy (a live X-ray in theatre – see image) to be able to reach the lesion. The surgery took approximately 4 hours and allowed us to debulk and remove the mass. Malcom received advanced nursing after surgery, because he was showing pronounced neurological deficits, this included physiotherapy / rehabilitation and pain management from our anaesthetist team and care from our nursing team.
Correct and advanced nursing of spinal patients is essential to their recovery which can take several days, sometimes weeks. Although slow, recovery in cases with spinal diseases is usually good and it is extremely rewarding for everybody to see the return of mobility.
The lab confirmed that Malcom’s cancer is benign and is called a ‘nerve sheath tumour’, therefore originating from a nerve root. It is probably, for Malcom, the best case scenario compared to other types of cancer, but unfortunately the lesion will regrow . Surgery will once again be an option.
In the meantime, Malcom has made a great recovery and went home on the 10th January. Since then, he has recovered full use of all his limbs and is enjoying walks and does not currently need any medication.
Dorsal view of Malcom’s spine showing the lesion on the left (white arrow), appearing brighter than the spinal cord after a contrast agent has been injected in his blood.
Peri-operative X-ray of Malcom’s neck helping us to localise the vertebral site of the lesion (black arrow).
Malcom after surgery
Malcom after surgery