Video Gait abnormality
Laura O'Sullivan, VMD, Media Veterinary Hospital, Media, Pennsylvania
Eric N. Glass, MS, DVM, DACVIM (Neurology), Red Bank Veterinary Hospital/Compassion First Pet Hospital
Gena Silver, MS, DVM, DACVIM (Neurology), Massachusetts Veterinary Referral Hospital, Woburn, Massachusetts
This is a filled error message
To access full articles on www.cliniciansbrief.com, please sign in below.
Create an account for free
Want free access to the #1 publication for diagnostic and treatment information? Create a free account to read full articles and access web-exclusive content on cliniciansbrief.com.
Account Details
Passwords do not match
Where are you from?
US|United States
CA|Canada
AF|Afghanistan
AL|Albania
DZ|Algeria
AS|American Samoa
AD|Andorra
AO|Angola
AI|Anguilla
AQ|Antarctica
AG|Antigua and Barbuda
AR|Argentina
AM|Armenia
AW|Aruba
AU|Australia
AT|Austria
AZ|Azerbaijan
BS|Bahamas
BH|Bahrain
BD|Bangladesh
BB|Barbados
BY|Belarus
BE|Belgium
BZ|Belize
BJ|Benin
BM|Bermuda
BT|Bhutan
BO|Bolivia
BA|Bosnia and Herzegowina
BW|Botswana
BV|Bouvet Island
BR|Brazil
IO|British Indian Ocean Territory
BN|Brunei Darussalam
BG|Bulgaria
BF|Burkina Faso
BI|Burundi
KH|Cambodia
CM|Cameroon
CA|Canada
CV|Cape Verde
KY|Cayman Islands
CF|Central African Republic
TD|Chad
CL|Chile
CN|China
CX|Christmas Island
CC|Cocos (Keeling) Islands
CO|Colombia
KM|Comoros
CG|Congo
CD|Congo, the Democratic Republic of the
CK|Cook Islands
CR|Costa Rica
HR|Croatia (Hrvatska)
CU|Cuba
CY|Cyprus
CZ|Czech Republic
DK|Denmark
DJ|Djibouti
DM|Dominica
DO|Dominican Republic
TP|East Timor
EC|Ecuador
EG|Egypt
SV|El Salvador
GQ|Equatorial Guinea
ER|Eritrea
EE|Estonia
ET|Ethiopia
FK|Falkland Islands (Malvinas)
FO|Faroe Islands
FJ|Fiji
FI|Finland
FR|France
FX|France, Metropolitan
GF|French Guiana
PF|French Polynesia
TF|French Southern Territories
GA|Gabon
GM|Gambia
GE|Georgia
DE|Germany
GH|Ghana
GI|Gibraltar
GR|Greece
GL|Greenland
GD|Grenada
GP|Guadeloupe
GU|Guam
GT|Guatemala
GN|Guinea
GW|Guinea-Bissau
GY|Guyana
HT|Haiti
HM|Heard and Mc Donald Islands
VA|Holy See (Vatican City State)
HN|Honduras
HK|Hong Kong
HU|Hungary
IS|Iceland
IN|India
ID|Indonesia
IR|Iran (Islamic Republic of)
IQ|Iraq
IE|Ireland
IL|Israel
IT|Italy
JM|Jamaica
JP|Japan
JO|Jordan
KZ|Kazakhstan
KE|Kenya
KI|Kiribati
KR|Korea, Republic of
KW|Kuwait
KG|Kyrgyzstan
LV|Latvia
LB|Lebanon
LS|Lesotho
LR|Liberia
LY|Libyan Arab Jamahiriya
LI|Liechtenstein
LT|Lithuania
LU|Luxembourg
MO|Macau
MK|Macedonia, The Former Yugoslav Republic of
MG|Madagascar
MW|Malawi
MY|Malaysia
MV|Maldives
ML|Mali
MT|Malta
MH|Marshall Islands
MQ|Martinique
MR|Mauritania
MU|Mauritius
YT|Mayotte
MX|Mexico
FM|Micronesia, Federated States of
MD|Moldova, Republic of
MC|Monaco
MN|Mongolia
MS|Montserrat
MA|Morocco
MZ|Mozambique
MM|Myanmar
NA|Namibia
NR|Nauru
NP|Nepal
NL|Netherlands
AN|Netherlands Antilles
NC|New Caledonia
NZ|New Zealand
NI|Nicaragua
NE|Niger
NG|Nigeria
NU|Niue
NF|Norfolk Island
MP|Northern Mariana Islands
NO|Norway
OM|Oman
PK|Pakistan
PW|Palau
PA|Panama
PG|Papua New Guinea
PY|Paraguay
PE|Peru
PH|Philippines
PN|Pitcairn
PL|Poland
PT|Portugal
PR|Puerto Rico
QA|Qatar
RE|Reunion
RO|Romania
RU|Russian Federation
RW|Rwanda
KN|Saint Kitts and Nevis
LC|Saint LUCIA
VC|Saint Vincent and the Grenadines
WS|Samoa
SM|San Marino
ST|Sao Tome and Principe
SA|Saudi Arabia
SN|Senegal
SC|Seychelles
SL|Sierra Leone
SG|Singapore
SK|Slovakia (Slovak Republic)
SI|Slovenia
SB|Solomon Islands
SO|Somalia
ZA|South Africa
GS|South Georgia and the South Sandwich Islands
ES|Spain
LK|Sri Lanka
SH|St. Helena
PM|St. Pierre and Miquelon
SD|Sudan
SR|Suriname
SJ|Svalbard and Jan Mayen Islands
SZ|Swaziland
SE|Sweden
CH|Switzerland
SY|Syrian Arab Republic
TW|Taiwan
TJ|Tajikistan
TZ|Tanzania, United Republic of
TH|Thailand
TG|Togo
TK|Tokelau
TO|Tonga
TT|Trinidad and Tobago
TN|Tunisia
TR|Turkey
TM|Turkmenistan
TC|Turks and Caicos Islands
TV|Tuvalu
UG|Uganda
UA|Ukraine
AE|United Arab Emirates
GB|United Kingdom
UM|United States Minor Outlying Islands
UY|Uruguay
UZ|Uzbekistan
VU|Vanuatu
VE|Venezuela
VN|Viet Nam
VG|Virgin Islands (British)
VI|Virgin Islands (U.S.)
WF|Wallis and Futuna Islands
EH|Western Sahara
YE|Yemen
YU|Yugoslavia
ZM|Zambia
ZW|Zimbabwe
AL|Alabama
AK|Alaska
AZ|Arizona
AR|Arkansas
CA|California
CO|Colorado
CT|Connecticut
DE|Delaware
DC|District of Columbia
FL|Florida
GA|Georgia
HI|Hawaii
ID|Idaho
IL|Illinois
IN|Indiana
IA|Iowa
KS|Kansas
KY|Kentucky
LA|Louisiana
ME|Maine
MD|Maryland
MA|Massachusetts
MI|Michigan
MN|Minnesota
MS|Mississippi
MO|Missouri
MT|Montana
NE|Nebraska
NV|Nevada
NH|New Hampshire
NJ|New Jersey
NM|New Mexico
NY|New York
NC|North Carolina
ND|North Dakota
OH|Ohio
OK|Oklahoma
OR|Oregon
PA|Pennsylvania
RI|Rhode Island
SC|South Carolina
SD|South Dakota
TN|Tennessee
TX|Texas
UT|Utah
VT|Vermont
VA|Virginia
WA|Washington
WV|West Virginia
WI|Wisconsin
WY|Wyoming
AS|American Samoa
GU|Guam
MH|Marshall Islands
Micronesia (Federated States Of)
PW|Palau
PR|Puerto Rico
US Minor Outlying Islands
MP|Northern Mariana Islands
Armed Forces Africa
Armed Forces Americas Aa (except Canada)
Armed Forces Canada
Armed Forces Europe Ae
Armed Forces Middle East Ae
Armed Forces Pacific Ap
AB|Alberta
NS|Nova Scotia
BC|British Columbia
ON|Ontario
MB|Manitoba
PE|Prince Edward Island
NB|New Brunswick
QC|Quebec
NF|Newfoundland
SK|Saskatchewan
NT|Northwest Territories
YT|Yukon Territory
Nunavut
Tell us about yourself
Choose the category that describes your business/professional activity
What best describes your position? (question 1 of 2)
Veterinarian Role: (question 2 of 2)
Non-Veterinarian Role: (question 2 of 2)
Already have an account? Sign in here.
You must agree to Brief Media's Privacy Policy and Terms of Use.
Acceptance to the GDPR regulations is required.
Related Videos
Video Gait abnormality
Jax, a 10-month-old intact male English bulldog, was presented for acute onset of a pelvic limb gait abnormality. Jax was adopted at 6 months of age with no prior medical history reported. Three weeks after adoption, he was presented to the neurology service for a 5-day history of scuffing and dragging both pelvic limb paws when walking (see Gait Abnormality Video). There was no history of trauma or discomfort since adoption. The primary veterinarian performed a routine serum chemistry profile and CBC prior to referral; all results were within normal limits.
On examination, Jax was bright, alert, and responsive. Results of cranial nerve examination were normal. Moderate general proprioceptive ataxia and paresis were present in both pelvic limbs. Evaluation of postural reactions revealed delayed proprioceptive positioning in both pelvic limbs; in addition, all segmental reflexes were intact. No hyperpathia was noted on palpation of the vertebral column. Temperature was 102.4°F (39.1°C). The physical examination was otherwise normal.
Based on the neurologic examination, an anatomic diagnosis of T3-L3 myelopathy was made. Differential diagnoses included trauma, infection, inflammation, neoplasia, and a congenital vertebral malformation. A degenerative process (eg, storage disease) was also considered.
Imaging of the thoracolumbar vertebral column was performed. Survey radiographs of the vertebral column were obtained because of the possibility of trauma, infection, neoplasia, or a congenital vertebral malformation. For general practitioners, it should be noted that survey radiographs are usually not indicated when intervertebral disk disease is suspected. Although radiographs may show mineralized disks, they are not reliable because they are unable to definitively diagnose which disk is causing the problem and are unable to show the extent of any spinal cord compression. If intervertebral disk disease is the primary consideration, a practitioner should attempt to conserve finances for advanced, confirmatory imaging such as MRI or, in some instances, CT.
Figure 1 Lateral radiograph of the patient’s vertebral column. Narrowing of the L4-L5 space, reduction of the L4-L5 foramen, and an irregular lucent cleft at the level of the caudal endplate of L4 can be seen (arrow).
A lateral radiograph of Jax's vertebral column revealed narrowing of the L4-L5 intervertebral disk space, reduction of the L4-L5 intervertebral foramen, and an irregular lucent cleft at the level of the caudal endplate of L4 (Figure 1). These findings were most consistent with physitis (see Discussion) and an associated end plate fracture.
CT was performed to evaluate bony compartment involvement. The 3 compartments of the vertebral column include dorsal, middle, and ventral compartments. The dorsal compartment is composed of the spinous process, the vertebral arch, the articular process, and the associated ligaments. The middle compartment includes everything ventral to the articular process, including the ventral floor of the vertebral canal and the dorsal portion of the intervertebral disk. The ventral compartment includes the remaining portion of the intervertebral disk and the vertebral body.1 Two compartments were found to be involved: the dorsal vertebral body (ie, middle compartment) and the remaining vertebral body (ie, ventral compartment).
An MRI was performed and revealed indistinct periosteum with irregular physeal bone and no obvious sign of trauma at the level of L5 (Figure 2). The caudal endplate of L4 and the associated epidural space became strongly enhanced after administration of gadolinium contrast.
Figure 2 Sagittal T1+ contrast MRI revealing indistinct periosteum with irregular physeal bone at the level of L5, with strong enhancement of the L4 caudal endplate and associated epidural space (arrow)
Urinalysis, urine culture and susceptibility, and Brucella canis titer results were within normal limits.
Potential causes for Jax's physitis and fracture included a traumatic fracture that occurred before adoption and progressed to secondary physitis or a bony reaction secondary to a fracture. However, the most likely cause in this case—based on signalment, author experience, and a similar prior case report2 is active physitis that occurred secondary to infection elsewhere in the body with a subsequent pathologic fracture.
Cephalexin was prescribed at 22 mg/kg q12h for 8 months to treat physitis. An antibiotic regimen lasting 6 to 8 months is generally recommended in cases of vertebral infections because of the possible nature of these infections (see Discussion).
Typically, if 2 out of 3 compartments are involved in a vertebral column fracture, as in this case, surgical stabilization is recommended. However, the high suspicion of infection made this dog a poor candidate. Strict rest was emphasized to aid fracture healing.1
Physitis refers to inflammation and lysis of the caudal physeal zone of one or more vertebrae.3 This does not include inflammation of the intervertebral disk, which would be referred to as diskospondylitis.3 Diskospondylitis also affects both endplates.3 In cases of physitis and most other vertebral infections, the primary cause or infectious agent is usually not identified.2 It has been hypothesized that physitis arises from hematogenous spread of an infection elsewhere in the body.2 Common sources of a primary infection include the urogenital tract, skin, heart, and oral cavity.2 Infections associated with physitis are most commonly thought to result from the urogenital system when the lumbar vertebrae are involved.2
Knowledge of the vascular system of the vertebrae and vertebral column is necessary to understand how primary infection elsewhere in the body may result in physitis.
Within the vertebral bodies, venous blood drains through the basivertebral vein. This venous structure (usually paired) occurs in the midbody of the vertebra in an osseous canal. Blood drains dorsally to enter the ventral internal vertebral venous plexus. The ventral internal vertebral venous plexus, also a paired structure, courses from the cranial cavity caudally throughout the vertebral canal. Venous blood from the ventral internal vertebral plexus drains into the intervertebral veins, which course along with spinal nerves out of the vertebral column. In the 5th through 7th lumbar vertebrae, the intervertebral veins continue as paired lumbar veins. At each vertebra, L5 through L7, the paired lumbar veins anastomose with each other and enter the dorsal aspect of the caudal vena cava, which lies immediately ventral to the ventral surface of the lumbar region of the vertebral column. This entire venous system is a collection of valveless vessels. Blood may flow in either direction based on the pressure in the system. The caudal abdominal organs drain into the common iliac vein, which becomes the caudal vena cava.4 Consequently, there is a close relationship with venous drainage of the lumbar vertebrae and caudal abdominal organs (eg, the urogenital tract).2,4,5
With increases in abdominal pressure, there can be a reversal of venous blood flow whereby blood from the caudal vena cava flows retrograde into the basivertebral veins. This retrograde venous flow can transport bacteria and other potentially infectious organisms into the vertebral bodies.2
For a helpful diagram of the vascular system, see video.
Within the vertebral bodies, venous blood drains through the basivertebral vein. This venous structure (usually paired) occurs in the midbody of the vertebra in an osseous canal. Blood drains dorsally to enter the ventral internal vertebral venous plexus. The ventral internal vertebral venous plexus, also a paired structure, courses from the cranial cavity caudally throughout the vertebral canal. Venous blood from the ventral internal vertebral plexus drains into the intervertebral veins, which course along with spinal nerves out of the vertebral column. In the 5th through 7th lumbar vertebrae, the intervertebral veins continue as paired lumbar veins. At each vertebra, L5 through L7, the paired lumbar veins anastomose with each other and enter the dorsal aspect of the caudal vena cava, which lies immediately ventral to the ventral surface of the lumbar region of the vertebral column. This entire venous system is a collection of valveless vessels. Blood may flow in either direction based on the pressure in the system. The caudal abdominal organs drain into the common iliac vein, which becomes the caudal vena cava.4 Consequently, there is a close relationship with venous drainage of the lumbar vertebrae and caudal abdominal organs (eg, the urogenital tract).2,4,5
With increases in abdominal pressure, there can be a reversal of venous blood flow whereby blood from the caudal vena cava flows retrograde into the basivertebral veins. This retrograde venous flow can transport bacteria and other potentially infectious organisms into the vertebral bodies.2
For a helpful diagram of the vascular system, see video.
Because of the location of the lesion in this case, it was hypothesized that the patient may have had an occult urogenital infection (eg, prostatis) that reached the lumbar vertebrae due to retrograde blood flow through the unique vascular system as previously described.
This hypothesis is based on various research in the human literature showing evidence of prostatic metastasis to the lumbar vertebrae through similar mechanisms6,7 as well as on an authors previous case in which an occult pyelonephritis was identified following postmortem examination.
Article continues after advertisement
Research on causative organisms for vertebral infections such as physitis is limited. In diskospondylitis, the most common organism isolated is Staphylococcus spp.2 A primary causative organism has not been isolated for physitis. However, Escherichia coli, Serratia spp, Streptococcus spp, and Staphylococcus spp have been identified in patients with uncomplicated physitis.2 Urine culture and serology for Brucella canis are strongly recommended in all patients. Although there is no clear evidence linking brucellosis to vertebral infections, its zoonotic potential and localization in the urogenital tract make it an imperative rule-out. Although expensive and often negative, blood cultures should also be considered.
Typically, an antibiotic with efficacy against gram-positive organisms (specifically Staphylococcus spp), such as amoxicillin—clavulanic acid or cephalexin, is recommended. If extensive neurologic deficits are involved, combination therapy with enrofloxacin is recommended to increase the antimicrobial spectrum. Antibiotics should be continued for at least 6 to 8 months or several months past resolution of clinical signs. Pain can be treated with gabapentin or tramadol. If the patient does not respond to pain medication alone, an NSAID (eg, carprofen) may be considered.
In this case, surgical debridement and/or stabilization were not pursued because of the increased risk for implant failure. If a patient does not respond to medical management, surgery may be indicated to debride the region and obtain samples for culture. In these cases, the benefits of surgical intervention are thought to outweigh the risks.
Jax remained on an 8-month course of cephalexin and strict rest. His neurologic signs resolved, antibiotics were discontinued, and his clinical signs never recurred.
References and Author Information
Reinhard KR, Miller ME, Evans HE. The craniovertebral veins and sinuses of the dog. Am J Anat. 1962;111:67-87.
Author Information
Material from Clinician’s Brief may not be reproduced, distributed, or used in whole or in part without prior permission of Educational Concepts, LLC. For questions or inquiries please contact us.
Clinician's Brief provides relevant diagnostic and treatment information for small animal practitioners. It has been ranked the #1 most essential publication by small animal veterinarians for 9 years.*
*2007-2017 PERQ and Essential Media Studies
© 2017 Educational Concepts, L.L.C. dba Brief Media ™ All Rights Reserved. Privacy Policy (Updated 02/09/2015) Terms of Use (Updated 02/09/2015)