Diseases / List of Physical / Traumatic Diseases / Disease description:

Spinal Injury in Lagomorphs and Ferrets

KE_Spinal_traumaRTAwild_rabbit.JPG (44938 bytes) Farcture-dislocation lumbar spine. Click here for full page view with caption Spinal fracture L6. Click here for full page view with caption Spinal fracture L6. Click here for full page view with caption RSrabbit_spinal_2_Lat_andX.jpg (31418 bytes) RSrabbit_spinal_Fx_xray_DV_andX.jpg (35327 bytes)

INFORMATION AVAILABLE

GENERAL INFORMATION

CLINICAL CHARACTERISTICS & PATHOLOGY

INVESTIGATION & DIAGNOSIS

TREATMENT & CONTROL

SUSCEPTIBILITY & TRANSMISSION

ENVIRONMENT & GEOGRAPHY

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General and References

Disease Summary

 
Lagomorphs
  • Vertebral fracture or dislocation is a very common cause of acute posterior paresis and paralysis in rabbits. (B602.20.w20, B603.3.w3, B606.10.w10, B609.2.w2, N12.38.w1)
  • Rabbits are susceptible to this type of injury because they have relatively powerful hind limb muscles that are attached to quite a light and fragile skeleton. (B614.15.w15, N12.38.w1)
  • Fractures are more common than dislocations. (B602.20.w20, B609.2.w2)
Ferrets One of the most common neurological problems in ferrets is spinal trauma. 

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Alternative Names (Synonyms)

  • Broken back
  • Paralysis of the hindquarters
  • Spinal fracture
  • Traumatic spinal disease
  • Traumatic vertebral dislocation
  • Vertebral fracture
  • Vertebral luxation

See also: 

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Disease Type

Physical/Traumatic

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Infectious/Non-Infectious Agent associated with the Disease

  • Improper handling and restraint, struggling during restraint (B601.11.w11, B602.20.w20, B603.3.w3, B606.10.w10, B606.10.w10, B609.2.w2, B614.15.w15, J15.28.w1, N12.38.w1)
  • Kicking out due to fear. (N12.38.w1)
  • Trauma during anaesthetic induction (B609.2.w2)
  • Trauma in cage (B606.10.w10, B609.2.w2)
  • In wild lagomorphs, road traffic accidents. (V.w26)
Pathogenesis
  • Fracture or luxation most commonly occurs when the heavily muscled hindquarters are permitted to twist around the lumbosacral junction and this acts as a fulcrum applying leverage to the vertebral column. (B602.20.w20, B603.3.w3)
  • The lumbosacral region is most commonly affected and in particular, L6 to L7. (B601.11.w11, B602.20.w20, B606.10.w10, B609.2.w2, B614.15.w15)
  • Spinal fracture or dislocation can occur if the rabbit struggles during improper restraint and kicks out with its hindlegs. (B601.11.w11)
  • Caged rabbits may suffer from osteoporosis due to a combination of inadequate exercise and poor diet and therefore are susceptible to vertebral fractures when startled in their cage. (B603.3.w3, B606.10.w10)
  • There is no cauda equina in the rabbit; the spinal cord extends along the whole length of the vertebral column and so damage at any level can affect both the upper and lower motor neurons. Loss of skin sensation (panniculus reflex) and urinary and faecal incontinence are often seen. (B601.11.w11)
  • Intervertebral disc rupture can also occur in rabbits particularly in the lumbar region, and the extrusion of disc material into the vertebral canal can result in spinal cord compression and paresis. (B602.20.w20) See: Intervertebral Disc Disease in Rabbits and Ferrets

Infective "Taxa"

  • --

Non-infective agents

--

Physical agents

-- Indirect / Secondary

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References

Disease Author

Nikki Fox BVSc MRCVS (V.w103); Bridget Fry BSc, RVN (V.w143)
Click image for main Reference Section

Referees

John Chitty BVetMed CertZooMed MRCVS (V.w65)

Major References / Reviews

Code and Title List

B601.11.w11, B602.20.w20, B603.1.w1, B603.3.w3, B606.10.w10, B606.10.w10, B609.2.w2, B611.17.w17, B614.15.w15
J15.28.w1, J29.16.w7, J34.24.w3, J213.2.w2
N12.38.w1

Ferrets
B232.8.w8. B602.11.w11, B631.18.w18, B627.13.w13, B631.19.w19, B631.28.w28
P120.2008.w1
J213.10.w3

Other References

Code and Title List

V.w26

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Clinical Characteristics and Pathology

Detailed Clinical and Pathological Characteristics

General  

Clinical Characteristics

 
Lagomorphs

Clinical signs of lumbar vertebral injury may include:

  • Acute posterior paresis/paralysis (B602.20.w20, B603.3.w3, B606.10.w10, B614.15.w15, J34.24.w3)
  • Pain or hyperaesthesia can often be elicited at the site of spinal cord damage. (B609.2.w2)
  • Loss of skin sensation (panniculus reflex). (B601.11.w11, B602.20.w20, B614.15.w15, J15.28.w1)
  • Loss of anal sphincter tone/faecal incontinence (B606.10.w10, J15.28.w1, J34.24.w3, N12.38.w1)
  • Constipation. (N12.38.w1)
  • Faecal or urine staining of the perineum due to loss of motor control of the anal sphincter and the urinary bladder (urinary and fecal incontinence), or due to an inability to posture properly. (B601.11.w11, B602.20.w20, B603.3.w3, B606.10.w10, B611.17.w17, B614.15.w15, J15.28.w1, J34.24.w3, N12.38.w1)
  • Bladder distension due to urine retention resulting from loss of motor control of the urinary bladder. (B606.10.w10, B614.15.w15)
    • It is important to distinguish "overflow urination" from normal micturition. (B614.15.w15)
    • Clinical signs of uraemia may be seen if the bladder is not frequently manually expressed. (B614.15.w15)
  • Perineal scalding and dermatitis or decubitus ulcers (if there is faecal or urinary soiling). (B614.15.w15, J29.16.w7)
  • In milder cases where there is just spinal pain rather than paresis or paralysis, the following non-specific clinical findings may be found:
    • Dysuria. (B603.1.w1)
    • Caecotroph accumulation. (B603.1.w1)
    • Anorexia. (B603.1.w1)
    • Myiasis (B603.1.w1)
    • Altered gait, reluctance to exercise or reluctance to climb stairs. (J29.16.w7)

Often, an episode of spinal fracture in a rabbit that has made a substantial recovery may be recognised months or even years later as hyperflexion of the sacrum. (B614.15.w15)

Clinical pathology
  • Azotaemia or uraemia may be seen secondary to urinary retention in rabbits that have broken their backs and treatment has been delayed. (B602.20.w20)
Ferrets Neurological
  • Hind limb paresis (partial paralysis). (P120.2008.w1, B232.8.w8, B602.11.w11)
  • Ataxia (loss of muscle coordination). (P120.2008.w1)
  • Abducted hind limbs. (B232.8.w8)
  • Uncoordinated body. (B232.8.w8)
  • Possible loss of spinal flexibility, which causes the back to appear less curved. (B232.8.w8)
  • Absence of withdrawal and placing reflexes may be noted. (B232.8.w8)

General

  • Urinary and faecal incontinence. (J213.10.w3, B232.8.w8, B602.11.w11)
  • Often the ferret appears bright and alert. (B232.8.w8)

Incubation

--
Lagomorphs
Ferrets --

Mortality / Morbidity

  •  
Lagomorphs
Prognosis
  • Often a poor prognosis. (J34.24.w3)
  • The site and the severity of the lesion will influence the prognosis. (B601.11.w11, B606.10.w10)
  • Absence of deep pain reflexes indicates a poor prognosis; however, since rabbits often hide signs of pain, this reflex is not always reliable. Note that a withdrawal reflex is purely local so it does not confirm an intact cord. (B601.11.w11, J15.28.w1)
  • Prognosis is improved if the hind limbs and bladder have retained some motor function. (B606.10.w10)
  • Frequently, the clinical signs of spinal cord injury are associated with the transient oedema at the trauma site if the fractured bone ends don't become displaced. Over the course of the next one to two weeks, resolution of the "spinal shock" may lead to return of locomotor function and the rabbit may be able to move independently around the cage. (B614.15.w15)
Ferrets
  • Prognosis is dependant on the severity of the injury, from good to hopeless. (B631.28.w28)
    • Guarded prognosis if severe spinal cord damage has occurred. (B627.13.w13)

Pathology

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Lagomorphs --
Ferrets --

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Human Health Considerations

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Susceptibility / Transmission

General information on Susceptibility / Transmission

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Lagomorphs
Susceptibility
  • Rabbits are susceptible to this type of injury because they have relatively powerful hind limb muscles that are attached to quite a light and fragile skeleton. (B602.14.w14, B614.15.w15, J213.2.w2)
  • Caged rabbits: startled rabbits that suddenly jump in their cage can damage their spine. (B602.20.w20, B609.2.w2) 
    • Caged rabbits may suffer from osteoporosis due to a combination of inadequate exercise and poor diet and therefore are susceptible to vertebral fractures when startled in their cage. (B603.3.w3, B606.10.w10)
Transmission
Ferrets
Susceptibility
  • One of the most common causes of neurological disease is spinal trauma. (J213.10.w3)

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Disease has been reported in either the wild or in captivity in:

Further information on Host species has only been incorporated for species groups for which a full Wildpro "Health and Management" module has been completed (i.e. for which a comprehensive literature review has been undertaken). Host species with further information available are listed below:

Host Species List

(List does not contain all other species groups affected by this disease)

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Disease has been specifically reported in Free-ranging populations of:

  • --

Further information on Host species has only been incorporated for species groups for which a full Wildpro "Health and Management" module has been completed (i.e. for which a comprehensive literature review has been undertaken). Host species with further information available are listed below:

Host Species List

  • --

(List does not contain all other species groups affected by this disease)

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Environment/Geography

General Information on Environmental Factors/Events and Seasonality

  • --

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Regions / Countries where the Infectious Agent or Disease has been recorded

  • --

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Regions / Countries where the Infectious Agent or Disease has been recorded in Free-ranging populations

  • --

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General Investigation / Diagnosis

General Information on Investigation / Diagnosis

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Lagomorphs

Based on clinical signs, neurological examination, radiography and myelography. (B601.11.w11, B606.10.w10)

  • Test movement, proprioception, reflexes, bladder and perineal tone, skin sensation, and deep pain sensation. (B603.3.w3)

Ferrets A clinical examination should carried out, a history taken (including vaccination status) and a diagnostic work up carried out (including clinical pathology) to eliminate the possibility of systemic diseases which may lead to hind limb weakness (B232.8.w8, B602.11.w11, B627.13.w13 B631.28.w28, P120.2008.w1) Response to treatment can also confirm the diagnosis. (B627.13.w13)

History:

  • Check the disease status of the colony. (B232.8.w8)
  • Check the reproductive status of the ferret. (B232.8.w8)
  • Eliminate the possibility of poisoning. (B232.8.w8)
  • There is usually a gistory of a traumatic event associated with spinal injury. (B631.28.w28) 

Clinical examination (to rule out systemic disease)

  • Paresis may be due to weakness; the weight of the ferret should be checked. (B631.18.w18)
    • Weakness occurring when the ferret has not eaten, and resolving after a meal, suggests Insulinoma in Ferrets. (P120.2008.w1)
  • Palpate the ferret's abdomen (P120.2008.w1, B232.8.w8) and lymph nodes. (J213.10.w3)
  • Check for cardiac arrhythmias. (P120.2008.w1, B232.8.w8, B602.11.w11)
    • A respiratory sinus arrhythmia can be normal in some ferrets. (B602.11.w11)
    • Take the heart rate and the femoral pulse. (P120.2008.w1)
  • Listen to the lungs. (J213.10.w3)
  • Take the ferret's temperature. (J213.10.w3)
  • Faecal samples can be taken for parasitology and culture. (B232.8.w8)
  • Biochemistry and haematology (J213.10.w3, B602.11.w11), including glucose levels (Insulinoma in Ferrets), and serology for Aleutian disease (Aleutian Disease in Ferrets) (P120.2008.w1) and distemper (Canine Distemper) should be run. (B232.8.w8, P120.2008.w1)
    • Neurological examination can take place once it is known that the blood glucose is in normal range. (P120.2008.w1)

Neurological examination

  • A neurological examination should be carried out. (B631.18.w18)
    • As for cats and dogs (J213.10.w3), assess spinal, proprioceptive and hind limb reflexes including the knuckling-over reflex and placement reflexes. Assess consciousness and awareness of pain in the hind limbs. (B631.18.w18, P120.2008.w1)
      • The flexor reflex and the patellar ligament reflex are the spinal reflexes most commonly tested. (P120.2008.w1)
    • Cranial nerve assessment of the ferret; this involves examining the symmetry of the face, tongue usage, swallowing, pupillary light reflexes. (J213.10.w3)
    • The presence or absence of nystagmus, head tilt or falling to one side should be checked. (J213.10.w3)
  • CSF (cerebrospinal fluid) can be taken from between L5 and L6, for culture and sensitivity testing. (P120.2008.w1, J213.10.w3)
  • An electromyogram can be run to detect electrical impulses. (P120.2008.w1)

Imaging (radiography, myelography)

  • If signs are local to the spinal column (spinal reflexes absent or diminished), spinal radiographs should be taken under general anaesthetic (B232.8.w8, B602.11.w11, B631.18.w18, B631.28.w28)
    • Normal vertebral formula for ferrets is C7, T15, L5-7, S3, Cd18. (B631.19.w19)
    • Note: growth plates close in ferrets at seven months. (B631.19.w19)
  • Myelography is useful to rule out Intervertebral Disc Disease, although due to the small size of the structures involved, decreased space with intervertebral disk disease may not easily be seen. (P120.2008.w1) Myelography may show where on the spinal cord there are pressures (P120.2008.w1) or where fractures are present. (B232.8.w8)
    • A myelogram should be performed with the ferret in sternal recumbency, contrast being injected through the lumbar approach. (B232.8.w8)
    • The ferret's hind legs should be extended forward, this will open up the intervertebral space. (B232.8.w8)
    • A 20 or 23 gauge spinal needle, can be placed between L5 and L6. This is done under aseptic conditions. (B232.8.w8)

    • Alternatively, a needle can be placed in the atlanto-occipital joint and a sample of cerebrospinal fluid can be taken from this site. (B232.8.w8)
  • MRI scan is also recommended. (J213.10.w3, B631.28.w28)

Related Techniques
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Similar Diseases (Differential Diagnosis)

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Ferrets Differential diagnoses in hind limb weakness/paralysis include:

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Treatment and Control

Specific Medical Treatment

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Lagomorphs
  • In acute cases:
    • Methylprednisolone sodium succinate can be given at shock doses. (B602.20.w20, J15.28.w1)
      • 30 mg/kg by intravenous injection. Administer within eight hours of the initial injury to be effective in limiting tissue damage; if it is given after this period it may have detrimental effects. (B601.11.w11)
      • Note: it has been suggested that this should only be given in the first hour, and that administration after that time may be detrimental. (V.w65)
  • In chronic cases:
    • In mildly affected rabbits where the spinal cord is not transected and the defect is stable:
      • Cage rest: for six weeks (B601.11.w11, B602.20.w20)
      • Prednisolone: 0.25 mg/kg orally every twelve hours for five days. (B602.20.w20)
      • NSAIDs can be used as long term antiinflammatory and analgesic treatment. (B601.11.w11, B602.20.w20, J15.28.w1)
  • Surgical stabilisation
    • This should be carried out if possible in cases with spinal compression or instability. (B601.11.w11, B603.3.w3, J15.28.w1)
  • Euthanasia is often indicated. (B602.20.w20)
    • In serious cases where normal urination and defecation are affected, euthanasia should be considered if there is no improvement after several days. (B614.15.w15)
    • However: "Euthanasia need not be considered in cases where control over the urinary bladder and anal sphincter remains unimpaired and where partial to complete motor recovery follows an observation period of 2 weeks". (B614.15.w15)
Ferrets
  • The treatment depends on the severity of the injury and the location. (B631.28.w28)
  • Ultra-short-acting corticosteroids can be used when acute injury is suspected. (B631.18.w18)
  • Alternatively antibiotic cover, NSAIDs and analgesia can be given as required. (B631.18.w18)

Prognosis is dependant on the severity of the injury and varies from good to hopeless. (B631.28.w28)

Related Techniques

 

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General Nursing and Surgical Techniques

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Lagomorphs
  • Surgical stabilisation
    • This should be carried out if possible in cases with spinal compression or instability. (B601.11.w11, B603.3.w3, J15.28.w1)
Supportive therapy

Intensive nursing care is essential. (N12.38.w1)

  • Prolonged cage rest (N12.38.w1) for six weeks (B601.11.w11, B602.20.w20)
  • Provide good padded bedding for recumbent rabbits and turn the rabbit carefully every two hours to prevent development of pressure sores. (N12.38.w1)
    • Rotation of the rabbit's position every four to six hours to prevent pressure sores. (B601.11.w11)
  • Manual bladder expression (B602.20.w20, J15.28.w1)
    • This may be necessary three to four times a day to limit the risk of urinary tract infection and bladder wall damage due to overdistension. (B601.11.w11)
    • Diazepam at 0.25 to 0.5 mg/kg orally is useful for relaxing the external urethral sphincter and so aiding manual bladder expression. (B601.11.w11)
  • Urinary catheterisation and/or enemas may be required in individuals with urinary incontinence or problems urinating, and faecal constipation, respectively. (N12.38.w1)
  • Management/prevention of faecal/urinary soiling
    • This is important in itself but also to avoid development of Myiasis secondary to soiling. (B606.10.w10)
    • Daily bathing to remove faeces and urine. (B601.11.w11, B606.10.w10) See: Bathing Rabbits
    • Application of barrier creams to the perineal area to protect from urine scald. (B601.11.w11, B606.10.w10)
    • Use disposable nappies, or absorbent bedding. (B606.10.w10)
  • Feeding assistance: ensure food and water are easily in the rabbit's reach, and if necessary support the rabbit while it feeds. (B606.10.w10)
  • To compensate for inability to carry out normal coprophagy, feed the rabbit its own caecotrophs, and supplement with vitamins (orally, plus weekly injections of B vitamins). (B606.10.w10)
  • Body bandage
    • In one report of a rabbit with a severe spinal fracture, treatment using a body bandage and confinement to small cage for three weeks was partially successful. Return to full function was not achieved but the rabbit was apparently able to move around by itself and have a reasonable quality of life. (B601.11.w11)
  • Hydrotherapy - this is much better tolerated than might be expected, and can be beneficial. (B601.11.w11)
Carts
  • A cart that supports the hindquarters is tolerated well in some rabbits and apparently these animals may go on to lead a good quality life. (B602.20.w20)
    • Note: consider the welfare implications of using a cart in a highly stress-susceptible animal. (B601.11.w11, J15.28.w1)
Ferrets
  • Supportive care. (B232.8.w8)
  • If paresis or paralysis is present, physical therapy is an important part of treatment. (B602.11.w11)
    • Passive motion exercise three to four times daily carry out for affected limbs. Massage the limbs to enhance the blood flow. (B602.11.w11)
    • Massaging the ferret's muscles will increase muscle tone and help stimulate the neurological function. (B602.11.w11)
  • Catheterisation (Urethral Catheterization in Ferrets) is necessary if the ferret becomes incontinent. (J213.10.w3)
Related Techniques
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Preventative Measures

Vaccination --
Lagomorphs --
Prophylactic Treatment

--

Lagomorphs
Related Techniques
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Environmental and Population Control Measures

General Environment Changes, Cleaning and Disinfection --

Lagomorphs

  • --
Population Control Measures --
Lagomorphs --
Isolation, Quarantine and Screening --
Lagomorphs --
Related Techniques
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