Case Studies | A new breed of specialist referral hospital | Based in High Wycombe, covering the whole of the UK

Tia presented to Hamilton Specialist Referrals (HSR) as an emergency following a road traffic accident. Unfortunately, she sustained a severe injury which resulted in her being paralysed in her back legs. Her out of hours vet service promptly identified this and acquired some x-rays of her back (see images below). The x-rays revealed a high suspicion of a back fracture (red arrows) and as such, Tia was referred to HSR for emergency treatment. On presentation, Tia was very bright but unable to walk.

Luckily, Tia was still able to feel her back legs. The prognosis for being able to walk again after a back fracture is good, provided patients can feel their toes, despite not being able to move them. Therefore, we gave Tia every opportunity and began treatment.

Tia was assessed by our amazing anaesthesia team and surgery nurses who stabilised her so that she could be anaesthetised. Under a general anaesthetic, a CT (cat scan) of the back confirmed the fracture in her back (Red Arrow in images below). From the x-rays, the fracture looked to be very mild, unfortunately the CT revealed that the break was severe and the bones had moved.

Furthermore, the image below shows that the spine was shunted to one side. The red line and blue lines, which are on either side of the fracture, should be in a straight line, which they are not.

The severe break and the shift in the alignment of the bones meant there was compression of the spinal cord. This compression and bruising of the spinal cord meant that the signals from the brain were not able to get to Tia’s legs and thus the cause of her being paralysed.

Therefore, one of our specialist surgeons (Andy Craig) recommended surgery to stabilise the vertebra. This meant that he could restore alignment of the vertebra, relieve the compression of the spinal cord, and allow the bruising of the spinal to resolve. Tia was taken to theatre where the vertebra (the bones that house the spinal cord) were approached through an incision in his back. One of our surgical interns assisted Andy, where the vertebra were put back into a normal position and stabilised with some pins and medical grade cement. These implants keep everything stable while the fracture heals. A CT scan was taken after the surgery and confirmed normal alignment. In the images you can see that before surgery (left image) the alignment of the vertebra is not perfect (red lines) before surgery and after surgery (image on right) you can see that the vertebrae are in line (green line).

The images below (left with no labelling, right with labelling) reveals part of the final fracture repair. The metal pins (bright white lines, pointed out by blue arrows) were placed in the bone of the vertebra, staying away from the vertebral canal (red circle) which houses the spinal cord (green star). Medical grade cement (orange arrows) was then placed to secure the metal pins together.

Tia recovered well from surgery. She was kept in the hospital for about a week for care by our amazing wards nurses, interns and physiotherapy department. After about a week, we were happy with Tia and she went home, much to her Mummy and Daddy's delight.

Our physiotherapy team provided her Mummy and Daddy with some advice on how to best aid in Tia’s recovery. About three to four weeks after surgery, Tia was able to walk, albeit a little bit wobbly.

Above video shows Tia 10 days post-surgery

Above video shows Tia 2 and a half months post-surgery

Tia is a lovely girl and it was a pleasure to treat her here at HSR. We couldn’t be happier with her progress and we hope she and her, her Mummy and her Daddy enjoy lots of playful times in the future.

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