兽研1. 引言
脊柱创伤在小动物临床中仍是一个高度相关的课题。这些病例的成功管理不仅需要准确的诊断和适当的治疗决策，还需要参与神经外科手术的外科医生对脊柱解剖有透彻的理解。全面的解剖学知识有助于精确的病变定位、合适的植入物选择以及细致的手术规划。因此，将诊断性解剖评估整合到临床评估中可能有助于改善治疗策略，并提高脊柱创伤猫获得良好手术和神经学结局的可能性[1,2,3,4]。
一般来说，椎体骨折和脱位约占猫所有神经学病例的10%[5,6]。
在脊柱创伤患者中快速有效地应用神经学检查程序是成功管理这些病例的重要方面[7,8,9]。为了预防或尽量减少创伤后的继发性脊髓损伤，应稳定患者的呼吸和循环功能[10]。
腰椎最常受脊柱创伤影响，其次是荐尾椎、胸椎和颈椎。此外，胸腰段和腰荐段交界处骨折或脱位的发生率显著[11,12,13]。
在椎体骨折中，由于血肿、创伤性椎间盘突出或脱位的骨碎片，或稳定性受损，会发生脊髓压迫。消除这种压迫并实现适当的稳定是椎体骨折和脱位手术治疗的主要目标[1,8,10,12,14]。
椎体骨折和脱位可通过手术和保守方法治疗[12,15]。保守治疗包括夹板、绷带包扎、外固定、笼内休息、限制运动和给予类固醇[11,16]。
已有许多不同的稳定技术被描述用于稳定脊柱。其中，通过应用钢板稳定棘突、用钢板稳定椎体、使用聚甲基丙烯酸甲酯（PMMA）配合钢针或螺钉进行稳定、使用外固定支架进行稳定、钢针-环扎应用以及使用椎弓根螺钉和棒系统进行稳定是常用的方法[12,13]。这些手术的成功实施需要对脊柱解剖有透彻的理解和相当的手术经验。
本研究的目的是通过将诊断性解剖特征与手术规划相结合，评估脊柱创伤猫的治疗策略和结局。
2. 材料与方法
2.1. 动物材料
本研究于2022年至2025年间在迪克莱大学兽医学院动物医院外科诊所进行。共纳入20只不同品种、年龄和性别、诊断为脊柱创伤的猫。对病例的损伤病因、脊柱病变定位、所采用的治疗方式和临床结局进行了全面评估。
2.2. 临床检查
根据病史、临床表现、神经学检查和放射学检查结果选择病例。表现为与脊柱创伤一致的神经学缺损（包括轻瘫、截瘫或感觉障碍）的猫被纳入研究。对每只猫记录品种、年龄、性别、体重、损伤原因、并发损伤以及入院至手术之间的间隔时间。进行完整的体格和骨科检查以识别脊柱损伤和任何并发的非神经学病变。对所有猫进行全面神经学检查，包括评估脊髓反射、脊柱触诊疼痛或感觉过敏、浅部和深部痛觉感知、大小便控制能力以及是否存在肌肉萎缩。深部痛觉感知通过使用钳子对趾部和趾间皮肤施加牢固压力来评估。当观察到有意识的行为反应（如发声、转头或试图咬）时，认为深部痛觉感知存在。无反应或仅有退缩反射而无意识识别的猫被认为深部痛觉感知阴性。
每只猫根据Grasmueck和Steffen（2004）[17]描述的分类系统进行神经学分级。神经学分级定义如下：
I级：脊柱疼痛无神经学缺损。
II级：可行走的轻瘫伴正常排尿功能。
III级：可行走的轻瘫伴尿潴留。
IV级：不能行走的轻瘫或截瘫伴尿潴留且深部痛觉感知保留。
V级：截瘫伴尿潴留且深部痛觉感知消失。
2.3. 放射学检查
在放射学检查期间拍摄标准侧位和背腹位X线片。
2.4. 麻醉、镇痛和抗生素治疗
每只病例均在注射美托咪定（Domitor®，Orion Pharma，埃斯波，芬兰）80 μg/kg 肌内注射、布托啡诺（Butomidor® 10 mg/mL，Richter-Pharma，韦尔斯，奥地利）0.4 mg/kg 皮下注射和氯胺酮（Ketasol®，Richter-Pharma，奥地利）5 mg/kg 肌内注射后诱导插管，并使用异氟烷和100%氧气维持麻醉（如先前报道[18,19]）。
为提供多模式镇痛，按不同作者先前描述的方法[19,20]，将12 mg氯胺酮、4.8 mg布托啡诺和40 mcg美托咪定稀释于100 mL 0.9%等渗氯化钠溶液中，在手术前、术中和术后使用自动输液泵以5 mL/kg每小时的速度静脉输注给药。
所有患者均在手术开始前开始接受抗生素预防，静脉注射头孢唑林钠（Cezol，Deva，Şahinbey，土耳其），剂量为20–22 mg/kg，并在术后继续使用5天[19,20]。
2.5. 植入物与器械
在所有病例中，椎体稳定均使用多轴螺钉-棒系统（Hasvet Medikal A.Ş.，安塔利亚，土耳其）或2.0或2.7 mm SOP钢板系统（Orthocat Vet，伊斯坦布尔，土耳其）完成。在有指征时，使用配备金刚石钻头的高速手术钻通过背侧椎板切除术或半椎板切除术实现脊髓减压。
2.6. 手术操作
将动物置于胸卧位，四肢在手术台上自由伸展。用无菌手术巾划定区域后，沿背部中线做皮肤切口，从病变部位延伸至至少两个头侧和两个尾侧椎骨。进行皮肤切口和皮下筋膜分离，注意保留竖脊肌与椎突的附着。做背侧筋膜切口后，使用双端骨钳对不稳定椎骨进行复位，并开始稳定操作。将这些骨钳置于棘突或椎体上，通过轻柔施加向上牵引实现复位，以确保脊柱的正常解剖对线。为稳定不稳定椎骨，通过在患椎头侧和尾侧至少各放置两枚螺钉实现稳定。由于其解剖结构，胸椎使用多轴螺钉-棒系统，而腰椎则优先使用SOP钢板。螺钉孔以背外侧至腹内侧的方向定位，位于横突与椎体连接点的上方（图1A,B）。在这些操作过程中，考虑了患椎的解剖结构和特征，这对确定螺钉的直径和长度尤其具有影响。
[图：椎骨上的螺钉位置：（A）SOP钢板螺钉和（B）多轴螺钉（本图绘制中使用了AI]
2.7. 术后评估
在术后检查期间，拍摄侧位或腹背位双侧X线片，以评估植入物位置和骨折复位情况。术后评估阶段获得的结果分为转归不良、功能恢复和恢复良好[12,19]。手术后，猫通常住院约2天。当认为需要额外临床监测或支持性护理时，延长住院时间。住院期间，定期监测一般临床和神经学状态、自主运动功能、排尿功能、食欲和手术部位。出院后，建议限制活动并进行笼内休息，并通过临床、神经学和影像学随访检查对猫进行重新评估。转归不良定义为治疗后持续存在排尿困难和/或步态无改善。功能转归被认为是指猫能够排尿并恢复行走能力。良好转归定义为排尿、步态正常且无本体感觉异常。
3. 结果
根据我们研究中的数据，发现所有猫均因高楼综合征（如从阳台或窗户坠落）遭受脊柱创伤。
所有病例（20只猫）均表现出不同程度的神经功能障碍，其中3只猫为III级，9只猫为IV级，8只猫为V级（表1）。所有病例均观察到尿潴留（100%）。在III级神经功能障碍的猫中，治疗后观察到功能改善。在归类为IV级神经功能障碍的猫中，7只显示功能改善，2只显示极好改善。在归类为V级神经功能障碍的猫中，4只显示改善不佳，1只显示功能改善，值得注意的是，3只猫在进行随访之前死亡。除这3例死亡外，未记录到其他重大术中或术后并发症。具体而言，在随访期间未观察到手术部位感染、伤口裂开、临床明显的植入物松动或失效，或需要翻修手术。
Table 1. Grading of neurological symptoms according to Grasmueck and Steffen (2004) [ 17 ].
| Grade | Neurological Dysfunction | Number of Cats |
|---|---|---|
| I | No back pain or neurological deficits | 0 |
| II | Ambulatory paraparesis, normal urination | 0 |
| III | Ambulatory paraparesis, urinary retention | 3 (15%) |
| IV | Non-ambulatory paraparesis/paraplegia, urinary retention, and deep pain perception | 9 (45%) |
| V | Paraplegia, urinary retention, absence of deep pain perception | 8 (40%) |
猫的中位年龄为2.5岁（范围5个月至4岁）。9只公猫中，7只（77.8%）已去势，2只（22.2%）未去势；11只母猫中，8只（72.7%）已绝育，3只（27.3%）未绝育。所有病例（20只猫）均因椎体或终板骨折或脱位导致脊髓不稳和压迫。因此，主要目标是脊髓和神经根减压及椎体稳定。为此，11例应用多轴螺钉，9例应用SOP钢板（图2和图3）。为进行椎体减压，2例实施背侧椎板切除术（图4），1例实施半椎板切除术（表2）。
[图：第十四例的X线片：术前左侧位（A），术后腹背位（B），右侧位（]
[图：不同病例的X线影像。（A）L2尾侧终板骨折，（B）使用SOP钢板在不同]
[图：术中背侧椎板切除术后脊髓的外观（Cr：头侧，Ca：尾侧，R：右侧，L：左侧，PS：s]
Table 2. A summary of the findings for each case.
| No. | Grade | Localization | Treatment Applied | Other Findings | Treatment Results | ||
|---|---|---|---|---|---|---|---|
| Poor | Functional | Good | |||||
| 1 | IV | L6-L7 | Polyaxial screw | * | |||
| 2 | V | T13-L1 | Polyaxial screw | * | |||
| 3 | III | L5-L6 | SOP | * | |||
| 4 | IV | L2-L3 | SOP | * | |||
| 5 | V | L6-L7 | SOP | * | |||
| 6 | IV | T13-L1 | SOP | * | |||
| 7 | IV | L3-L4 | SOP Dorsal laminectomy | * | |||
| 8 | III | L1-L2 | Polyaxial screw | * | |||
| 9 | V | T12-T13 | Polyaxial screw | Radius ulna fracture | * | ||
| 10 | IV | L7-S1 | Polyaxial screw | * | |||
| 11 | V | T12-T13 | Polyaxial screw | Scapula fracture | * | ||
| 12 | V | T10-T11 | Polyaxial screw, dorsal laminectomy | Coxa fracture | * | ||
| 13 | V | L7-S1 | SOP | * | |||
| 14 | IV | T11-T12 | SOP | * | |||
| 15 | IV | L4-L5 | SOP | Ilium fracture | * | ||
| 16 | IV | L2-L3 | Bilateral polyaxial screw, hemilaminectomy | * | |||
| 17 | V | T11-T12 | Polyaxial screw | * | |||
| 18 | IV | T12-T13 | Polyaxial screw | * | |||
| 19 | IV | L4-L5 | SOP | * | |||
| 20 | V | T9-T10 | Polyaxial screw | * | |||
在本研究中，总共20只椎体不稳的猫中有3只（15%）存在终板骨折。终板骨折椎体的分布如下：1只猫为L4头侧，1只猫为L2尾侧，1只猫为L6尾侧。在其他病例中，C1-C5和C6-T2区域未观察到椎体骨折或脱位，而13例（65%）发现于T3-L3区域，7例（35%）发现于L4-S1区域。骶尾区域未发现病变（表2）。4只猫（20%）发现并发骨盆和附肢骨骼骨折，包括1例肩胛骨骨折、2例骨盆骨折和1例桡尺骨骨折。鉴于椎体不稳和脊髓压迫可能导致进行性神经损伤，神经减压和受累椎节段稳定被视为主要手术优先事项。脊柱手术完成后，所有并发骨折均在同一次麻醉期间进行手术治疗，从而避免额外麻醉，并实现对创伤的全面管理。
4. 讨论与结论
根据本研究数据，就创伤而言，所有病例（100%）的猫均因高楼综合征，具体为从阳台或窗户坠落。这再次证实，如其他研究[12,13,21]所报道，猫的脊柱损伤因高楼综合征而非常普遍（84%），因此应告知并提醒猫主人采取必要的预防措施。本研究观察到的所有病例中，高楼综合征并非预期为创伤原因，但城市中垂直结构的存在可能有助于解释这一高发生率。
在脊柱创伤病例中，据报道，对于患有退行性椎间盘、脊髓损伤或自发性突出等疾病的截瘫患者，如果及时进行减压，预后良好[12,17,22]。因此，将患者适当转移至创伤后中心，随后进行创伤管理和损伤修复，至关重要。在我们的研究中观察到，所有病例入院时间均超过24小时，在24至72小时之间变化。建议尽可能提前这一时间。
脊柱损伤中最常受累的区域是胸腰段交界处T11-T13和L1，其次是最后腰椎和腰骶交界处。Yayla等人（2023）报告[12]，猫脊柱骨折中最常受累的区域是L4-L7区域，占48%。其次是T3-L3区域，占猫脊柱骨折的46%。C6-T2区域占猫脊柱骨折的3%，而S1-S3区域的发生率为1%。在我们的研究中，未发现C1-C5和C6-T2区域损伤的病例，而有13例（65%）在T3-L3区域有损伤，7例（35%）在L4-S1区域有损伤。胸腰段最常受创伤影响的原因可归因于该节段在解剖上柔韧性较差且缺乏保护。该区域的损伤通常导致截瘫或轻截瘫。猫的颈部损伤罕见，但可导致更严重的神经功能丧失[23]。在胸椎中，每侧的头侧和尾侧边缘存在头侧和尾侧肋凹，用于与肋骨形成关节。前一位椎骨的尾侧肋凹与后一位椎骨的头侧肋凹相接，并与椎间盘边缘连接，从而形成关节窝。该关节窝与肋头（art. capitis costa）形成关节。连接此处肋头与对侧肋头的关节内韧带（lig. capitis costa intraarticulare和lig. intercapitale）有助于脊柱稳定性。最后三节椎骨椎体前部的侧面含有一个肋凹，肋头与之形成关节。胸腰段最常受累的原因被认为是解剖学上椎体前部外侧存在一个肋凹，尤其是最后三节椎骨，且肋头仅与该肋凹形成关节，肋弓中最后两根肋骨缺失，其作为浮肋位于腹部肌肉内。胸腰段脊柱创伤高发的原因之一是该处位于脊柱中部，承受最大的弯曲力矩（图5）。
[图：脊柱胸腰段交界处：最后三节椎体前部肋凹的视图]
已有报告[3,11]指出，用于椎体不稳定的各种技术包括使用多轴螺钉、聚甲基丙烯酸甲酯（PMMA）稳定和钢板应用[14,15]。本研究包括使用多轴螺钉和钢板应用进行稳定。由于猫存在脊柱后凸，胸腰段优先选用多轴螺钉，而由于腰椎排列更为均匀，腰椎区域优先选用SOP钢板应用。
已知尿潴留或尿失禁等泌尿系统问题在遭受脊柱创伤的患者中很常见[4,8]。膀胱受累患者的预后往往较差。大多数V级神经功能损伤的患者在丧失深部痛觉后24-48小时建议安乐死，预后不良[16,22]。此外，据报道，6-15%的脊柱损伤患者同时伴有腹部损伤[16]。这可能导致腹腔积血、腹膜腔积尿或胃肠道或肝胆损伤。在我们的研究中，腹部创伤导致2例腹壁疝，另1例轻度肝脏血肿。据报道，14-48%的椎体骨折或脱位动物同时存在骨盆和附肢骨骼骨折[12,16]。在我们的研究中，3例涉及胸部创伤，1例患者有肩胛骨骨折，1例患者有前臂（桡骨+尺骨）骨折，2例患者有骨盆骨折。据报道，同时存在的损伤（如气胸、附肢骨折或腹腔积血）在猫中更为常见（猫83%，犬66%）[22]。在我们的研究中，20%的椎体骨折或脱位动物检测到骨盆和附肢骨骼同时骨折。
Grasmueck和Steffen（2004）报告[17]，在存活猫中，临床结果为完全恢复（II至IV级）12例，功能恢复（III至IV级）3例，恢复不良（III至IV级）3例。他们报告在这一相对较小的群体中，初始神经功能障碍程度与结果之间没有明确相关性。然而，如果脊髓损伤猫的深部痛觉未受影响，则可得出预后良好的结论。在我们的研究中，III级神经功能障碍的猫（3只）恢复为功能恢复。在归类为IV级神经功能障碍的猫（9只）中，7只功能恢复，2只完全恢复。在8只V级神经功能障碍的猫中，4只恢复不良，1只功能改善，3只在治疗一周内死亡。
确保充足的血流和维持氧合对于脊髓的全身稳定至关重要。因此，静脉液体疗法和氧气补充对于预防创伤事件（原发损伤）后的继发性脊髓损伤是必要的[3,10]。据报道，根据脊柱损伤的程度，继发性脊髓损伤由局部或全身血压调节丧失以及血管损伤导致的脊髓血流减少引起[3,24]。在本研究中，通过静脉液体疗法和氧气补充尝试为全身稳定提供充足的血液循环和氧合。
三例在治疗一周内死亡。由于研究涉及的人群相对较小，无法建立神经功能障碍程度与结局之间的明确相关性。然而，可以说脊髓损伤的猫如果深部痛觉完整，则预后良好。
脊柱手术对大多数从业者来说可能具有挑战性，尤其是除了良好的手术入路和解剖知识外还需要经验[12]。由Mullins等人（2024）[25]修改的Zdichavsky分类识别并描述了脊柱手术中正确和错误的操作（图6）。在这些错误操作中，永久性神经损伤是不可避免的。此外，由于螺钉从椎体右侧向左侧置入，而降主动脉位于附近，因此在准备螺钉通道时应仔细注意钻头和螺钉长度，以避免血管损伤。因此，除非存在禁忌症，我们建议SOP钢板或多轴螺钉-棒系统的入路从脊柱左侧进行。
[图：改良Zdichavsky分类，I级对应于未穿破的钻道，IIa级表示部分]
本研究的主要局限性是病例数量相对较少，且仅纳入因高楼综合征后遭受脊柱创伤的猫。因此，这些发现可能不能直接推广到其他创伤机制引起的脊柱损伤。此外，病变位置、神经严重程度和所用稳定系统的差异限制了亚组比较。需要包括不同创伤机制的更大规模多中心研究来证实这些发现。此外，由于研究所在的兽医医院没有CT扫描仪，因此缺乏CT成像。CT成像本可以实现对病变更详细的表征和评估。
在本研究中，将诊断解剖学整合到临床情境中，使得能够确定病变的解剖定位（位于哪个椎段），改善放射影像的解读，更好地进行手术规划、手术入路选择、安全解剖走廊的选择以及神经血管结构的保护。此外，得益于诊断解剖学方法，评估了解剖结构的尺寸，并确定了合适的植入物类型和大小。最后，降低了并发症的风险。了解解剖变异和关键结构如主动脉和后腔静脉有助于预防医源性损伤。此外，通过将螺钉放置在正确位置，可以预防脊髓压迫或植入物相关的椎体骨折。
致谢
我们要感谢Dicle大学兽医学院外科系的教职人员Berna ERSÖZ KANAY、Emine ÇATALKAYA和Nahit SAYLAK在本研究中执行手术和监测患者，本研究为博士论文。
作者贡献
M.K.和S.Y.设计了研究。本研究是M.K.的博士论文（M.K.，解剖学教授，拥有第二个外科学博士学位），在S.Y.的指导下进行。所有作者解读了数据，对稿件进行了重要的批判性修订以确保重要的知识内容，并批准了最终版本。所有作者已阅读并同意稿件的发表版本。
机构审查委员会声明
本研究经Dicle大学HADYEK于2022年6月16日批准，编号305415。此外，已告知患者主人并获得了同意。
知情同意声明
已获得参与研究的所有受试者的知情同意。
数据可用性声明
本研究呈现的原始贡献包含在文章中。进一步咨询可联系通讯作者。
利益冲突
作者声明无利益冲突。
资助声明
本研究由Dicle大学科学研究项目协调单位（DÜBAP）资助，项目编号VETERİNER.26.032。
脚注
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参考文献
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关联数据
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本研究呈现的原始贡献包含在文章中。进一步咨询可联系通讯作者。
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1. Introduction
Spinal trauma remains a highly relevant topic in small animal practice. Successful management of these cases requires not only accurate diagnosis and appropriate therapeutic decision-making but also a thorough understanding of spinal anatomy by surgeons involved in neurosurgery. Comprehensive anatomical knowledge facilitates precise lesion localization, appropriate implant selection, and meticulous surgical planning. Consequently, integrating diagnostic anatomical evaluation into the clinical assessment may contribute to improved treatment strategies and increase the likelihood of favorable surgical and neurological outcomes in cats with spinal trauma [1,2,3,4].
In general, vertebral fractures and dislocations account for approximately 10% of all neurological cases in cats [5,6].
The rapid and effective application of neurological examination procedures in spinal trauma patients is an important aspect of the successful management of these cases [7,8,9]. In order to prevent or minimize secondary spinal cord injury following trauma, the respiratory and circulatory functions of the patients should be stabilized [10].
Lumbar vertebrae are most commonly affected by spinal trauma, followed by sacrococcygeal, thoracic, and cervical vertebrae. In addition, there is a significant incidence of fractures or dislocations occurring at the thoracolumbar and lumbosacral junctions [11,12,13].
In vertebral fractures, compression of the spinal cord occurs due to hematoma, traumatic disc extrusion or dislocated bone fragments, or compromised stability. Eliminating this compression and achieving proper stabilization is the main goal of surgical treatment of vertebral fractures and dislocations [1,8,10,12,14].
Vertebral fractures and dislocations can be treated both surgically and conservatively [12,15]. Conservative treatment includes splinting, bandaging, external stabilization, cage rest, exercise restriction, and steroid administration [11,16].
Many different stabilization techniques have been described to stabilize the vertebral column. Among these, stabilization of the spinous processes by plate application, stabilization of the vertebral bodies with plates, stabilization with polymethyl methacrylate (PMMA) with pin or screw application, stabilization using external fixators, pin-cerclage applications, and stabilization using pedicle screws and rod systems are commonly used [12,13]. Successful implementation of these procedures requires a thorough understanding of spinal anatomy and considerable surgical experience.
The aim of this study is to evaluate treatment strategies and outcomes in cats with spinal trauma by integrating diagnostic anatomical features with surgical planning.
2. Materials and Methods
2.1. Animal Material
This study was conducted at the Surgery Clinic of the Animal Hospital, Faculty of Veterinary Medicine, Dicle University, between 2022 and 2025. A total of 20 cats of various breeds, ages, and sexes diagnosed with spinal trauma were included. The cases were comprehensively evaluated with respect to the etiology of the injury, the localization of spinal lesions, the treatment modalities applied, and clinical outcomes.
2.2. Clinical Examination
Cases were selected based on the history, clinical presentation, neurological examination, and radiographic findings. Cats presenting with neurological deficits consistent with spinal trauma, including paresis, paraplegia, or sensory impairment, were included in the study. For each cat, breed, age, sex, body weight, cause of injury, concomitant injuries, and the interval between hospital admission and surgery were recorded. A complete physical and orthopedic examination was performed to identify spinal injury and any concurrent non-neurological lesions. A comprehensive neurological examination was conducted in all cats, including assessment of spinal reflexes, spinal palpation for pain or hyperesthesia, superficial and deep pain perception, urinary and fecal continence, and the presence of muscle atrophy. Deep pain perception was assessed by applying firm pressure to the digits and interdigital skin using forceps. Deep pain perception was considered present when a conscious behavioral response, such as vocalization, turning of the head, or an attempt to bite, was observed. Cats showing no response or only withdrawal reflexes without conscious recognition were considered negative for deep pain perception.
Each cat was neurologically graded according to the classification system described by Grasmueck and Steffen (2004) [17]. The neurological grades were defined as follows:
Grade I: Spinal pain without neurological deficits.
Grade II: Ambulatory paraparesis with normal urinary function.
Grade III: Ambulatory paraparesis with urinary retention.
Grade IV: Non-ambulatory paraparesis or paraplegia with urinary retention and preserved deep pain perception.
Grade V: Paraplegia with urinary retention and absence of deep pain perception.
2.3. Radiography
Standard latero-lateral and ventro-dorsal radiographs were taken during the radiographic examination.
2.4. Anesthesia, Analgesia, and Antibiotic Therapy
Each case was induced with intubation following injection of medetomidine (Domitor®, Orion Pharma, Espoo, Finland) at a dose of 80 μg/kg IM, butorphanol (Butomidor® 10 mg/mL, Richter-Pharma, Wels, Austria) at a dose of 0.4 mg/kg SC, and ketamine (Ketasol®, Richter-Pharma, Austria) at a dose of 5 mg/kg IM, and anesthesia was maintained with isoflurane and 100% oxygen (as previously reported [18,19]).
To provide multimodal analgesia, 12 mg ketamine, 4.8 mg butorphanol and 40 mcg medetomidine, as previously described by different authors [19,20], were diluted in 100 mL of 0.9% isotonic sodium chloride solution and administered intravenously by infusion using an automatic infusion pump at a rate of 5 mL/kg per hour before, during and after surgery.
All patients were started on antibiotic prophylaxis with intravenous (IV) cefazolin sodium (Cezol, Deva, Şahinbey, Turkey) at a dose of 20–22 mg/kg before the start of surgery and continued for 5 days postoperatively [19,20].
2.5. Implants and Instruments
In all cases, vertebral stabilization was performed using either a polyaxial screw–rod system (Hasvet Medikal A.Ş., Antalya, Türkiye) or a 2.0 or 2.7 mm SOP plate system (Orthocat Vet, Istanbul, Türkiye). When indicated, spinal cord decompression was achieved by dorsal laminectomy or hemilaminectomy using a high-speed surgical drill fitted with diamond burs.
2.6. Surgical Procedure
The animals were placed in the sternal position, and their legs were freely extended on the table. After the area was demarcated with a sterile drape, a skin incision was made along the midline of the back, extending from the lesion site to at least two cranial and two caudal vertebrae. The skin incision and dissection of the subcutaneous fascia were performed, taking care to preserve the attachments of the m. erector spinae to the vertebral processes. After making the dorsal fascial incision, the unstable vertebrae were reduced using double-ended bone forceps, and stabilization was initiated. These forceps were placed on the spinous processes or vertebral body, and reduction was achieved by gently applying upward traction to ensure normal anatomical alignment of the spine. To stabilize instable vertebrae, stabilization was achieved by placing at least two screws cranial and caudal to the affected vertebra. Due to their anatomical structure, a polyaxial screw–rod system was used for thoracic vertebrae, while an SOP plate was preferred for lumbar vertebrae. The screw holes were positioned dorsolaterally to ventromedially, above the points where the transverse processes join the vertebral bodies (Figure 1A,B). During these procedures, the anatomical structure and characteristics of the affected vertebra were taken into account, which was particularly influential in determining the diameter and length of the screws.
[图：Screw locations on the vertebrae: ( A ) screw for SOP plate and ( B ) polyaxial screw (AI was used in the drawing of thi]
2.7. Postoperative Evaluation
During postoperative checks, bilateral radiographs were taken laterolaterally or ventrodorsally to assess implant position and fracture reduction. The results obtained during the postoperative evaluation phase were categorized as poor outcome, functional recovery, and good recovery [12,19]. Following surgery, the cats were typically hospitalized for approximately 2 days. Hospitalization was extended when additional clinical monitoring or supportive care was considered necessary. During hospitalization, general clinical and neurological status, voluntary motor function, urinary function, appetite, and the surgical site were regularly monitored. Following discharge, activity restriction and cage rest were recommended, and the cats were reassessed through clinical, neurological, and radiographic follow-up examinations. Poor outcome was defined as persistent difficulty in urination and/or no improvement in gait after treatment. Functional outcome was considered to be when the cat could urinate and regained the ability to walk. Good outcome was defined as normal urination, gait, and the absence of proprioceptive abnormalities.
3. Results
According to the data in our study, all cats were found to have suffered spinal trauma due to high-rise syndrome, such as falling from a balcony or window.
All cases (20 cats) showed varying degrees of neurological dysfunction, with grade III in three cats, grade IV in nine cats, and grade V in eight cats (Table 1). Urinary retention was observed in all cases (100%). In cats with grade III neurological dysfunction, functional improvement was observed after treatment. Of the cats classified as grade IV neurological dysfunction, seven showed functional improvement, and two showed excellent improvement. Of the cats classified as grade V neurological dysfunction, four showed poor improvement, one showed functional improvement, and it was noteworthy that three cats died before follow-up could be conducted. Apart from these three deaths, no additional major intraoperative or postoperative complications were recorded. Specifically, no surgical-site infection, wound dehiscence, clinically evident implant loosening or failure, or requirement for revision surgery was observed during the follow-up period.
Table 1. Grading of neurological symptoms according to Grasmueck and Steffen (2004) [ 17 ].
| Grade | Neurological Dysfunction | Number of Cats |
|---|---|---|
| I | No back pain or neurological deficits | 0 |
| II | Ambulatory paraparesis, normal urination | 0 |
| III | Ambulatory paraparesis, urinary retention | 3 (15%) |
| IV | Non-ambulatory paraparesis/paraplegia, urinary retention, and deep pain perception | 9 (45%) |
| V | Paraplegia, urinary retention, absence of deep pain perception | 8 (40%) |
The median age of the cats was 2.5 years (range, 5 months to 4 years). Of the nine male cats, seven (77.8%) were neutered and two (22.2%) were sexually intact, whereas eight (72.7%) of the 11 female cats were spayed and three (27.3%) were sexually intact. In all cases (20 cats), there was instability and compression on the spinal cord due to vertebral body or end plate fractures or dislocations. Therefore, the primary goal was spinal cord and nerve root decompression and vertebral stabilization. For this purpose, polyaxial screws were applied in 11 cases and SOP plates in nine cases (Figure 2 and Figure 3). For vertebral decompression, dorsal laminectomy was performed in two cases (Figure 4) and hemilaminectomy in one case (Table 2).
[图：Radiographs of case number fourteen: preoperative left lateral ( A ), postoperative ventrodorsal ( B ), right lateral ( ]
[图：Radiographic images from various cases. ( A ) L2 caudal end plate fracture, ( B ) stabilization with SOP plate in a diff]
[图：Appearance of the spinal cord after dorsal laminectomy during surgery (Cr: cranial, Ca: caudal, R: right, L: left, PS: s]
Table 2. A summary of the findings for each case.
| No. | Grade | Localization | Treatment Applied | Other Findings | Treatment Results | ||
|---|---|---|---|---|---|---|---|
| Poor | Functional | Good | |||||
| 1 | IV | L6-L7 | Polyaxial screw | * | |||
| 2 | V | T13-L1 | Polyaxial screw | * | |||
| 3 | III | L5-L6 | SOP | * | |||
| 4 | IV | L2-L3 | SOP | * | |||
| 5 | V | L6-L7 | SOP | * | |||
| 6 | IV | T13-L1 | SOP | * | |||
| 7 | IV | L3-L4 | SOP Dorsal laminectomy | * | |||
| 8 | III | L1-L2 | Polyaxial screw | * | |||
| 9 | V | T12-T13 | Polyaxial screw | Radius ulna fracture | * | ||
| 10 | IV | L7-S1 | Polyaxial screw | * | |||
| 11 | V | T12-T13 | Polyaxial screw | Scapula fracture | * | ||
| 12 | V | T10-T11 | Polyaxial screw, dorsal laminectomy | Coxa fracture | * | ||
| 13 | V | L7-S1 | SOP | * | |||
| 14 | IV | T11-T12 | SOP | * | |||
| 15 | IV | L4-L5 | SOP | Ilium fracture | * | ||
| 16 | IV | L2-L3 | Bilateral polyaxial screw, hemilaminectomy | * | |||
| 17 | V | T11-T12 | Polyaxial screw | * | |||
| 18 | IV | T12-T13 | Polyaxial screw | * | |||
| 19 | IV | L4-L5 | SOP | * | |||
| 20 | V | T9-T10 | Polyaxial screw | * | |||
In this study, three out of a total of 20 cats with vertebral instability (15%) had end plate fractures. The distribution of vertebrae with end plate fractures was as follows: one cat had L4 cranial, one cat had L2 caudal, and one cat had L6 caudal. In other cases, vertebral fractures or dislocations were not observed in the C1-C5 and C6-T2 regions, while they were found in the T3-L3 region in 13 cases (65%) and in the L4-S1 region in seven cases (35%). No lesions were found in the sacrococcygeal region (Table 2). Concurrent fractures of the pelvis and appendicular skeleton were identified in four cats (20%), including one scapular fracture, two pelvic fractures, and one radius–ulna fracture. Given the potential for progressive neurological injury associated with vertebral instability and spinal cord compression, neural decompression and stabilization of the affected vertebral segment were considered the primary surgical priorities. Following completion of the spinal procedure, all concurrent fractures were surgically treated during the same anesthetic session, thereby avoiding an additional anesthetic episode and enabling comprehensive management of the traumatic injuries.
4. Discussion and Conclusions
According to the data in this study, in terms of trauma, all cases (100%) of the cats were due to high-rise syndrome, specifically falls from balconies or windows. This once again confirms that spinal injuries in cats are highly prevalent (84%) due to high-rise syndrome, as reported in other studies [12,13,21], and therefore, cat owners should be informed and reminded about taking the necessary precautions. High-rise syndrome was not expected to be the cause of trauma in all cases observed in this research, but the presence of vertical structures in cities may help explain this high incidence.
In cases of spinal trauma, paraplegic patients with conditions such as degenerative discs, cord injury, or spontaneous herniation have been reported to have a good prognosis if timely decompression is performed [12,17,22]. Therefore, appropriate transfer of the patient to a post-traumatic center, followed by trauma management and damage repair, is of paramount importance. In our study, it was observed that the time to hospital admission for all cases was more than 24 h and varied between 24 and 72 h. It is recommended that this period be brought forward as much as possible.
The most frequently affected region in spinal injuries is the thoracolumbar junction T11-T13 and L1, followed by the last lumbar vertebra and the lumbosacral junction. Yayla et al., 2023, reported [12] that the most frequently affected region in cats with spinal fractures is the L4-L7 region, accounting for 48%. This is followed by the T3-L3 region, which accounts for 46% of spinal fractures in cats. The C6-T2 region constitutes 3% of spinal fractures in cats, while the S1-S3 region has a rate of 1%. In our study, no cases with damage in the C1-C5 and C6-T2 regions were found, while 13 cases (65%) had damage in the T3-L3 region, and seven cases (35%) had damage in the L4-S1 region. The reason why the thoracolumbar region is most frequently affected by trauma can be attributed to the fact that this segment is anatomically less flexible and unprotected. Injuries in this region usually result in paraplegia or paraparesis. Cervical injuries in cats are rare but can cause more-serious neurological loss [23]. In the thoracic vertebrae, on the cranial and caudal edges of each side, there are cranial and caudal costal foveas for the articulation of the ribs. The caudal fovea of the cranial vertebra and the cranial fovea of the caudal vertebra meet, joining with the edge of the intervertebral disc, thus forming an articular fossa. This fossa articulates with the costal cap (art. capitis costa). The intraarticular ligament (lig. capitis costa intraarticulare and lig. intercapitale) connecting the costal cap located here to the costal cap on the opposite side contributes to spinal stability. The lateral aspect of the anterior portion of the body of the last three vertebrae contains a costal fovea, with which the costal cap articulates. The reason why the thoracolumbar region is most frequently affected is thought to be the anatomical presence of one costal fossa on the lateral side of the cranial part of the vertebral body, especially the last three vertebrae, and the articulation of the costal head only with this fossa, the absence of the last two ribs in the costal arch, and their location as asternal ribs within the abdominal muscles. One of the reasons for the high frequency of TL spinal trauma is that this is the middle of the spine, and it experiences the greatest bending moment (Figure 5).
[图：Thoracolumbar junction of the spine: view of the costal fovea in the anterior part of the body of the last three vertebr]
It has been reported [3,11] that various techniques used for vertebral instability include the use of polyaxial screws, stabilization with polymethyl methacrylate (PMMA), and plate applications [14,15]. This study includes the use of polyaxial screws and plate applications for stabilization. Polyaxial screws were preferred for the thoracolumbar region due to kyphosis in cats, while SOP plate application was preferred for the lumbar region due to the more even arrangement of the vertebrae.
It is known that urinary problems such as retention or incontinence are common in patients who have suffered spinal trauma [4,8]. The prognosis tends to be worse in patients with bladder involvement. Most patients with grade V neurological damage are recommended for euthanasia 24–48 h after losing deep pain perception and poor prognosis [16,22]. Furthermore, it has been reported that 6–15% of patients with vertebral column injury also have concomitant abdominal injury [16]. This can result in hemoperitoneum, uroperitoneum, or gastrointestinal or hepatobiliary injuries. In our study, abdominal trauma resulted in abdominal hernia in two cases and mild liver hematoma in another. Simultaneous fractures of the pelvis and appendicular skeleton have been reported in 14–48% of animals with vertebral fractures or dislocations [12,16]. In our study, three cases involved thoracic trauma, one patient had a scapular fracture, one patient had an antebrachium (radius + ulna) fracture, and two patients had pelvic fractures. Simultaneous injuries (such as pneumothorax, appendicular fractures, or hemoperitoneum) have been reported to be more common in cats (83% in cats, 66% in dogs) [22]. In our study, simultaneous fractures of the pelvis and appendicular skeleton were detected in 20% of animals with vertebral fractures or dislocations.
Grasmueck and Steffen (2004) reported [17] that, in surviving cats, clinical outcomes were complete (grade II to IV) in 12 cases, functional (grade III to IV) in three, and poor (grade III to IV) in three. They reported no clear correlation between the degree of initial neurological dysfunction and outcome in this relatively small population. However, if deep pain perception is unaffected in cats with spinal cord injury, a favorable prognosis can be concluded. In our study, recovery was functional in cats with grade III neurological dysfunction (three cats). Of the cats classified as grade IV neurological dysfunction (nine cats), seven recovered functionally, and two recovered completely. Of the eight cats with grade V neurological dysfunction, four showed poor recovery, one showed functional improvement, and three died within a week of treatment.
Ensuring adequate blood flow and maintaining oxygenation is crucial for systemic stabilization of the spinal cord. Therefore, intravenous fluid therapy and oxygen supplementation are necessary to prevent secondary spinal cord injury following a traumatic event (primary injury) [3,10]. Depending on the level of spinal column damage, secondary spinal cord injury is reported to result from loss of local or systemic blood pressure regulation and decreased spinal cord blood flow caused by vascular damage [3,24]. In our study, adequate blood circulation and oxygenation for systemic stabilization were attempted through intravenous fluid therapy and oxygen supplementation.
Three cases died within one week of treatment. Because the study involved a relatively small population, a clear correlation between the degree of neurological dysfunction and the outcome could not be established. However, it can be said that cats with spinal cord injury have a favorable prognosis if their deep pain perception is intact.
Spinal surgery can be challenging for most practitioners, especially as it requires experience in addition to a good surgical approach and anatomical knowledge [12]. The Zdichavsky classification, modified by Mullins et al. (2024) [25], identifies and figurate correct and incorrect practices during spinal surgery (Figure 6). Permanent neurological damage is inevitable during these incorrect practices. Furthermore, because the screws are inserted from the right to the left side of the vertebra, where the descending aorta lies in close proximity, careful attention should be paid to the drill bit and screw lengths during preparation of the screw tract to avoid vascular injury. Therefore, unless there is a contraindication, we recommend that the approach for the SOP plate or polyaxial screw–rod system be performed from the left side of the spine.
[图：Modified Zdichavsky classification with grade I corresponding to a non-breached drill tract, grade IIa denoting partial ]
The main limitations of this study were the relatively small number of cases and the inclusion of only cats that had sustained spinal trauma following high-rise syndrome. Therefore, the findings may not be directly generalizable to spinal injuries caused by other trauma mechanisms. In addition, differences in lesion location, neurological severity, and the stabilization system used limited subgroup comparisons. Larger multicenter studies including different trauma mechanisms are required to confirm these findings. There was also a lack of CT imaging, as a CT scanner was not available at the veterinary hospital where the study was conducted. CT imaging could have enabled a more detailed characterization and evaluation of the lesions.
In this study, integrating diagnostic anatomy into the clinical situation allowed for the determination of the anatomical localization of the lesion (which vertebral segment it is in), improved interpretation of radiographic images, better surgical planning, selection of surgical approaches, selection of safe anatomical corridors, and protection of neurovascular structures. Furthermore, thanks to the diagnostic anatomical approach, the dimensions of anatomical structures were evaluated, and the appropriate implant type and size were determined. Finally, the risk of complications was reduced. Knowledge of anatomical variations and critical structures such as the aorta and caudal vena cava contributed to the prevention of iatrogenic injuries. Additionally, spinal cord compression or implant-related vertebral fractures can be prevented by placing the screws in the correct location.
Acknowledgments
We would like to thank Berna ERSÖZ KANAY, Emine ÇATALKAYA, and Nahit SAYLAK, faculty members of the Department of Surgery at Dicle University Faculty of Veterinary Medicine, for performing the operations and monitoring the patients in this study, which is a doctoral thesis.
Author Contributions
M.K. and S.Y. designed the study. This study is M.K.’s doctoral thesis (M.K., a professor of anatomy, holds a second doctorate in surgery) and was conducted under the supervision of S.Y. All authors interpreted the data, revised the manuscript critically for important intellectual content, and approved the final version. All authors have read and agreed to the published version of the manuscript.
Institutional Review Board Statement
This study was carried out with the permission of Dicle University HADYEK dated 16 June 2022 and numbered 305415. In addition, patient owners were informed, and consent was obtained.
Informed Consent Statement
Informed consent was obtained from all subjects involved in the study.
Data Availability Statement
The original contributions presented in this study are included in the article. Further inquiries can be directed to the corresponding author(s).
Conflicts of Interest
The authors declare no conflicts of interest.
Funding Statement
This study was supported by the Dicle University Scientific Research Projects Coordination Unit (DÜBAP) under Project No. VETERİNER.26.032.
Footnotes
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References
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Associated Data
Data Availability Statement
The original contributions presented in this study are included in the article. Further inquiries can be directed to the corresponding author(s).