Page 141 - Veterinary Laser Therapy in Small Animal Practice

Pointing light at musculoskeletal and neurological conditions: clinical applications 127

9.8.1 Intervertebral disk disease

A definitive diagnosis of IVDD requires diagnostic
imaging; nowadays computed tomography (CT) and
magnetic resonance imaging (MRI) provide the best
and most accurate information. But even before these
are performed, location of the lesion must be clinically
determined, in terms of spinal segment, since clinical
signs are different. So even if MRI is not a possibility for
that patient, we know if we should focus over T3–L3
or caudal to it, for instance. Scoring the severity is nec-
essary both at initial evaluation and during treatment
Figure 9.15 Treatment of the medial side of the hip area. course, to assess results objectively.
The Modified Frankel Score (MFS) is often used to cat-
egorize the severity of neurological deficits (Table 9.4).
9.15). A good way is to follow the pectineus muscle; An alternative scoring system was published by Texas
start with gentle pressure as this muscle may hold a A&M University, named the Texas Spinal Cord Injury
trigger point. If there is a contracture of the iliopsoas Score (TSCIS) for dogs (Table 9.5). Both systems corre-
muscle or other hip flexors, the patient will experience late with each other and with MRI findings, have a high
discomfort with hip extension, and you should address degree of inter-rater agreement, and show a predictive
this. The iliopsoas contracture is a common problem value in canine patients with thoracolumbar IVDD. [367]
both in sports dogs and in older patients with limb Patients with acute signs who are non-ambulatory
weakness who fall on slippery floors. The whole lumbar but retain pain perception are often surgical candi-
area up to the last rib should be treated, calculating a dates, and loss of pain perception makes this a surgical
2
dose of about 8–10 J/cm . emergency. This does not change even if we can use LT;
however, keep the following in mind.
Stifle
When calculating your area of treatment, include at • LT can help in postoperative recovery: animal
least up to the femoral condyles and down to the head models show LT can help in acute damage to the
of the fibula. In cases of CCLR it is likely that the medial spinal cord by modulating the immune response
side (Fig. 9.16) will be more sensitive, especially if there and improving axonal and functional recovery. [171]
is any damage to the meniscus. Check for trigger points A clinical study with dogs suffering from thora-
cranial and distal to the head of the fibula (peroneus columbar IVDD with acute signs and neurological
longus TP). deficit graded 0 to 3 revealed a significant (four

Tarsus (hock)
Include the distal tibia from the level of the calcaneus to
the proximal part of the metatarsal bones. Palpate the
calcaneus tendon for any fibrosis and, if present, treat
it as well.

9.8 Laser therapy in neurological patients
Small animals can present with conditions affecting
both the CNS and peripheral nerves that may be helped
with LT. Probably the most common examples are
intervertebral disk disease (IVDD) and neurapraxias.

Figure 9.16 Treatment of the medial aspect of the stifle.

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