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136 Veterinary Laser Therapy in Small Animal Practice

Case no. 15

P., canine, 10 years old, Pug, FNS, 6.7 kg
• Complaint: non-ambulatory paraparesis and difficult defecation.
• History: P. had started to show symptoms 6 months previously. She had initially been treated with
steroids with little response, and she showed increased panting and restlessness. Two months previously a
neurologist evaluated her and prescribed gabapentin, tramadol, firocoxib, and ozone therapy due to spinal
pain, which improved with medical treatment. Nevertheless, a few days ago P. showed non-ambulatory
paraparesis and MRI was recommended.
• MRI: arachnoid cyst causing severe compressive myelopathy at T12–T13. Hypoplastic vertebral facets at
same location. Multifocal disk degeneration in other locations not causing spinal cord compression.
• Physical examination:
• Body condition score 7/9.
• Non-ambulatory paraparesis, dragged her weight on forelimbs, unable to support herself in standing
position for more than a few seconds. Passive ROM not affected.
• Symmetric hindlimb circumference (15 cm and 15.5 cm, measured at 70% of thigh).
• Contracted forelimb muscles (triceps, biceps brachii, supraspinatus). Flaccid hypotrophic hindlimb
muscles (quadriceps, gluteus, femoral biceps, semimembranosus, semitendinosus).
• Increased sciatic and flexor patellar reflexes. Deep and superficial pain present. Severe proprioceptive
deficit.
• Absence of movement in the tail. Normal urinary and fecal continence.
• Pain assessment: 2/10 NRS, mild discomfort in the caudal thoracic spine.
• Diagnosis: caudal thoracic compressive myelopathy causing non-ambulatory paraparesis and mild pain.
• Treatment:
• Laser therapy:
• Treatment area initially included T10–L1, with a dose of 8 J/cm , which after the second visit was
2
increased to 10 J/cm and extended to cover the whole T10–S1 area.
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• After treating twice a week for 2 weeks, a weekly treatment was performed for another month,
and after that the patient was treated once a month. However, a much broader treatment plan was
performed during those visits, and the owners committed to daily home exercise sessions.
• Medical treatment with firocoxib and gabapentin was maintained for the first month.
• Acupuncture: 20 min sessions once a week for 3 weeks, then once a month for 4 more months.
Treatment included dry needle technique and electro-acupuncture with variable combinations of the
following acupoints: GV20, BL-11, GV-6, GV-4, BL-23, Shen shu, Shen peng, ST-36, SP-3, KID-1, KID-3,
BL-20, Wei jie, Wei jian, and Liu feng. Aqua-acupunture was performed at Hua-tuo-jia-ji points from T10
to L2, BL-40, ST-36, and Liu feng, using diluted B12 vitamin. Herbal prescription of Bu Yang Huang Wu
formula at 1 g/10 kg twice a day.
• Other physical therapies: every 2 weeks initially, then once a month.
• NMES: 40 Hz, biphasic, to stimulate hamstrings, quadriceps, and gluteus muscles; 10 min for each
limb.
• TENS: local treatment for 20 min. The electrodes were positioned bilateral to the spine (T11–L2).
• Pulsed magnetic field (PMF) therapy: low frequency program 12–20 Hz.
• Exercise program:
• Assisted standing exercises, including weight-shifting, bicycling movement, assisted walking, and
proprioceptive Physioroll exercises. Assisted treadmill was introduced after the second session and its
duration progressively increased.
• Manual intervention: massage of neck muscles (effleurage and petrissage). Passive ROM with
bicycling movement of all limbs.
• Home exercise program: all techniques were initially performed with the owners in the clinic to ensure
proper delivery.

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