Neurologic issue post-TPLO

[lehughes]

Hey Laurie
Hope that you are enjoying spring. It took such a long time to arrive this year. Now we're sweltering up here in Edmonton.
I have a question re a 3 yr old F/S Golden Retriever that received a LHL TPLO at the Western College of Veterinary Medicine in January. The dog is owned by a brand new vet that graduated from WCVM last month and is now working at our clinic. Since the TPLO, the dog has had an abnormal gait. She took the dog back to the WCVM surgeons last month for reassessment of the gait and they said that rads show the tibia to be healing well and that the abnormal gait is likely from a gracillus issue.
I looked at this dog yesterday and I disagree with the surgeons. The gracillus muscle is comfortable and is completely normal on palpation and full stretch (hip abduction and flexion with stifle extension). All LHL joints have normal ROM and are comfortable. All LHL muscles are comfortable and normal on stretches but are mildly decreased in muscle mass. A LHL muscles have normal tone except the cranial tibial muscle. All peripheral reflexes are normal except for a markedly decreased cranial tibial muscle reflex.
No obvious pain around the TPLO plate.
Definitely some soreness on palpation of left aspect of L5-6. Tail jack is normal.
SIJs are normal.
I think all sensory nerves are normal - but this dog is not totally consistant on this test.
Gait analysis: when dog first rises she will hyperflex both LHL stifle and hip and abduct the hip. This will settle down somewhat after about 1-2 minutes, but still is noticeable.
My summary: I am very suspicious of sciatic nerve injury but am at a loss of whether this may be stemming from the sore L5-6 area (maybe injury from the epidural?) or is the sciatic injury more localized to the TPLO plate placement. Anyhow, my question to you is: have you ever seen sciatic nerve injury post TPLO? And if so, at what level did the injury occur?
Also, if you think that there is anything that I am missing on this case, I'd love to have you share it with me.
Thanks so much
J

[lehughes]

Hi J!

Fascinating case!!!

I would agree with some sort of neuropathy. I’ve not seen this with a TPLO. I’ve seen a peripheral neuropathy with an extracapsular method before. I have seen an issue subsequent to an epidural error… but the whole leg was affected.

So, I’d add into the test the dural tension testing for the sciatic nerve (check out FourLeg Training Videos 118 - 120 for the Adverse Neural Tissue Testing videos). Sounds to me like a neuropraxia… some compression, but warms out of it… so you should be able to help it! It makes more sense from an anatomy standpoint that the issue is higher up as compared to where the plate is.

Try some L/S mobs, some traction, and some nerve glides. I’d then treat up at the lumbar spine with laser (and acupuncture if available).
Any meds on board? Might be a good case to use gabapentin.

I’m definitely posting this to the forum!

And we have had great weather down here! Absolutely perfect. (I missed the heat wave when the air conditioning broke down in the clinic… so for me it’s all been great!)

Cheers,

Laurie

[David Lane]

Hello,

Just to double check, no iliopsoas pain?
I have trouble linking a TPLO procedure with sciatic injury (peroneal nerve injury from extracapsular repair is a thing, especially in small dogs - see LEH comment above), but I too have never heard of a sciatic complication from a TPLO.
Were lumbosacral rads taken as part of the presurgical workup? If so, were there any abnormalities?