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34th Annual Scientific Meeting proceedings


Stream: SA   |   Session: Neurological Injuries Associated with Pelvic Fractures
Date/Time: 05-07-2025 (09:30 - 09:50)   |   Location: Darwin Hall
Tail pull injuries
De Decker SDD
Royal Veterinary College, London, United Kingdom.

Although ‘tail pull injuries’, also referred to as sacrocaudal fractures/luxations, can occur in dogs, this condition is most commonly seen in cats. It is even likely that this type of injury represents the most common form of spinal trauma in felines. It typically occurs when a cat tries to escape while the tail is trapped under a vehicle’s tire. Damage to the nerve roots and associated spinal cord is caused by traction, resulting in injury to the more cranial lumbosacral intumescence. Affected cats usually have a paralysed tail with complete anaesthesia. Urinary and faecal incontinence are often seen and represent the biggest clinical concern. Depending on the severity of the injury, paraparesis and partial loss of sciatic nerve function can occur. Concurrent pelvic trauma is common.

Obtaining a diagnosis is based on a combination of a suggestive clinical history, compatible clinical signs, and radiography. There is no indication that advanced diagnostic imaging, such as computed tomography or magnetic resonance imaging offer an advantage in clinical decision-making.  The degree of displacement following tail pull injuries varies considerably. There is no evidence that the degree of vertebral displacement is associated with the severity of clinical signs or the likelihood of recovery. In rare instances there is no evidence of a fracture or luxation but the signs and history are consistent with a traction injury.

Paresis, if present, usually resolves within a few days. Urinary and fecal incontinence can remain for longer and can even be permanent. Management and assessment of affected cats therefore focuses on bladder and bowel function. The bladder must be manually expressed or catheterized until function is regained. Although the bladder is often soft and easy to express in the first few days, it can become hard and almost impossible to express after a few days. Placement of a cystotomy tube can become necessary. Lactulose and intermittent enemas can be considered in cats with fecal constipation. There is unfortunately not much specific medical treatment available. Several medical options, such as prazosin and bethanechol, have been suggested. These medical options can however be associated with severe side-effects and there is no clear evidence that using them results in improved bladder management or outcome. There is some debate as to whether early tail amputation is beneficial in cats with sacrocaudal luxation. Early amputation has been recommended to relieve ongoing neuronal traction and persistent motion. It can however take several months for tail function to return, and one study has not been able to demonstrate a beneficial effect of early tail amputation. Primary internal tail stabilisation has been suggested as a treatment option that combines preservation of the tail, reduces excessive motion and prevents further neuronal traction.

Tail base sensation is the most reliable prognostic factor and easy to perform. The prognosis for return of urinary continence is good if anal tone, perineal sensation, or tail base sensation are present on initial examination. More severe neurological deficits are associated with a decreased likelihood and longer duration of regaining urinary function. Although neurological grading systems can be used to identify cats that will likely regain urinary function, it remains challenging to identify cats at the time of injury with a poor prognosis. Of cats with the most severe neurological signs (lack of pain perception in the tail base and perineal region, absent anal tone, absent perineal reflex and flaccid bladder tone), 50% to 60% still regain the ability to urinate voluntarily. A proportion of cats will have concurrent traumatic injuries, which might require advanced and expensive treatment. Clinical decision-making is clearly complicated by the inability to reliably recognise cats that will not recover urinary function. It is further unclear how long cats should be given the opportunity to regain urinary continence. Most cats that recover the ability to urinate will do so within the first two weeks after injury. Although cats that do not become continent within 1 month are unlikely to regain urinary function, one study suggested that approximately 10% of affected cats will regain urinary function between 31 and 52 days after injury.

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