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Acquisition of Involuntary Spinal Locomotion (Spinal Walking) in
Dogs with Irreversible Thoracolumbar Spinal Cord Lesion: 81 Dogs
A. Gallucci, L. Dragone, M. Menchetti, T. Gagliardo, M. Pietra, M. Cardinali, and G. Gandini
Background: Spinal walking (SW) is described as the acquisition of an involuntary motor function in paraplegic dogs and
cats without pain perception affected by a thoracolumbar lesion. Whereas spinal locomotion is well described in cats that
underwent training trials after experimental spinal cord resection, less consistent information is available for dogs.
Hypothesis: Paraplegic dogs affected by a thoracolumbar complete spinal cord lesion undergoing intensive physical reha-
bilitation could acquire an autonomous SW gait under field conditions.
Animals: Eighty-one acute paraplegic thoracolumbar dogs without pelvic limb pain perception.
Methods: Retrospective study of medical records of dogs selected for intensive rehabilitation treatment in paraplegic dogs
with absence of pain perception on admission and during the whole treatment. Binary regression and multivariate logistic
regression were used to analyze potential associations with the development of SW.
Results: Autonomous SW was achieved in 48 dogs (59%). Median time to achieve SW was of 75.5 days (range:
16–350 days). On univariate analysis, SW gait was associated with younger age (P=.002) and early start of physiotherapy
(P=.024). Multivariate logistic regression showed that younger age (≤60 months) and lightweight (≤7.8 kg) were positively
associated with development of SW (P=.012 and P<.001, respectively). BCS, full-time hospitalization, and type and site of
the lesion were not significantly associated with development of SW.
Conclusions: Dogs with irreversible thoracolumbar lesion undergoing intensive physiotherapic treatment can acquire SW.
Younger age and lightweight are positively associated with the development of SW gait.
Key words: dog; pain perception; paraplegia; physiotherapy.
Acute spinal cord injuries (ASCI) in dogs are com-
mon and mainly result from intervertebral disk
extrusion (IVDE) or traumatic injuries.
1,2
Recovery rate
from ASCI is variable and depends on the severity of
the spinal cord damage, rate of onset of clinical signs,
and type of treatment.
1,3,4
Considering the difficulty of
objectively establishing the extent of the spinal cord
damage, it is generally accepted to use the absence of
pain perception as the most important indirect sign to
asses complete functional spinal cord transection.
1,5
Absence of pain perception is classically associated with
a severe to poor prognosis for functional recovery of
voluntary locomotion.
2,6–9
A recent study on paraplegic
TL dogs with absent pain perception due to IVDE did
not identify prognostic factors for any of the investi-
gated variables, including age, corticosteroid adminis-
tration, early surgical treatment, and severity of
compression.
10
Few studies described the treatment and
the outcome of paraplegic dogs without pelvic limb
pain perception,
1,4,7,11
and only one assessed the long-
term outcome (>6 months) describing a small percent-
age of dogs (11%) regaining the ability to walk without
pain perception.
1
Spinal walking (SW) is the term commonly used to
define the acquisition of an involuntary motor function
in paraplegic mammals affected by a complete thora-
columbar (TL) spinal cord lesion. SW is a reflex gait,
resulting from complex dynamic interactions between
the pelvic limb locomotor central pattern generator
(CPG) and proprioceptive feedback from the body in
the absence of superior control by the brain after com-
plete spinal cord damage.
12,13
CPG is the network of
interconnected interneurons in the spinal cord gray mat-
ter that modulates motor neuron activity for the genera-
tion of gait.
5
Lumbar CPG, which displays a
rostrocaudal excitability gradient for rhythmogenic
From the Department of Veterinary Medical Sciences, University
of Bologna, Bologna, (Gallucci, Gandini, Gagliardo, Menchetti,
Pietra, Cardinali); Physiotherapy and Rehabilitation Center “Dog
Fitness”, Reggio Emilia, Italy (Dragone).
Fundings: No grant support.
The results of this study were presented at the 28th ECVN-ESVN
Symposium, Amsterdam, the Netherlands, September 18–19, 2015.
Corresponding author: A. Gallucci, Department of Medical
Sciences, University of Bologna, Via Tolara di Sopra 50, 40064
Ozzano Emilia, Italy; e-mail: antonella.gallucci@unibo.it
Submitted April 22, 2016; Revised October 28, 2016;
Accepted December 6, 2016.
Copyright ©2017 The Authors. Journal of Veterinary Internal
Medicine published by Wiley Periodicals, Inc. on behalf of the Ameri-
can College of Veterinary Internal Medicine.
This is an open access article under the terms of the Creative
Commons Attribution-NonCommercial License, which permits use,
distribution and reproduction in any medium, provided the original
work is properly cited and is not used for commercial purposes.
DOI: 10.1111/jvim.14651
Abbreviations:
95% CI 95% confidence interval
ASCI acute spinal cord injury
BCS body condition score
CPG central pattern generator
CT computed tomography
IVDE intervertebral disk extrusion
MRI magnetic resonance imaging
No-SW no-spinal walking
OR odds ratio
ROC receiver operating characteristic
ROM range of motion
SD standard deviation
SW spinal walking
TL thoracolumbar
UWTM under water treadmill
Standard Article
J Vet Intern Med 2017
capacity, influences the alpha-motor neurons activity
via short propriospinal pathways, located in the fascicu-
lus proprius.
5,13
In experimental trials, spinal locomotion is well
described in cats and showed that treadmill training
exercise could improve the recovery of autonomous
motor function after complete and incomplete spinal
cord injury.
14–20
Less consistent information is available
for dogs.
20–23
To the authors’ knowledge, there is no published
information on the effect of physiotherapy in the devel-
opment of successful spinal walking in dogs under field
conditions.
The aim of this study was to evaluate the number of
TL paraplegic dogs without pain perception that devel-
oped an autonomous SW gait after a period of intensive
physical rehabilitation training. Attention was focused
on the identification of potential parameters (age,
weight, type and site of lesion, duration of clinical signs,
hospitalization during physiotherapy, onset of physio-
therapy) associated with involuntary pelvic limb motor
function recovery.
Materials and Methods
Medical records of paraplegic dogs with TL spinal cord lesion
due to acute IVDE or exogenous trauma, referred at the Physio-
therapy and Rehabilitation Centre “Dog Fitness” (Reggio Emilia,
Italy) between 2005 and 2014, were retrospectively reviewed.
Dogs were included in the study if they had a medical record
documenting paraplegia and absent pelvic limb pain perception,
after physical and neurological examinations by the referring neu-
rologist and at the admission at the Physiotherapy and Rehabilita-
tion Centre; a spinal cord lesion confirmed by magnetic resonance
imaging (MRI) or computed tomography (CT); a complete proto-
col of physiotherapic rehabilitation treatment; and had absence of
pelvic limb pain perception at the end of the physiotherapic reha-
bilitation treatment.
For the purpose of this study, absence of pain perception was
defined as lack of a conscious response (e.g, crying, looking
around, or similar reaction) to the application of heavy pressure
to the pelvic limb digits with forceps.
5
Dogs showing tail wagging
in response to the owner’s presence or voice were excluded by the
study. SW was defined as the ability to develop an unassisted
involuntary gait. Specifically, dogs were considered spinal walkers
if they could walk for a potentially infinite period of time and, in
case of falling, were able to regain unassisted the standing posture
and continue to walk.
Clinical records of each dog included the following parameters:
signalment, clinical presentation (by Olby scoring system
24
), type
(acute IVDE or traumatic vertebral luxation/fracture) and site of
the lesion, presence of surgery (hemilaminectomy in dogs with
IVDE or stabilization in dogs with exogenous trauma), type of
hospitalization regimen (full-time or day-hospital) during the phys-
ical rehabilitation and outcome.
A personalized physio therapy protocol was settled based on
the specific needs of each dog, including the following five basic
categories of exercises, differently arranged: passive range of
motion (ROM) exercises, flexor reflex and crossed extensor reflex
stimulation, active assisted exercises, electrostimulation (only in
case of postspinal shock hypotonia) and hydrotherapy on under-
water treadmill (UWTM).
Each physiotherapic treatment lasted approximately 60 minutes
and was performed on all dogs every day, twice per day regardless
of their status of hospitalization. UWTM was started on admit-
tance or, in case of surgical management, at least 5 days after sur-
gery at the speed of 1.8 km/h. UWTM bouts lasted 5 minutes at
the beginning of the treatment and were progressively increased
up to 15 minutes when dogs started to show pelvic limbs
movements.
The duration of the cycle of physiotherapic treatment was
tailored to each single dog depending on the physiotherapist’s
opinion in terms of deciding whether to continue or stop the
treatment. Thus, the duration of the entire physiotherapic
treatment was considered either the time elapsed between the
start of the rehabilitation and the acquisition of independent
spinal walking gait or the period between the start and the dis-
continuance of physio therapy due to the failure in achieving
SW.
All statistical analyses were performed with a commercially
available statistical data analysis program (MedCalc
Ò
version
12.2.1.0). Assessment of data for normality was calculated by
applying the D’Agostino-Pearson test. Data with normal distribu-
tion were expressed as mean and standard deviation (SD), while
when normality is rejected, median with 95% confidence interval
(95% CI) was used. Values of P<.05 were considered significant.
A Wilcoxon signed-rank test (P<.05) was used to consider the
influence of the anatomic localization of the lesion on development
of SW.
Dogs were divided into two groups: the spinal walking group
(SW group), including dogs that achieved the ability to develop an
autonomous unassisted involuntary locomotion, and the no-spinal
walking group (No-SW group), including dogs that did not develop
an autonomous unassisted involuntary locomotion.
In order to detect specific variables significantly associated with
the development of SW gait, age, sex, weight, BCS, type of lesion
(acute IVDE or trauma), hospitalization during the physical ther-
apy treatment, and time between loss of pain perception and start
of physiotherapic treatment were compared between the SW and
No-SW groups by a binary logistic regression. Variables that meet
a cutoff of P<.15 at the univariate analysis were entered into a
multivariate logistic regression. The odds ratio (OR) and 95% CI
were calculated from the final model. A receiver operating charac-
teristic (ROC) curve was used to select the optimum cutoff value
of the variables to discriminate dogs with SW gait from dogs with
No-SW gait.
Results
Eighty-one dogs met the inclusion criteria and were
included in the study. Figure 1 describes the process of
selection of the cases. Descriptive data of the general
population are detailed in Table 1. Table 2 reports the
descriptive data of the SW and No-SW groups.
SW Group
At the end of the cycle of physiotherapic treatment,
48 dogs (59%) developed an autonomous spinal
locomotion. Of the 48 SW dogs, 31 (64%) underwent
surgery. The spinal cord lesion was situated between
Th4-Th5 and L2-L3. The most frequently affected site
(20 dogs) was at the level of Th12-Th13 (Fig 2).
Median time between loss of pain perception and the
beginning of physical therapy was 9.5 days (range:
2–210), and the median duration of physiotherapic
treatment was 75.5 days (range: 16–350). Thirty-nine
dogs (81%) had full-time hospitalization.
2 Gallucci et al
The median duration between the start of physiother-
apic treatment and the ability to stand up unassisted,
recorded in 29 dogs, was 20 days (range 2–150).
No-SW Group
At the end of the cycle of physiotherapic treatment,
33 dogs (41%) did not develop an autonomous spinal
locomotion. Of the 33 No-SW dogs, 30 (91%) under-
went surgery. The spinal cord lesion was situated
between Th7-Th8 and L2-L3. The most frequently
affected site (13 dogs) was at the level of Th12-Th13
(Fig 2).
Fig 1. Selection of the dogs’ population.
Table 1. Data of the general population.
Dogs 81
Breeds
(most represented)
Mixed breed (n =29; 36%),
Dachshund (n =16; 25%),
Miniature poodle (n =6; 7%),
Yorkshire Terrier (n =5; 6%),
Cocker Spaniel (n =5; 6%)
Age m: 60 months (range: 8–144; 95%
CI: 48–66)
Sex Male: 41 (50.6%) (C: 4; 3.7%)
Female: 30 (37%) (N: 7; 8.6%)
Weight m 8 kg (range: 2.3–29.6; 95% CI: 8–9.79)
≤10 kg: 49; >10 kg: 32
BCS m: 5 (range: 3–8; 95% CI: 5–5)
Dogs with IVDE 54 (66%)
Dogs with traumatic
injuries
27 (34%)
Dogs with full time
hospitalized
65 (80%)
Delay in onset of
physiotherapy*
m: 12 days (range: 2–1260;
95% CI: 8.21–19.38)
Duration of
physiotherapy
m: 74 days (range 10–370;
95% CI: 60.41–81.79)
*Days between the onset of paraplegia and the beginning of
physical therapy.
m, median; BCS, body condition score; C, castrated, N,
neutered.
Table 2. Spinal Walking (SW) and No-Spinal Walking
(No-SW) groups.
Spinal Walking
(SW) Group
No-spinal Walking
(No-SW) Group
Dogs 48 (59%) 33 (41%)
Breed (most
represented)
Mixed breed
(n =17; 35%),
Dachshund
(n =8; 17%),
Miniature poodle
(n =5; 10%)
Mixed breed
(n =13; 39%),
Dachshund
(n =8; 24%),
Beagle (n =2; 6%)
Age m: 54 months
(95% CI: 48–60)
m: 72 months
(95% CI: 52.93–84)
Sex Males: 23 (C: 2) Males: 21 (C: 1)
Females: 25 (N: 5) Females: 12 (N: 2)
Weight Range: 7–29.6 kg
m 7.3 kg
(95% CI: 7–8.26)
m10kg
(95% CI: 8.24–12.59)
≤10 kg: 33; >10 kg:
15
≤10 kg: 16; >10
kg: 17
BCS m: 5 (95% CI: 5–5) m: 5 (95% CI: 5–5)
Dogs affected
by IVDE
34 (71%) 20 (61%)
Surgical
management
27 (56%) 20 (61%)
Medical
management
7 (15%) 0
Traumatic injuries 14 (29%) 13 (39%)
Surgical
management
4 (8%) 10 (30%)
Medical
management
10 (21%) 3 (9%)
Hospitalization 39 (81%) 26 (79%)
Delay in onset of
physiotherapy*
m: 9.5 days
(95% CI: 6–12.77)
m: 23 days
(95% CI: 11.41–60)
Duration of
physiotherapy
m: 75.5 days
(95% CI: 58–94.84)
m: 69 (95%
CI: 46.64–92.95)
*Days between neurological deficit onset and the beginning of
physical therapy.
m, median; BCS, body condition score; C, castrated, N,
neutered.
Acquisition of Spinal Walking in Dogs 3
Median time between loss of pain perception and the
beginning of physio therapy was 23 days (range: 2–
1260), and the median duration of physiotherapic treat-
ment was 69 days (range: 10–370). 26 No-SW dogs
(79%) had full-time hospitalization.
On univariate analysis, comparison between the SW
and the No-SW groups showed that age was signifi-
cantly lower in SW group (P=.002; OR =4.14; 95%
CI: 1.61–10.66). Early start of physiotherapy was posi-
tively associated with achievement of SW gait
(P=.024; OR =2.81; 95% CI: 1.12–7.01).
Weight (P=.089), BCS (P=.051), full-time hospital-
ization (P=.78), type (P=.33), and site of the lesion
(P=.93) were not significantly associated with develop-
ment of SW.
By a multivariate logistic regression, younger age and
lower weight were significantly associated with develop-
ment of SW (P=.012 OR =5.66; 95% CI: 1.69–18.94
and P<.001, OR =5.09; 95% CI: 1.54–16.78,
respectively). ROC curve showed that dogs aging
≤60 months and dogs weighting ≤7.8 kg had higher
possibilities to achieve SW (95% CI: 0.53–0.75; sensitiv-
ity: 72.9%; specificity: 60.6% and 95% CI: 0.63–0.83;
sensitivity: 54.2%; specificity: 93.9%, respectively)
(Figs 3 and 4).
Discussion
In veterinary literature, SW is rarely described in
dogs
4,20–23
and most of studies report SW gait develop-
ment in training cats experimentally spinalized.
14–16,19,20
This study shows that paraplegic dogs with absent
pain perception undergoing intensive physiotherapic
treatment have good chance (59% in our population) to
develop an unassisted involuntary gait. Our study found
that younger age (≤60 months on ROC curve analysis)
was positively associated with development of SW. Lit-
erature does not provide comparable data, except for
Fig 2. Distribution of different site of lesion in SW and No-SW dogs. SW: Spinal walking group; No-SW: group of dogs that did not
achieve spinal walking. Figure shows that the most frequently site of lesion was at the level of Th12-Th13 in both groups (20 and 13 dogs
in SW and No-SW dogs, respectively). No significant association was found between the site of lesion and the development of SW
(P=.93). Nine dogs of “SW group” had multiple sites of lesions; 6 dogs of “No-SW group” had multiple sites of lesion.
020 40 60 80 100
0
20
40
60
80
100
100-Specificity
Sensitivity
Sensitivity: 72,9
Specificity: 60,6
Criterion : <=60
Fig 3. ROC curve of age. Figure shows the receiver operating
characteristic (ROC) curve used to select the optimum cutoff value
of age to discriminate dogs with SW gait from dogs with No-SW
gait. It shows that dogs aging equal or less than 60 months had
higher possibilities to achieve SW, with a sensitivity of 72.9% and
a specificity of 60.6%. (95% CI: 0.53–0.75).
0 20 40 60 80 100
0
20
40
60
80
100
100-Specificity
Sensitivity
Sensitivity: 54,2
Specificity: 93,9
Criterion : <=7,8
Fig 4. ROC curve of weight. Figure shows the receiver operating
characteristic (ROC) curve used to select the optimum cutoff value
of weight to discriminate dogs with SW gait from dogs with No-
SW gait. It shows that dogs weighting equal or less than 7.8 kg
had higher possibilities to achieve SW, with a sensitivity of 54.2%
and a specificity of 93.9%. (95% CI: 0.63–0.83).
4 Gallucci et al
experimental studies. In the eighties, it was demon-
strated that adult dogs could develop SW gait after
experimental mid-thoracic spinal cord transection, dis-
puting the earlier statements that functional recovery of
locomotion in TL spinalized animals depended upon
their very young age at the time of transection.
22
A
recent study on the outcome of paraplegic dogs without
pain perception did not find any significant association
with age.
10
In another study, younger age was associ-
ated with faster rather than better recovery of the
motor function.
1
Our analysis showed that lightweight dogs (≤7.8 kg
on ROC curve analysis) have a significantly better pos-
sibility of developing SW. Despite the empiric belief
that lightweight dogs with acute spinal cord lesion have
a better outcome, literature does not provide specific
information concerning the association between weight
and outcome, including development of SW. It is worth
mentioning that one 26 kg dog with IVDE developed
SW after appropriate physio therapy, indicating that
even larger dogs, occasionally, can achieve SW gait.
Experimental studies showed that the functional expe-
rience obtained in cats by step training (on a treadmill
at the greatest speeds possible) facilitated or reinforced
the capacity of the adult lumbar spinal cord to generate
full weight-bearing stepping after the elimination of
supraspinal connectivity.
15
The experimental results of
different authors suggest that the recovery of motor
function in cats seems to be improved by the level and
types of exposure of assisted training after the
injury.
14,15,18,19
Consequently, exercise is considered to
play an important beneficial role in promoting motor
recovery after ASCI.
19
While confirmed on univariate
analysis, our multivariate analysis failed to confirm the
association between early start of physiotherapy and
development of SW. Nevertheless, the high percentage
of dogs developing SW suggests that, also under field
conditions, specific motor training could play an impor-
tant role in facilitating the CPG in the development an
involuntary motor function. Ethical reasons and the ret-
rospective nature of our study did not allow us having
a control group of dogs, thus preventing the possibility
to demonstrate the real influence of physiotherapy. In a
study that assessed the long-term outcome of paraplegic
dogs without pelvic limb pain perception,
1
the small
number of dogs (n =7) which developed a SW gait
took longer time when compared to our SW group.
Possible explanations include the lack of clearly men-
tioned physiotherapic treatment. Further studies should
be encouraged to demonstrate our belief that physio-
therapy could play a crucial role in the development of
SW.
In our study, the site of the lesion was not signifi-
cantly associated with the outcome. In the seventies,
the results of a study influenced the general opinion
for many years, stating that SW could develop only
if the lesion was not cranial to the 13th thoracic ver-
tebra, to avoid the atrophy of paravertebral
muscles.
21
Further experimental study contradicted
these results, showing that 7 of 9 dogs with a com-
plete transection of the T9-T10th spinal cord segment
developed SW gait.
22
Our results support these latter
experimental findings also under field conditions.
Unexpectedly, five dogs with spinal cord lesions at
the presumed level of the CPG (L2-L3) developed
SW gait. Unfortunately, their number is too small to
draw suitable conclusions.
Future studies are needed to appropriately investigate
some specific physiotherapic parameters, which may be
relevant in facilitating the achievement of SW gait.
Authors believe that UWTM plays an important role in
facilitating paraplegic dogs to start reflex pelvic limbs
movements and, consequently, develop SW. In our clin-
ical experience, almost all dogs undergoing UWTM
physiotherapy develop pelvic limbs movements several
days before than in the normal treadmill. Nevertheless,
specific studies are necessary to compare physiotherapic
treatment protocols with or without UWTM, to con-
firm the anectodal statement that rehabilitation centers
using UWTM have increased development of SW. In
addition, cage restriction may play an important role in
order to avoid dogs learning wrong behavior, such as
freely dragging on their pelvic limbs, which could affect
the development of correct involuntary limbs
movements.
Besides the lack of a control group, our study has
several limitations. Authors are aware that multiple
analyses of small datasets are liable to false discovery
and the conclusions require suitable cautions because
they could not fit to other datasets. The retrospective
nature of the study did not prevent the possibility to
have bias in the case selection, including the relative
paucity of large breed dogs and the lower number of
cases with lumbar injuries. Furthermore, inclusion crite-
ria excluded dogs that developed myelomalacia, possi-
bly affecting the percentage of dogs which gained SW.
Finally, physiotherapic treatment of the No-SW group
was stopped according to the subjective physiothera-
pist’s judgment on the lack of response.
In conclusion, our study demonstrates that a percent-
age of paraplegic dogs without pain perception under-
going a cycle of intensive physio therapy treatment can
acquire SW gait.
Veterinarians and owners, when facing a catastrophic
event such as an ASCI leading to paraplegia without
pain perception, should be aware of the possibility that
their pets can develop SW gait and encouraged to act
consequently. Further studies are necessary to objec-
tively assess the role of intensive physiotherapy in the
acquisition of SW gait in paraplegic dogs without pain
perception.
Acknowledgments
The practical work (neurological assessment and
physiotherapy) was made at the “Dog Fitness” Veteri-
nary Physiotherapy and Rehabilitation Centre, Reggio
Emilia, Italy; processing and analysis of the data were
made at the Department of Veterinary Medical
Sciences, University of Bologna, Italy. Authors thank
all clinicians and physiotherapist who contributed to
clinical management of dogs enrolled in the study.
Acquisition of Spinal Walking in Dogs 5
Conflict of Interest Declaration: Authors disclose no
conflict of interest.
Off-label Antimicrobial Declaration: Authors declare
no off-label use of antimicrobials.
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6 Gallucci et al
