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Case Report
Tail amputation for treatment of osteomyelitis
of the first and second coccygeal vertebrae in a cow
K. Nuss1; M. Feist2
1Department
of Farm Animals, Vetsuisse Faculty, University of Zürich, Switzerland; 2Ruminant Clinic, Veterinary Faculty of the University of Munich, Germany
Introduction
Case history
Diseases of the tail are common in cattle (3, 4). Infection or necrosis of the tail tip, injury of the coccygeal vertebrae resulting in tail
paralysis (8, 12) as well as fracture or luxation of the coccygeal vertebrae (6) are some of the most common disorders. Congenital
defects, diskospondylitis and tumours of the tail occur occasionally (5, 8).
Tail fractures or luxations are usually the result of trauma, such
as falls, excessive traction on the tail when moving a downer cow,
excessive traction on a calf during assisted delivery, and mounting
by other cows or heavy bulls (3, 13). Clinical signs depend on the
severity of nerve damage and the location of the fracture. Fractures
involving the second (S2), third and fourth sacral (S3 and S4) segments may affect the pudendal nerve, pelvic nerves and the tail
nerve resulting in paralysis of the urinary bladder, anus and tail.
Tail paralysis without other neurological deficits indicates damage
to the coccygeal nerve (7).
Diseases of the tail may be treated conservatively or by amputation cranial to the affected area. Tail amputation in cattle is a very
controversial subject because in some countries, it is carried out
prophylactically for management reasons without any medical indication (1, 9, 11). Prophylactic tail amputation is done 7–8 cm
below the vulva in calves and 5–6 cm below the vulva in heifers and
mature cows. The present case report describes complete amputation of the tail at the level of the sacrum in a cow with osteomyelitis of the first (C1) and second coccygeal (C2) vertebrae.
History
A 3.5-year-old German Fleckvieh cow was referred to our clinic because of limited tail movement and a non-healing wound on the
tail head. The cow was a valuable breeding animal and 8 months
pregnant. Four weeks before referral, a small round wound with
purulent exudate was noticed on the tail head and was treated with
antibiotics locally and systemically. The amount of exudate increased markedly over the following 4 weeks and there was no
response to local antibiotics and lavage of the fistulous tract.
Clinical and radiographical examination
Except for the wound on the tail head, the results of a physical
examination were unremarkable and haematological and biochemical analyses were within normal limits. The fistula and purulent exudate on the tail head were readily apparent. Caudal to
the fistula there was a deviation in the contour of the tail head
(씰Fig. 1). The tail was held slightly to the right at the level of the
tail head, and the cow could not completely lift the tail during defecation and urination, which resulted in soiling of the tip of the
tail. There was reduced tail tone, and passive movement of the tail
elicited pain. Anal tone and the anal reflex were normal. A probe
Schwanzamputation bei einer Kuh zur Behandlung einer Osteomyelitis des ersten und zweiten Schwanzwirbels
Tierärztl Prax 2011; 39 (G): 176–178
Received: November 18, 2010
Accepted after revision: December 28, 2010
Correspondence to
Karl Nuss
Prof. Dr. med. vet., Dipl. ECVS, Dipl. ECBHM
Department of Farm Animals
Vetsuisse Faculty, University of Zurich
Winterthurerstrasse 260
CH-8057 Zürich, Switzerland
E-Mail: [email protected]
Fig. 1
Purulent fistulous
tract at the tail head
in a 3.5-year-old
dairy cow.
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K. Nuss; M. Feist: Tail amputation in a cow
Fig. 2 Laterolateral radiographic view of the tail head (S5 = fifth sacral
segment) of a 3.5-year-old dairy cow with luxation of the second coccygeal
vertebra (C2) and osteolysis of the first (C1) and second coccygeal vertebrae
at the intervertebral space (A = location of abscess).
could be advanced approximately 10 cm ventrally into the fistulous
tract. A deviation in the coccygeal vertebral column and instability in the region of S1 and S2 were also detected by transrectal
palpation.
Radiography (씰Fig. 2) revealed osteomyelitis of C1 and C2
with complete destruction of the intervertebral disc and showed a
ventral luxation of the vertebral collum at this location. Based on
all the findings, a diagnosis of osteomyelitis of C1 and C2, infection
of the associated intervertebral disc and luxation of C2 was made.
Treatment and outcome
Because of a poor response to conservative treatment and risk of
rupture of the abscess into the rectum, pelvic cavity or spinal cord,
complete amputation of the tail and affected tissues was carried
out with the owner’s consent. The operation was done with the cow
standing because of advanced pregnancy. The cow was sedated
with 0.01 mg xylazine administered intravenously and her head
and body secured to a hydraulic tilt table. Hobbles were placed on
the hind limbs. Epidural anaesthesia using 10 ml of 2% procaine
solution was carried out between S5 and C1. Additionally a total of
100 ml of 2% procaine solution per side was injected in the region
of the second last sacral segment, lateral to the spinous processes
and subcutaneously over the spinous processes to desensitize the
nerves of the skin and musculature. The local anaesthetic was effective for the entire duration of surgery, which was 2 hours. The
cow remained standing and did not try to lie down at any time during the procedure.
After aseptic preparation and draping of the surgical site, an elliptical skin incision was made around the fistulous tract, which
was then clamped in the subcutaneous tissues to prevent discharge
of pus during the operation. The skin incision was extended along
the median distally 10 cm to the tail folds (씰Fig. 3a). A circular incision around the tail was made at that point and the distal portion
of the tail was amputated between C5 and C6. Excision of C5 to C1
was achieved by carefully dissecting close to the bones to preserve
the sacrococcygeal muscles (dorsal, medial and lateral sacrococcygeal muscles, ventral sacrococcygeal muscle, coccygeal muscle) and
prevent perforation of the rectum. Bleeding was controlled by cauterization or ligation of the vessels. Care was taken not to open the
abscess cavity in the region of C1 and C2. Starting dorsally at the
proximal aspect of the wound, the supraspinal ligament, interspinal muscle, intertransversal muscles and ventral sacrococcygeal
muscles (2, 10), blood vessels and the caudal nerves were transected between S5 and C1. The intervertebral disk was cut dorsally
and C1 to C5 were tipped ventrally away from the sacrum to allow
identification and ligation of the middle sacral artery and vein.
After ligation, the blood vessels were transected and C1 to C5 were
removed. The wound was lavaged liberally with lactated Ringer’s
solution containing penicillin, and the various muscles were sutured in five layers using USP 2 (5 metric) synthetic braided ab-
Fig. 3
a) Amputation of the tail in a cow with osteomyelitis of the first and second coccygeal vertebrae. The
fistulous tract was circumcised and the incision extended distally to the level of the tail folds. A circular skin incision was made and the distal tail amputated. The tail head was then dissected from the soft
tissues and amputated at the sacrum. b) Wound region after suture removal 12 days after amputation;
uneventful healing.
a
b
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177
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K. Nuss; M. Feist: Tail amputation in a cow
sorbable suture material in a continuous suture pattern. The subcutaneous tissues were sutured with the same suture material but a
smaller size (USP 0) (3.5 metric) using a horizontal mattress suture
pattern. The skin was closed with USP 2 (5 metric) non-absorbable
suture material using a single interrupted suture pattern.
Postoperatively, the cow received procaine penicillin (25000 IU/
kg) intramuscularly every 24 hours for 7 days and ketoprofen
(1.1 mg/kg) intramuscularly every 24 hours for 3 days. Other than
mild swelling of the incisional area, which resolved within a week,
there were no complications. The position of the anus and vulva
remained normal (씰Fig. 3b). The cow was housed in a tie-stall for
15 days before being discharged from the clinic. During the last
days of her hospital stay she was hand-walked and the sacrum reradiographed. Examination of video recordings of the cow’s gait
showed no neurological deficits. Anal and perineal reflexes and
skin sensitivity at the operative site were normal. Two weeks after
discharge from the clinic, the cow calved without difficulty under
veterinary supervision. In the following 6 months, embryos were
collected from the cow on two occasions, after which time she was
bred and conceived. The cow calved the third time at term without
difficulty with the owner present. Daily milk production eight
weeks post-calving (2010) was 45 litres.
coccygeal nerves, and not the pudendal branches of the perineum,
were affected at the time of surgery. Thus, there was no loss of anal
or perineal function before or after the operation. The loss of part
of the dorsal attachment of the vagina and rectal sphincter did not
result in urine pooling or abnormal defecation at any time during
long-term follow-up evaluations. Fertility and calving were normal, which indicated that pelvic organ function was unaffected by
surgery. In a telephone follow-up the owner reported that the cow
was more pruritic than herd mates. The cow used the cow brush
and other objects frequently to scratch her anal region, but had no
evidence of ectoparasitism.
The aetiology of the infection was not identified. Haematogenous spread of infection causing diskospondylitis or infection of the
tips of vertebral processes after blunt trauma (luxation), infection
attributable to non-aseptic epidural anaesthesia or another sharp
injury were possible causes. The surgical technique used in our
patient appears suitable for treatment of diseases of the tail head,
including injuries and tumours.
Conflict of interest
The authors confirm that they do not have any conflict of interest.
References
Discussion
To the authors’ knowledge, amputation of the entire tail in cattle
has not been reported. The procedure was indicated in our patient
because conservative treatment had not resolved the infection and
the cow had bilateral coccygeal nerve damage. Furthermore, there
was a risk of pararectal abscess formation or ascending infection of
the spinal cord. The musculature in the operative site was preserved as much as possible to protect the caudal pelvic tissues, particularly with respect to the impending parturition, and to protect
the function of the rectal sphincter and vagina and the musculature dorsal to the rectum. The preparation of the coccygeal vertebrae was difficult because the first five coccygeal vertebrae have all
the features of normal vertebrae including transverse processes,
and in addition they have ventral hemal processes. Because the
cauda equina ends at the last sacral segment in cattle (2), only the
Conclusion for practice
Trauma to the tail head in cattle occurs probably more frequently than
reported in the literature. Sequelae can be sacral or coccygeal fractures and luxations, which can become infected. Infections may also
occur following a laceration or after epidural anaesthesia. In selected
cases amputation of the entire tail can be performed. The described
surgical technique appears suitable for treatment of diseases of the
tail head.
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