Tail pull injury

Question 1

What is it?

Answer 1

• traction injury to the cauda equine secondary to trauma resulting in avulsion of the nerve roots where they are stretched or pulled out from the spinal cord

Question 2

Presentation

Answer 2

• sudden onset paresis to paralysis affecting the tail and bladder function +/- the hindlimbs depending upon the extent of injury

Question 3

Diagnosis

Answer 3

• radiography may confirm fracture/luxation of tail
• no currently available investigations can confirm the degree of injury to nerve roots
• advanced imaging is usually not definitive

Question 4

Prognosis

Answer 4

• if nerve roots avulsed then very poor prognosis for recovery of continence
• if nerve roots stretched then can be good return of continence given time
• hindlimb function can often return without eventual return of continence

Question 5

Tx

Answer 5

• conservative and supportive with analgesia and most importantly bladder management
• tail amputation may be needed if continence returns without tail function, or to treat fracture avulsion