**Background:** Patients with severe spinal cord injury (SCI) are highly predisposed to clinical occurrences such as pressure ulcers, urinary tract infections (UTIs), gastrointestinal disorders, and respiratory complications. While human medicine has extensively studied these complications, veterinary literature is limited. This study aimed to evaluate the frequency of clinical occurrences in dogs with neurological conditions undergoing intensive inpatient neurorehabilitation and to develop preventive measures.
**Methods:** This prospective observational clinical study was conducted from September 2016 to February 2023 at two rehabilitation centers in Portugal. A total of 488 dogs with plegic presentation (grade 0 or 1 on Modified Frankel Scale and Open Field Score 0 or 1) were included. Inclusion criteria required hospitalization for more than two weeks and up to nine months. Etiologies included compressive myelopathy (93%, n=454) such as intervertebral disk herniation and lumbosacral stenosis, and non-compressive myelopathy (7%, n=34) such as ANNPE, HNPE, and FCEM. At admission, 74% (361/488) were paraplegic and 26% (127/488) tetraplegic; 72.5% (354/488) were deep pain-positive (DPP) and 27.5% (134/488) deep pain-negative (DPN). All dogs underwent a standardized functional neurorehabilitation (FNR) protocol with adaptations based on etiology, neuroanatomical location, and deep pain status. A checklist was used to record clinical occurrences at admission and throughout hospitalization. Statistical analysis included descriptive statistics and chi-square tests.
**Key Results:** At least one clinical occurrence was observed in 79.5% (388/488) of dogs. The most prevalent occurrences were neurogenic bladder (58%, 283/488) and diarrhea (35.5%, 173/488). Urinary incontinence occurred in 21.3% (104/488) and fecal incontinence in 20.5% (100/488). Pressure sores were present in 19.5% (95/488). Respiratory complications were low: aspiration pneumonia in 1.8% (9/488) and bronchopneumonia in 0.2% (1/488). UTIs occurred in 6.1% (30/488). Significant associations were found between occurrences and neuroanatomical localization (χ²=150.703, p≤0.001), with 85% (330/388) of occurrences in thoracolumbar dogs. Deep pain-negative dogs had significantly more occurrences (χ²=40.926, p≤0.001), with only 2 of 134 DPN dogs having no occurrences. Fecal incontinence was exclusively in DPN dogs with thoracolumbar (n=98) or lumbosacral (n=2) localization (χ²=44.366, p≤0.001). Brachycephalic breeds (21.9%, 107/488) showed significant associations with dermatitis (74.1%, 80/108; χ²=220.325, p≤0.001), ophthalmic occurrences (44% conjunctivitis, 33.6% episcleritis, 9.3% corneal ulcers; χ²=168.246, p≤0.001), and vomiting (35.2% of 71 vomiting dogs; χ²=8.566, p=0.023). Pressure sores were significantly associated with DPN status in paraplegic dogs (65% of 63 paraplegic dogs with pressure sores were DPN; χ²=25.562, p≤0.001) and inability to maintain sternal recumbency (77.9% of 95 dogs with pressure sores; χ²=25.154, p≤0.001). Aspiration pneumonia was significantly associated with absence of sternal recumbency (88.9% of 9 cases; χ²=4.274, p=0.039).
**Clinical Implications:** This study demonstrates that intensive inpatient neurorehabilitation can be associated with a high prevalence of clinical occurrences, particularly in DPN dogs and those with thoracolumbar injuries. However, the low incidence of respiratory problems and UTIs suggests that preventive measures—including point-of-care ultrasound (POCUS) for bladder and gastrointestinal monitoring, strict sternal positioning, respiratory kinesiotherapy, manual bladder expression, and early implementation of FNR protocols—may effectively reduce these complications. The high occurrence rates in brachycephalic breeds (especially French Bulldogs) highlight the need for breed-specific preventive strategies. These findings support the use of a systematic, multidisciplinary approach to improve quality of life and potentially reduce euthanasia in dogs with severe SCI.