Try as we might, this rational expression just doesn't factor easily. The next step is to try long division because the degree of the numerator is greater than the degree of the denominator.
Express x^2-4 as the numbers 1color(white)(aa)0color(white)(aa)4
Express -x^4+5x^3-5x^2-6x-2 as -1color(white)(aa)5color(white)(aa)-5color(white)(aa)-6color(white)(aa)2
This gives us the long division problem
color(white)(aaaaaaaaa)-1color(white)(aa)5color(white)(aa)-9
1color(white)(aa)0color(white)(a)-4|bar(-1color(white)(aa)5color(white)(aa)-5color(white)(a)-6color(white)(aa)2)
color(white)(aaa1aaaa)-ul(1color(white)(aa)0color(white)(aaaa)4)color(white)(aaaa)darr color(white)(a.)darr
color(white)(aaaaaaaaaaaaa)5color(white)(aa)-9color(white)(aa)-6
color(white)(aaaaaaaaaaaaa)ul(5color(white)(aaaa)0color(white)(aa)-20)color(white)(a1)darr
color(white)(aaaaaaaaaaaaaaaa)-9color(white)(aaaa)14color(white)(a)-2
color(white)(aaaaaaaaaaaaaaaa)ul(-9color(white)(aaaaa)0color(white)(a.a)36)
color(white)(aaaaaaaaaaaaaaaaaaaaaaa)14color(white)(a)-38
So the answer is
-x^2+5x-9+(14x-38)/(x^2-4)