Lumbo-Sacral Disease

Dogs

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Lumbo-sacral disease is a term used to describe compression of the nerve roots and spinal cord as they pass through the lumbo-sacral portion of the lower spine, which is the lower back near the hips. It may also be referred to as "cauda equina" syndrome by your veterinarian.

There are a variety of causes of lumbo-sacral disease. It can be congenital (present at birth) or acquired (developed after birth); thus, dogs may show clinical signs at any age. Lumbo-sacral disease is most common in large breed dogs, particularly German shepherds, and males and females are equally affected.

The disease is characterized by marked back pain, which can become excruciating and severely debilitating, and hind leg weakness. Because the nerves that supply the bladder, rectum and anus pass through this region, urinary and fecal incontinence can result.

What to Watch For

  • Pain when lying down and getting up
  • Reluctance to move
  • Worn nails
  • Inappropriate urination

    Diagnosis

    Veterinary care should include diagnostic tests and subsequent treatment recommendations. Diagnostic tests are needed to recognize lumbo-sacral disease and exclude other diseases that may cause similar symptoms. Diagnostic tests may include the following:

  • Complete medical history and physical examination. Affected dogs are typically painful on palpation or manipulation of the lower spine. If your dog has a history of trauma, and/or a fracture or dislocation of this region is suspected, then minimal and careful manipulation of this region will be done prior to stabilization of your dog for shock and confirmation of the injury with radiographs (X-rays).

  • A neurological examination

  • X-rays can be helpful to define some congenital abnormalities of the spine, some bony tumors and bone and disk related infections.

  • Further diagnostic tests may include an electromyogram (EMG), myelography and epidurography. A CT scan or MRI may also be helpful.

  • Routine blood tests

  • Treatment

    Treatment for lumbo-sacral disease can be either medical or surgical and depends on the severity of the disease.

    Medical management may be most helpful where the compression occurs secondary to infection and may include:

  • Rest, anti-inflammatory medication and antibiotics
  • Strict confinement
  • Surgery, especially if medical management is not effective or the problem is severe

    Surgical treatment may be recommended after spinal X-rays, a myelogram, epidurogram, CT or MRI. A fracture or dislocation usually needs to be stabilized with surgery. Other surgical treatments may include:

  • In cases of congenital bony compression, disc compression, ligament compression or pressure from a growing tumor, a window is usually created in the bone to allow freedom of the nerve roots.

  • When possible, removal of the source of the compression may be necessary.

    Home Care and Prevention

    Regardless of whether your dog has medical or surgical management of the problem, an initial period of rest and restriction is usually important. Your dog may require assistance to get up, to go outside, or even to urinate. Your veterinarian will usually demonstrate supportive care and physiotherapy techniques when necessary. Follow your veterinarians recommendations carefully to avoid exacerbating the condition.

    Excessive weight gain may predispose some dogs to increased stress upon their lower spine. Therefore, do not allow your dog to become overweight.

    Most spinal fractures and spinal dislocations are caused when dogs are hit by cars. Common sense and judicious use of a leash should help prevent this occurrence.

    The remaining causes of lumbo-sacral disease, for the most part, cannot be prevented. Certain activities such as jumping and twisting to catch a flying disk might tend to jar or twist the lower spine. However, there are no specific long-term recommendations to prevent lumbo-sacral nerve root compression.

    It is important that you recognize hind limb weakness or back pain early. Once the disease has progressed to the point where urinary function is affected (urinary incontinence or urine dribbling) the prognosis for recovery is worse than if it is caught and treated earlier, before these signs develop. Early evaluation by your veterinarian for suspected lower back pain, clumsiness, reluctance to go up or down stairs or similar limitations is strongly recommended.

  • There are other causes of back pain and hind limb weakness that must be differentiated from lumbo-sacral disease. Thus, if your dog has back pain, your veterinarian will try to localize the pain to a specific segment of the spinal cord.

  • Although diseases of the spinal cord above the lumbo-sacral region may produce hind leg weakness, spinal pain should be evident when the spine in front of the pelvis is manipulated during a neurological examination. With lumbo-sacral disease, the pain is elicited when the spine at the pelvis is manipulated. The effect on the hind legs should be quite different also when there is disease of the spinal cord.

  • Hip dysplasia and ruptured cruciate ligaments within both knees can produce a clumsy hind leg gait. Hip dysplasia can produce pain on hip extension, which may be misinterpreted for lower spinal pain. But neither disease should produce neurological abnormalities, such as knuckling of the feet or urinary or fecal incontinence.

  • Metabolic diseases can produce hind leg weakness but will usually be associated with other clinical signs and blood work abnormalities.

  • Degenerative myelopathy is a slow progressive neurological disease that occurs most commonly in German shepherd dogs. Hind leg reflexes are usually quite different to those found in dogs with lumbo-sacral disease and the disorder is not associated with pain.

  • Veterinary care should include diagnostic tests and subsequent treatment recommendations.

    Diagnosis In-depth

    Diagnostic tests are necessary to recognize lumbo-sacral disease and exclude other diseases that may cause similar symptoms. Tests may include the following:

  • Complete medical history and physical examination. During the examination your veterinarian will watch how your dog stands, sits, lies down and gets up. The gait will also be monitored before assessing the lower spine and the back legs.

  • Typically, dogs with lumbo-sacral disease have significant back pain. Evidence of this can be elicited on direct palpation, which is checking body parts and organs by touching and feeling, by picking up and flexing the tail, or a combination of pushing on the lower spine and extending one or both hips. Pain elicited during hip extension must be distinguished from hip pain that occurs in dogs with hip dysplasia.

  • A neurological examination. This may include tests that assess your dog's awareness of the foot position, the reflexes of the hind legs and an assessment of bladder function and anal tone.

  • A blood sample may be obtained to ensure that your dog is healthy enough to undergo surgery. In cases where infection or other metabolic disease is suspected, blood work will also be performed.

  • Radiographs (X-rays) of the lumbo-sacral region may show bony changes associated with instability, evidence of infection, fracture or dislocation of the spine, or bone damage consistent with cancer. They do not demonstrate actual spinal cord or nerve root compression.

  • Electromyography (EMG). This is a study performed under general anesthesia in which needle probes are placed through the skin in order to measure the electrical activity of muscles and nerve conduction. Abnormal activity is recorded with lumbo-sacral disease, and this can be a good first diagnostic tool before more invasive tests such as myelography or epidurography are performed.

  • Myelography and epidurography. X-ray studies highlight the cord and nerve roots, respectively, as they pass through the lower portion of the spine. These studies can define the type of compression present and, therefore, give useful information as to whether surgery is appropriate and/or likely to be beneficial.

  • CT scans and MRI, if available, can help to determine the cause of the lumbo-sacral disease.


    Treatment In-depth

    Treatment for lumbo-sacral disease may include medical management or surgery. The severity of the disease helps determine the best course of treatment.

    Medical management is commonly used when bone infection or infection of the disc space is the cause of the lumbo-sacral disease. This will include strict confinement of your dog and administration of anti-inflammatory medications and specific antibiotics.

    In milder cases of lumbo-sacral disease due to nerve root compression, or where cost of surgery is prohibitive, strict rest and anti-inflammatory medication may be tried for four to six weeks.

    Surgical management is indicated for the repair of most lumbo-sacral fractures and many other causes of nerve root compression. Surgical treatments may include:

  • Surgery done under the same anesthesia as some diagnostic tests (such as an epidurogram or a CT scan). These procedures are not usually necessary when an obvious fracture or dislocation can be seen on a plain X-ray.

  • Spinal fractures and dislocations in the lumbo-sacral region usually can be repaired by a variety of techniques using pins, wires, metal clamps, plates, screws and sterile cement polymers.

  • Surgical repair of nerve root compression usually involves removing a "window" of the bony roof of the spinal canal (a dorsal laminectomy). This allows access to compressive disc material, tumor or thickened ligaments. Extra bone may need to be removed around the openings for outflow of nerves in the bone or at the articulating surfaces of the lumbo-sacral joint. The surgery usually ensures complete freedom of the spinal cord and nerve roots that flow through this region of the spinal canal.

    All dogs, whether they have surgery or not, require strict confinement and rest. Because many affected dogs are large, it may be easier to section-off a portion of a room, such as the kitchen, rather than using a carrier or cage.

    Assistance may be required to get your dog up and walking. A towel slung underneath your dog's abdomen can help.

    Many dogs, even those with dramatic back pain and horrible spinal fractures, can make a remarkably fast recovery. Nerve root pinching can be extremely uncomfortable and many dogs feel much better after surgical removal of the compression. It is important that these dogs do not exercise too soon.

    Do not allow your dog to jump on or off furniture or go up or down stairs. When your dog needs to go to the bathroom, take him outside on a leash so that he cannot run around.

    Medication may be necessary to assist your dog with normal urination; particularly to help prevent accidents in the house. It is important to provide plenty of soft padded bedding to avoid the development of pressure sores.

    After surgery, the incision should be checked daily for swelling, redness or discharge. Your veterinarian should remove the stitches or staples in two weeks.

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