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