ISSN 2398-2969      

Lumbosacral joint: acquired disease

icanis

Synonym(s): Lumbosacral stenosis, Lumbosacral spondylopathy, Lumbrosacral disease, Cauda equina syndrome


Introduction

  • Large breed dogs, particularly working dogs, affected.
  • Signs: pain at lumbosacral junction with hindlimb paresis +/- urine, fecal incontinence.
  • Cause: a variety of underlying pathologies cause pressure on the cauda equina.
  • May be mistaken for CDRM Degenerative myelopathy or hip dysplasia Hip: dysplasia.
  • Treatment: rest, NSAIDs or corticosteroids, gabapentin.
  • Prognosis: fair with conservative approach; guarded if surgery required unless surgically amenable disease; recurrence post surgery complicates prognosis in many cases.
    Print off the owner factsheet on Lumbosacral stenosis to give to your client.

Pathogenesis

Etiology

  • Type 2 Hansen disk protrusions.
  • Osteoarthrosis of articular facets.
  • Degeneration of the lumbrosacral disk leading to chronic hypertrophy of the dorsal annulus causing pressure on the cauda equina nerves.
  • Inherent congenital stenosis of the vertebral canal leading to pinching of nerve tissue.
  • Instability of the lumbosacral joint leading to chronic soft tissue inflammation and proliferation, ultimately impinging on nerve trunks.
  • The condition is insidious in onset as chronic changes slowly intrude/compress on the nerve tissue resulting in clinical signs.
  • + - Discospondylitis (inflammatory response to infection of the disk leads to a similar outcome as with disk degeneration).
  • + - Osteochondritis dissecans (especially in German Shepherd dogs).
  • + - Tumor of the nerves or bone in this area.

Predisposing factors

General

  • Working dogs more commonly affected so perhaps high levels of activity induce further instability and resultant chronic change.

Pathophysiology

  • Lumbosacral disease can occur as a congenital stenosis of this region or be acquired due to malarticulation, malformation, or IVD protrusion.
  • The latter is most common in older dogs.
  • The associated spinal compression usually affects the L7, sacral, and caudal nerve roots as these traverse through the lumbosacral area (LS).
  • Compression can result dorsally from the interarcuate ligament, or ventrally from the bulging annulus fibrosis.
  • The L7 nerve roots are often also compressed from a ventral direction as they exit the vertebral canal at the foramen.
  • Occasionally, neoplasia or discospondylitis can result in LS compression.
  • Primary inflammation of these nerves (cauda equina neuritis) is rare.
  • Chronic proliferative changes slowly impinge on the terminating spinal cord nerves (cauda equina).
  • Pain may be from pressure on meninges of dural sac or from stretching of pain receptors in the dorsal longitudinal ligament.
  • The nerves can adapt to slowly developing compression but ultimately clinical signs appear.

Timecourse

  • Usually a slow progressive disease that responds variably to periods of rest.

Diagnosis

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Treatment

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Prevention

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Carozzo C, Cachon T, Genevois J P, Fau D, Remy D, Daniaux L, Collard F, Viguier E (2008) Transiliac approach for exposure of lumbosacral intervertebral disk and foramen: technique description. Vet Surg 37 (1), 27-31 PubMed.
  • Suwankong N, Meij B P, Voorhout G, de Boer A H, Hazewinkel H A (2008) Review and retrospective analysis of degenerative lumbosacral stenosis in 156 dogs treated by dorsal laminectomy. Vet Comp Orthop Traumatol 21 (3), 285-293 PubMed.
  • Gödde T, Steffen F (2007) Surgical treatment of lumbosacral foraminal stenosis using a lateral approach in twenty dogs with degenerative lumbrosacral stenosis. Vet Surg 36 (7), 705-713 PubMed.
  • Suwankong N, Voorhout G, Hazewinkel H A & Meij B P (2006) Agreement between computed tomography, magnetic resonance imaging, and surgical findings in dogs with degenerative lumbosacral stenosis. JAVMA 229 (12), 1924-1929 PubMed.
  • Linn L L, Bartels K E, Rochat M C, Payton M E, Moore G E (2003) Lumbosacral stenosis in 29 military working dogs: epidemiologic findings and outcome after surgical intervention (1990-1999). Vet Surg 32 (1), 21-29 PubMed.
  • Mayhew P D, Kapatkin A S, Wortman J A, Vite C H (2002) Association of cauda equina compression on magnetic resonance images and clinical signs in dogs with degenerative lumbosacral stenosis. JAAHA 38 (6), 555-562 PubMed.
  • De Risio L, Sharp N J, Olby N J, Munana K R, Thomas W B (2001) Predictors of outcome after dorsal decompressive laminectomy for degenerative lumbosacral stenosis in dogs: 69 cases (1987-1997). JAVMA 219 (5), 624-628 PubMed.
  • Jones J C, Banfield C M, Ward D L (2000) Association between postoperative outcome and results of magnetic resonance imaging and computed tomography in working dogs with degenerative lumbosacral stenosis. JAVMA 216 (11), 1769-1774 PubMed.
  • Ramirez O III et al (1998) A review of imaging techniques for canine cauda equina syndrome. Vet Radiol Ultrasound 39 (4), 283-296 PubMed.
  • Ferguson H R (1996) Conditions of the lumbosacral spinal cord and cauda equina. Semin Vet Med Surg (Small Anim). 11 (4), 254-258 PubMed.
  • Chambers J N, Selcer B A, Butler T W et al (1994) A comparison of computed tomography to epidurography for the diagnosis of suspected compressive lesions at the lumbosacral junction in dogs. Prog Vet Neurol 5 (1), 30-4 VetMedResource.
  • deHaan J J, Shelton S B & Ackerman N (1993) Magnetic resonance imaging in the diagnosis of degenerative lumbosacral stenosis in four dogs. Vet Surg 22 (1), 1-4 PubMed.
  • Bagley R S (1992) Tremor syndromes in dogs - diagnosis and treatment. JSAP 33 (10), 485-90 VetMedResource.
  • Sisson A F, LeCouteur R A, Ingram J T et al (1992) Diagnosis of cauda equina abnormalities by using electromyography, discography, and epidurography in dogs. J Vet Int Med 6 (5), 253-63 PubMed.
  • Palmer R H & Chambers J N (1991) Canine lumbosacral diseases. Part I. Anatomy, pathophysiology, and clinical presentation. Comp Contin Ed 13 (1), 61-4 VetMedResource.
  • Palmer R H & Chambers J N (1991) Canine lumbosacral diseases. Part II. Diagnosis, treatment, and prognosis. Comp Contin Ed 13 (2), 213-22 VetMedResource.

Other sources of information

  • Summers B A, Cummings J F & de Lahunta A (1995) In:Veterinary Neuropathology.St. Louis:Mosby.
  • Oliver & Lorenz (1983) Handbook of Veterinary Neurologic Diagnosis. Philadelphia: W B Saunders. pp 177.

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