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Small Animal Medicine > Disorders of the Lumbosacral Spine > Flashcards

Disorders of the Lumbosacral Spine Flashcards

1
Q

What is the cauda equina?

A

spinal nerve roots of the lumbosacral spine derived from L7 caudally

  • shape reminiscent of a horse’s tail
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2
Q

What 3 things make up the lumbosacral junction/area?

A
  1. bone of L7 vertebra to sacrum
  2. connective tissue of L7/S1 disk, articular facets, joint capsules, and interarcurate ligaments
  3. cauda equina nerve roots
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3
Q

What is a dorsal laminectomy?

A

removing a small window of bone over the top of the spinal column to expose the spinal cord

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4
Q

What is a facetectomy?

A

removal of the articular facet

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5
Q

What is a foraminotomy?

A

enlargement of the intervertebral foramina to relieve pressure on nerves that are being compressed

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6
Q

What is the most consistent clinical sign associated with degenerative lumbosacral stenosis? What are clinical signs wrongly attributed to?

A

pain —> hyperesthesia

gait abnormalities can seem like degenerative changes associated with age or hip dysplasia

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7
Q

How do onset of clinical signs and lameness compare with degenerative lumbosacral stenosis and hip dysplasia?

A

DLSS - signs begin at middle-age to older, lameness worse after rest and improve with motion

HD - signs begin at younger ages, lameness worsens with activity

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8
Q

How do neurological deficits and pain compare with degenerative lumbosacral stenosis and hip dysplasia?

A

DLSS - neurological deficits present, lumbosacral and hip associated pain

HD - no neurological deficits, hip associated pain

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9
Q

How does response to therapy compare with degenerative lumbosacral stenosis and hip dysplasia?

A

DLSS - suboptimal response to NSAIDs and nutraceuticals, positive response to Gabapentin and Pregablin

HD - often responds well to NSAIDs and nutraceuticals, minimal response to Gabapentin and Pregablin

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10
Q

What dogs commonly present with degenerative lumbosacral stenosis AND hip dysplasia?

A

German Shepherds - often congenital
lumbosacral transitional vertebrae associated

  • importance of Hx, PE, NE, and response to medication
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11
Q

What is degenerative lumbosacral stenosis? What are the most common causes?

A

protrusion of the soft tissue structures in the LS regions compresses cauda equina and L7 nerve roots

  • anatomic abnormalities
  • chronic instability
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12
Q

What is the pathophysiology of degenerative lumbosacral stenosis like?

A
  • Type II disk degeneration or other degenerative changes at the LS junction causes collapse of the intervertebral disk space
  • progresses to facet subluxation and facet joint hypertrophy
  • transitional vertebrae (fused L7-S1) develops
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13
Q

What dogs commonly present with transitional vertebrae in DLSS? What is commonly involved?

A

German Shepherds - 8x more likely to develop DLSS 1-2 years earlier than normal

articular facets

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14
Q

What is the most common signalment associated with DLSS?

A

adult, large breed, males —> GSD overrepresented

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15
Q

What are 4 common historical features of the pelvic limb associated with DLSS?

A
  1. pain localized to back end
  2. unilateral or bilateral pelvic limb weakness
  3. scuffing of toes of the pelvic limbs
  4. muscle atrophy of the pelvic limbs due to sciatic nerve distribution

develops within weeks to months

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16
Q

What are 4 other historical features associated with DLSS?

A
  1. difficulty rising, especially after resting and at the stairs
  2. low tail carriage
  3. biting/chewing of hip region, tail, toes
  4. urinary and/or fecal incontinence
17
Q

What are 3 findings on neurological exam in patients with DLSS?

A
  1. abnormal gait, lameness
  2. poor withdrawal reflexes often only at the hock
  3. delayed to absent proprioceptive positioning of the pelvic limbs
18
Q

What are 4 common localizations of pain in patients with DLSS?

A
  1. at LS, with dorsal and/or ventral palpation
  2. lordosing LS
  3. dorsiflexing tail
  4. hip extension
19
Q

Where can the L7 nerve root be palpated? How do dogs with DLSS respond?

A

medial to the ventral ilium

will be painful —> normal dogs will not mind

20
Q

Where do L7 nerves come off?

A

off the transverse processes

DLSS = painful!

21
Q

What is indicative of DLSS in the stance phase of the gait? What happends when these patients have their caudal thigh musculature manipulated?

A

pronation of supination

tense up

22
Q

What 3 areas are commonly palpated to diagnose DLSS?

A
  1. BL 35 acupuncture point under the tail = painful
  2. tuber coxae and tuber sacrale with thumb and middle finger = L7 nerve root irritation
  3. groove between bicepfs femoris and semitendinosus = sciatic nerve irritation
23
Q

What is the preferred diagnostic for DLSS?

A

MRI

  • radiographs can rule out/in diskospondylitis
  • CT
  • contrast radiography
24
Q

What 2 views are preferred for diagnosing DLSS on MRI? What can highlight L7/S1 compression?

A
  1. standard
  2. flexed/extended

oblique parasagittal planes

25
Q

What medical management is recommended for DLSS? What additional treatments are also recommended?

A
  • anti-inflammatories: Rimadyl
  • analgesics: Tramadol, Gabapentin, Pregablin (Lyrica)

exercise restriction, physical therapy, electroacupuncture, laser therapy

26
Q

What commonly develops with long-term medical management of DLSS?

A

permanent incontinence if not addressed surgically

27
Q

What are 4 indications for surgical treatment for DLSS?

A
  1. refractory to medical therapy
  2. worsening pain
  3. worsening neurological deficits
  4. fecal and/or urinary incontinence
28
Q

What is the standard method for correcting DLSS? What may also be required?

A

dorsal laminectomy

  • facetectomy
  • foraminotomy
  • stabilization, diskectomy (controversial)
29
Q

What is diskospondylitis? At what location is it most commonly found? What is the most common chief complaint?

A

infection of the disk space adjacent to the vertebral endplate

LS —> L7/S1

pain

30
Q

What is the most common cause of diskospondylitis? What is seen in GSDs?

A

bacterial - Staphylococcus

fungal - Aspergillus

31
Q

How is diskospondylitis diagnosed? What treatment is recommended?

A
  • radiographs
  • MRI more sensitive

long-term antibiotics —> good prognosis with bacterial infections

Small Animal Medicine (52 decks)

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