Lumbo-Sacral Disc Disease Flashcards
clinical signs most commonly encountered in cases of lumbo-sacral dx. (5)
- Pain with spontaneous yelping/vocalisation usually when jumping or standing up
- Ipsilateral lameness with possible associated nerve root signature
- Pain on palpation and mobilisation of the affected limb
- Paraesthesia with excessive grooming/licking of the affected limb
- Lower motor neuron signs of the affected limb.
In severe cases of lumbo-sacral dx. What signs may be seen? (2)
Paresis/paralysis of the tail
Urinary and/or faecal incontinence
In cases of lumbo-sacral disease the most common abnormalities on neurological examination are (6)
1 Proprioceptive deficits
2 Reduced hock flexion
3 Pseudo hyperreflexia patellar reflex
4 Muscle atrophy especially of the tibial cranial muscle can be present.
5 Reduced perineal reflex / anal tone
6 Low tail carriage.
Benefits of advanced imaging for LS dx (4)
- Investigate foraminal stenosis
- Good visual of vertebral foramen
- Identify bone proliferations
- Identify disc calacification extrusion
With lumbo-sacral dx. On the xrays what other dx should be ruled out? (3)
- Discospondylitits
- Neoplasia
- Hip dysplasia
What might be seen on survey radiographs of lumbar-sacral dx? (5)
- Foraminal opacification (in cases of lateralised calcified disc extrusion),
- Sclerosis of the endplates,
- Reduced disc space size as well
- Osteoproliferative changes around the articular facets
- Spondylosis deformans
What is a CT scan poor at identifying with LS dx? (2)
- Soft tissue
- Nerve root compression
What study is the imaging modality of choice to investigate associated enlargement of the affected spinal nerve proximal to the level of stenosis, especially on STIR sequences?
MRI
What can enable confirmation of the neurological lameness and confirmed the suspicion of LS disease over an orthopaedic disease?
Electromyography
What neurological deficits would you expect on examination with a LS subluxation (4)
Reduced / absent perineal reflex
Reduced / absent perineal nociception
Absent tail nociception
Reduced to absent withdrawal reflex
With a LS luxation; which of the following would you expect to see?
Urinary incontinence
Faecal incontinence
Flaccid tail
Paraplegia
Muscle wastage
Urinary incontinence
Faecal incontinence
Flaccid tail
Muscle wastage
Medical management of lumbo-sacral disc herniation encompasses the use of medication and associated extended periods of rest, for how long?
4-8 weeks
The lumbosacral region of the dog’s spine is normally approached using which approach?
dorsal approach with bilateral elevation of the paraspinal muscles from the dorsal spinous processes and the dorsal lamina of the vertebra
In which position should the patient be placed for dorsal laminectomy surgery?
Ventral with the pelvic limbs directed cranially
Dorsal laminectomy; why are the pelvic limbs directed cranially?
Opening of L7-S1 disc space.
Dorsal laminectomy at L7-S1;
Skin is incsed with a number 10 blade; where?
L5-S3
Dorsal laminectomy at L7-S1
Incise the fascia on both sides of the spinous process with what?
Number 11 scalpel
Dorsal laminectomy at L7-S1
Periosteal elevator is used to elevate which muscles?
Paraspinal m.
Dorsal laminectomy at L7-S1;
Expose the L7 and S1 spinous processes and dorsal lamina. How?
Gelpi retractor
Dorsal laminectomy at L7-S1; what is removed of L7 and S1?
Spinous processes
Dorsal laminectomy at L7-S1;
A) What is burred for L7 and S1?
B) What is left in tact?
A) Dorsal laminae
B) Articular facets
Dorsal laminectomy at L7-S1;
What is used to remove cortical bone? (3)
Rongeurs
Curettes
Kerrison bone punch
Dorsal laminectomy at L7-S1;
Explore vertebral canal and foramen ; why?
Remove disc material if present
Dorsal laminectomy at L7-S1;
What is retracted before both the disc cranial and caudal to surgical site is fenestrated?
Cauda equina
