Lumbosacral Dz (PKenny) Flashcards
What is lumbosacral disease?
Not specifically a disease, several diseases affect the lumbosacral spine
- several disease may cause cauda equina syndrome
What is cauda equina sydnrome?
- dysfunction of tail, urinary and anal sphincters, (pudendal n.) bladder and sciatic n. of pelvic limb
- L7 -> caudal nerve roots affected
Which pelvic lib nerves are not affected by cauda equina syndrome?
- femoral as leaves @ L4-L5
When localising the lesion within the SC what is the extra segment to remember?
L4-S3 cauda equina
Ddx for cauda equina syndrome
- DLSS
- IVDD
- Discospondylitis (another site)
- Myelitits
- Neoplasia
- Iliopsoas muscle injury
Which animals is DLSS seen in?
(Degerative lumbosacralstenosis)
- older large breed dogs
- GSD
- active working dogs
- LS malformations
What is DLSS? Aetiology?
> multifactorial disorder > combination of soft tissue and/or bony changes causing LS vertebral canal stenosis - IVD protrusion - ligamentous hypertrophy - articular process hypertrophy - osteophyte formation - vertebral misalongment - telescoping dorsal lamina - transitional vertebrae - lumbosacral osteochondrosis > resulting in cauda equina +_ L7 nerve root compression
Specific clinical signs of DLSS?
- lumbosacral pain (reluctance to jump, run, stairs, etc)
- paraparesis/ataxia
- pelvic limb lamness (“root signature”)
- flaccid tail and low tail carriage
- urinary and fecal incontinence (LMN signs to penineum)
Ddx DLSS?
- hip pain d/t resenting hip extension
What do femoral and sciatic n. control?
- femoral = hip flexion [patella reflex]
- sciatic = distal limb [gastroc reflex]
Neuro findings with DLSS?
- poor/absent postural reactions
> r/o OA or stifle dz will usually have good postural reactions unless extrememly painful
What other factors are commonly associated with lumbosacral dz?
Orthopeadic comorbidities are common
How can limbosacral stenosis (cauda equina syndrome) be diagnosed?
- imaging AND clinical signs +- electrodiagnostics
Does spondylosis deformans correlate with clinical signs?
NO
What may predispose to cauda equina syndrome in the dog?
Lumbosacral transitional vertebra
What is myelography? Is myelography useful in diagnosing cauda equina syndrome?
- injection radiopaque contrast into subarachnoid space
- thecal sac generally arrows and ends near LS
- may see attenuation of contrast over LS if severe midline compression
> Rarely
IS CT useful for dx of cauda equina syndrome?
> yes (??)
- epidural fat surrounds cauda equina nerv and thecal sac, providing natural source of soft tissue contrast
- in DLSS epidural fat is displaced
- confuses differentiation compressive soft tissues and adjecent neural structures
Gold standard diagnostics for dx of cauda equina syndrome?
MRI
+- electrodiagnostics
Tx of DLSS?
> medical - activity restriction \+- NSAIDs \+- analgesia \+- neuromodulatory drugs eg. Gabapentin for nerve root pain - topical coritcosteroids (epidural) > Surgical - decompressive laminectomy most common \+- discectomy (excision of protruding annulus fibrosis) - foraminotomy - stabilization - distraction + stabilisation
Prognositc indicator for decompressive laminectomy?
Urinary continence prior to surgery
Signs of cauda equina syndrome in horses?
- tail paralysis
- dilated anus
- loss of perineal sensation
- feacal retention
Ddx for cauda equina syndrome in horses ? FURTHER READING
> trauma - sacral fx (common) > infectious - EHV1 myeloencephalopathy (highly infectious and fatal) > inflammatory - polyneuritis equi
