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Neurology > The Lumbosacral syndrome > Flashcards

The Lumbosacral syndrome Flashcards

1
Q

What are the primary nerves from the L4-S3 spinal cord segments?

A
  • Sciatic nerve
  • Femoral nerve
  • Pudendal nerve
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2
Q

Where does the femoral nerve emerge from the spinal cord?

A

L4 and L5 (The F’s!)

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3
Q

Where does the sciatic nerve emerge from the spinal cord?

A

L6 and L7 (The S’s!)

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4
Q

Where does the pudendal nerve emerge from the spinal cord?

A

S1-S3 (PS)

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5
Q

What is the primary reflex test used to test the femoral nerve?

A

Patellar reflex

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6
Q

What is the primary reflex test used to test the sciatic nerve?

A

Withdrawal reflex; need to see flexion of all joints fully and with strength

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7
Q

What is the primary reflex test used to test the pudendal nerve?

A

Perineal (anal) reflex

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8
Q

What are the clinical signs associated with a lesion in the L4 to S3 spinal cord segment?

A
  • Pain (screaming; reluctant to jump, stand-up or sit; palpation/rectal)
  • Nerve root signature (crouched posture, low tail carriage)
  • Urinary/fecal incontinence
  • Motor deficits (LMN paresis/paralysis of pelvic limbs and/or tail)
  • Sensory deficits
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9
Q

What is a nerve root signature?

A

Pain associated with irritation or inflammation at a nerve root. Animals affected tend to hold their leg up when in pain

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10
Q

What sort of sensory deficits can be seen in L4-S3 lesions?

A
  • Proprioceptive deficits in pelvic limbs
  • Reduced perianal reflex
  • Hypoesthesia perineal area, pelvic limbs or the tail
  • Reduced bulbocavernosus reflex
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11
Q

What are common degenerative lesions seen in L4-S3?

A
  • Disc protrusion or extrusion

- Degenerative lumbosacral stenosis

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12
Q

What are common anomalous lesions seen in L4-S3?

A
  • Congenital vertebral malformations

- Syringohydromyelia

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13
Q

What is Syringohydromyelia and what breed is it predisposed?

A

-Presence of a cavity within the spinal cord parenchyma filled with cerebrospinal fluid

  • CKCs have an abnormal conformation (shape) of the back of the skull (called the occipital bone) - Caudal part of the brain (cerebellum) doesn’t have enough space in the occipital bone and tends to pass through the foramen magnum (exit hole of the spinal cord)
  • Creates a pressure point, giving rise to an abnormal flow of CSF from the brain to the spinal cord.
  • With time this flow disturbance can result in the formation of a syrinx
  • In some dogs, it can also cause a build up of fluid in the brain called hydrocephalus.
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14
Q

What are common inflammatory/infectious lesions seen in L4-S3?

A
  • Discospondylitis
  • Granulomatous meningo-encephalomyelitis (GME)
  • Neosporosis
  • Distemper, FIP, Protozoal
  • Bacterial myelitis (inflamm of spinal cord)
  • Traumatic disk
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15
Q

What dogs are commonly affected by lumbosacral stenosis?

A

Older large breed dogs

eg. GSD

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16
Q

What is lumbosacral stenosis? (CS)

A

Stenosis of the vertebral canal and/or intervertebral foramina and/or the related vasculature

Bladder dysfunction, L4-S3 spinal cord segments

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17
Q

What can cause lumbosacral stenosis/disesase?

A
  • Hansen type II disc degeneration and protrusion at the lumbosacral junction (v. common)
  • Subluxation of the articular facets
  • Thickening and in-folding of the interarcuate ligament
  • Epidural fibrosis
  • Thickened lamina and pedicles
  • Spondylosis, proliferative degenerative changes of the articular facets
  • Instability and misalignment between the last lumbar vertebra and the sacrum
18
Q

What is pseudo-hyperreflexia?

A

If the sciatic nerve is not working, you get an increased patellar reflex because no counter tone, not because it’s actually increased

19
Q

What would you want to do to visualize a possible dynamic lumbosacral stenosis?

A

Dynamic myelographic study (radiographs)

20
Q

What is the conservative treatment for lumbosacral stenosis?

A
  • Restricted exercise for 6-8 weeks
  • Anti-inflammatories
  • Pain relief
21
Q

What is the surgical treatment for lumbosacral stenosis?

A

Dorsal laminectomy; respond well but can get complications

A portion of the bone of a spinal vertebra is removed to allow access to the spinal canal and/or achieve decompression of the spinal cord

Rapid relief from pain in dogs

22
Q

What are some immediate post-surgical complications of lumbosacral surgery?

A

Seroma and hemorrhage, often due to too much movement after surgery

23
Q

What are some delayed post-surgical complications of lumbosacral surgery?

A
  • Discospondylitis

- Lamina formation/fibrosis (secondary compression)

24
Q

What are the clinical signs of polyneuritis equi?

A
  • Tail paralysis
  • Dilated anus
  • Fecal retention
  • Perineal loss of sensation
  • Muscle atrophy (some chronic cases)
25
Q

What are some differential diagnoses for polyneuritis equi?

A
  • Trauma (sacral fracture common)
  • Equine herpes virus 1 myeloencephalopathy - infectious and fatal
  • Primary or secondary cystitis
26
Q

What is the pathogenesis of polyneuritis equi?

A

Immune-mediated damage to the peripheral nerves of the cauda equina; may affect other nerves, but mainly the cauda equine eg. Cranial nerves
It may follow previous viral infection (possibly adenovirus)
Occasionally seen in outbreaks

27
Q

How is a diagnosis of polyneuritis equi made ante mortem?

A
  • Tail head muscle biopsy

- Lymphocytic infiltrate seen in or around the intramuscular nerves

28
Q

What is the treatment for polyneuritis equi?

A
  • Usually supportive

- Immunosuppressive steroids not usually effective

29
Q

What is the prognosis for polyneuritis equi?

A

OK for life, but poor return to normal function. Requires long term owner support

30
Q

What is the cauda equina in horses?

A
  • Bundle of spinal nerves and spinal nerve roots
  • L2 to L5 nerve pairs, S1 to S5 nerve pairs and the coccygeal nerve
  • Innervates pelvic organs + lower limbs to include motor innervation of the hips, knees, ankles, feet, internal anal sphincter and external anal sphincter
  • sensory innervation of the perineum and, partially, parasympathetic innervation of the bladder
31
Q

What does the lumbosacral region consist of in regards to anatomy?

A

L4-S3 spinal cord segments, cauda equina, nerve roots

32
Q

What are the two different plexuses that originate firstly from C6-T2 and L4-S3?

A 
C6-T2 = Brachial Plexus
L4-S3 = Lumbosacral Plexus
33
Q

What is the role of the UMN?

A

CNS: Brain —> LMN
Inhibitory (& Excitation) to LNM
Inhibition most affected

34
Q

What is the role of LMN?

A

CNS —> Periphery

Excitatory to muscles & glands

35
Q

What are the CS of UMN lesion?

A

Muscle tone
• Normal to increased
Reflexes
• Normal to increased

36
Q

What are the CS of LMN lesion?

A

Muscle tone
• Flaccid
Reflexes
• Reduced to absent

37
Q

What is a common nutritional lesion seen in L4-S3?

A

Hypervitaminosis

38
Q

What is discospondylitis?

A

Concurrent intervertebral disk infection and vertebral osteomyelitis of contiguous vertebrae (vertebral end plates + bodies)
CS: spinal pain in large breed dogs
Originates from: Blood stream or migrates to spine through adjacent diseased tissue

39
Q

What is spondylitis?

A

Degenerative, non-inflammatory condition of the spinal column
RADS: productions of bone spurs along the bottom, sides, and upper aspects of the vertebrae of the spine
CAUSE: Age, injury

40
Q

What are the common traumatic lesions to L4-S3?

A

Fractures

Luxations

41
Q

What are the common vascular lesions to L4-S3?

A

Ischaemic myelopathy

Haemorrhage

Neurology (13 decks)

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