The lumbosacral syndrome Flashcards
What nerves does the withdrawal reflex test?
Sciatic nerves L6-7
What nerves does the patellar reflex test?
Femoral nerves L4-5
What nerves does the perianal reflex test?
S1-3
What are the clinical signs of lumbosacral syndrome?
Pain/scream/reluctant to jump, palpation/rectal painful
Nerve root signature of crouched posture and low tail carriage
Urinary/faecal incontinence
Neuro findings of LMN paresis/plegia of pelvis limbs and/or tail, sensory deficits of propioception in pelvic limbs, reduced perineal reflex, hypoaesthesia of perianal area/pelvic limbs/tail, reduced bulbocavernosus reflex
What are the differential diagnoses for lumbosacral syndrome using DAMNITV?
Degenerative = disc protrusion/extrusion, degenerative lumbosacral disease, Anomalous = congenital malformations or syringohydromyelia, Neoplastic = primary/secondary, Inflammatory/Infectious = discospondylitis, granulomatous meningoencephalomyelitis, neosporosis, Traumatic = fractures or luxations, Vascular = ischaemic myelopathy or haemorrhage
What is lumbosacral stenosis?
Stenosis of the vertebral canal and/or intervertebral foramina and/or the related vasculature
What pathology is seen with lumbosacral stenosis?
Hansen type II disc degeneration and protrusion at lumbosacral junct.
Subluxation of articular facets
Thickening and in-folding of interarcurate ligament
Epidural fibrosis
Thickened lamina and pedicles
Spondylosis, proliferative degenerative changes of articular facets
Instability and misalignment between the last lumbar vertebra and the sacrum
What is pathogenesis of lumbosacral disease?
Due to the importance of motion
Anatomic conformation of articular joint tropism, straighter facet joints, change of plane
Congenital/developmental abnormalities of transitional vertebra and osteochondrosis
How do you diagnose lumbosacral stenosis?
Pseudohyperreflexia and urinary/faecal incontinence from the neuroexam
Radiographs, epidurography, discography, CT or MRI
EMG
How do you treat lumbosacral stenosis conservatively?
Restricted exercise for 6-8 weeks, anti-inflammatories and pain relief
How do you treat lumbosacral stenosis surgically? What are the possible complications?
Dorsal laminectomy
Immediate post-op complications include seroma (haemorrhage)
Delayed post-op complications include discospondylitis or lamina formation/fibrosis
What is the prognosis for lumbosacral stenosis?
Laminectomy +/- foramenotomy give rapid pain relief in most dogs
Lamenesss/mild neurological signs usually recover rapidly
Severe LMN deficits and/or chronic urinary incontinence show less favourable prognosis
What are the clinical signs of polyneuritis equi?
Tail paralysis, dilated anus, faecal retention, perianal loss of sensation and muscle atrophy in some severe chronic cases
What are the differential diagnoses of polyneuritis equi?
Trauma, EHV-1 and primary/secondary cystitis
What is the pathogenesis of polyneuritis equi?
Immune-mediated damage to peripheral nerves of cauda equinea
May follow previous viral infection and occasionally seen in outbreaks
