Lumbosacral disease

Also called cauda equina syndrome


The Anatomy

The lumbosacral area is where the last part of the spine meets the pelvis (lumbar spine meets the sacrum). The cauda equina is the tail end of the spinal cord and the associated nerve roots ( the bundles of nerves which exit the spinal cord and are just adjacent to the vertrabra)..

What happens in lumbosacral syndrome?

Usually due to old age and degeneration the lumbosacral area can become narrowed. This is commonly due to arthritis or a slipped disc (intervertabral disc herniation). This can result in the compression of the nerve roots which can lead to pain and loss of function. Occasionally lumbosacral syndrome may be caused by sudden trauma which affects the lumbosacral area but this is rare.

What are the signs of lumbosacral syndrome? 

These include the following:

-Difficulty walking

- Difficulty getting from sit to stand

- Trouble climbing stairs

- Can no longer jump on the lounge

- Carrying the tail lower or no longer wagging their tail

- Sinking lower in their hind legs

- Finding it hard getting in position to defaecate

- One or both legs may become weak

- Dragging the hind legs and wearing down the nails

- Sudden yelping in pain

- Severe cases may have urinary or faecal incontinence

How do we diagnose Lumbosacral syndrome?

A physical and neurological examination by your vet may raise suspicion of this disease. X-rays can help pinpoint the problem but it can only really be confirmed with CT or MRI.

 

Treatment

Conservative Therapy:      This can consist of:

  • Rest and modifying behaviours and activities at home.

  • Pain control – with medication, Shockwave Therapy, Laser Therapy, Acupuncture, Animal Biomechanical Medicine.

  • Treating compensations- many pets with lumbosacral disease will be loading more weight and forces on their neck, front legs and thorax. We can treat these compensations with acupuncture and Animal Biomechanical medicine.

  • Strengthening and balance – this can help improve movement and overall mobility. We will often use the underwater treadmill initially and then a home exercise program in the longterm. For owners that aren’t able to implement a home exercise program then a regular underwater treadmill session can be beneficial.

  • Weight loss – if needed this should always be part of treatment for musculoskeletal conditions.

 

Cortisone Injection: This is a relatively non- invasive procedure that involves injecting the lumbosacral space with cortisone. This can be helpful in about 70% of pets in helping to reduce pain. In these guys epidural injections of cortisone are administered at Day 1, 14 and 45. If a decrease in pain is appreciated then a booster injection will be administered when it is observed to be needed, usually after 3 to 9 months. Usually, there is no change in neurological deficits eg incontinence, however, a decrease in pain can result in improved mobility and function.

 

Surgery: This is an option when conservative therapy and cortisone injection have shown no benefit. Similar to cortisone injection this can help reduce pain but it is unlikely there will be an improvement in neurological deficits.

Treatments offered by Balance Vet Rehab that may be beneficial for these pets include:

Animal Biomechanical Medicine

Manual therapy can be helpful with pain relief in pets with lumbosacral disease.

Osteopathic manipulative treatment for low back pain: a systematic review and meta-analysis of randomized controlled trials John C Licciardone et al

Acupuncture 

Pain control is always an issue in pets with lumbosacral syndrome. Acupuncture is a very helpful tool for helping reduce pain in these guys.

Study: Meta-Analysis: Acupuncture for Low Back Pain Eric Manheimer et al

Electroacupuncture

Electroacupuncture is also another useful tool to help reduce pain in pets with this syndrome.

Clinical Effect of Additional Electroacupuncture on Thoracolumbar Intervertebral Disc Herniation in 80 Paraplegic Dogs Hyun-Jung Han et al

Evaluation of electroacupuncture treatment for thoracolumbar intervertebral disk disease in dogs. Hayashi AM et al

Laser Therapy

Laser therapy should always be considered as part of the treatment regime in pets with lumbosacral syndrome.

Home exercise program

We may be able to increase strength and overall balance thereby reducing the forces being placed on the lumbosacral area.

 

Shockwave (COMING SOON)

If there is facet pain of the vertabrae secondary to lumbosacral syndrome shockwave therapy is likely to be of benefit.

 Mechano-transduction effect of shockwaves in the treatment of lumbar facet joint pain: Comparative effectiveness evaluation of shockwave therapy, steroid injections and radiofrequency medial branch neurotomy Tomas Nedelka et al

 

Pulsed electromagnetic field therapy

This therapy should be considered because of its pain relieving mechanisms which have been shown to beneficial in dogs with disc pain.

The Effect of Electromagnetic Fields on Post-Operative Pain and Locomotor Recovery in Dogs with Acute, Severe Thoracolumbar Intervertebral Disc Extrusion: A Randomized Placebo-Controlled, Prospective Clinical Trial Natalia Zidan et al

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