Cauda equina syndrome is a painful condition in dogs that occurs when the nerves in the tail end of the spinal cord and adjacent nerve roots become compressed due to the narrowing of the spinal canal or the foramina (holes through which spinal nerves exit). This narrowing is most commonly caused by arthritic degeneration or intervertebral disc herniation, but it can also result from traumatic injury, congenital malformation, or tumor growth.
Symptoms
The most common symptom of lumbosacral stenosis (narrowing of the spinal canal) is pain. Dogs may show hind-end stiffness, and difficulty in walking, climbing stairs, and getting on furniture. They may also have trouble wagging their tail, defecating, or getting into a car. As the condition progresses, weakness in one or both back legs may develop. Some dogs may cry out in pain while moving. In severe cases, compression of the nerve roots can lead to urinary and fecal incontinence. The pain may also be intermittent, depending on the dog's position.
Large, active breeds like German Shepherds are most commonly affected, but lumbosacral stenosis can also occur in smaller breeds and even in cats. Signs are uncommon in dogs younger than 3 to 7 years old.
Diagnosis
A physical and neurological examination by a veterinarian is the first step in diagnosing lumbosacral stenosis. Additional diagnostic tests, such as x-rays, CT scans, MRI, and electromyography, may be required to establish a definitive diagnosis. MRI has become the preferred test for accurate diagnosis and treatment planning.
Treatment
The treatment for lumbosacral stenosis depends on the cause and severity of the symptoms. Mild cases can often be managed with supportive treatment, including crate rest, controlled exercise on a leash, and anti-inflammatory and pain-relieving medications.
If symptoms persist or worsen or if neurologic signs develop, surgery may be necessary. A dorsal laminectomy is a surgical procedure that creates an opening in the top of the spinal canal to relieve pressure from the compressed nerves. In some cases, adjacent unstable spinal vertebrae may need to be fused to prevent recurrent nerve trauma. If the foramina are narrowed, they may also need to be widened, and these procedures can be done in the same surgery.
Strict rest during the post-operative period is crucial to minimize complications.
In some cases, medical treatment with corticosteroid injections may be considered as a first approach before resorting to surgery.
Prognosis
Dogs with mild signs of lumbosacral stenosis have a good prognosis, as they can often be successfully managed with medical treatment. However, severely affected dogs, especially those with urinary or fecal incontinence due to severe nerve root compression, have a poor prognosis, as most do not regain continence even after surgery. However, surgery or epidural cortisone injections can help relieve pain and improve the quality of life in these cases. The best approach is to start with medical treatment and consider surgery or other interventions if there is no improvement or if neurologic signs are developing.
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