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CAUDA
EQUINA, ALSO KNOWN AS THE LUMBOSACRAL SYNDROME What
is the cauda equina syndrome? This
is a disease that occurs at the lumbosacral junction.
The term "lumbo" refers to the lumbar vertebrae. These are the bones in the lower part of the spinal column.
The term "sacral" refers to the sacrum, which is the part of
the spine that joins the lumbar spine and the pelvis.
This
disease is also known as the cauda equina syndrome.
This term comes from Latin words that mean "horse's tail".
At this level, the spinal cord is no longer a tubular structure.
Instead, it is a collection of large nerves that have the appearance of a
horse's tail. The
lumbosacral syndrome is an instability at this strategic point in the spine. What
causes it? Pressure
on the cauda equina or the nerves that exit the spine is the mechanism causing
the clinical signs. The cause of
the pressure may be a narrowed spinal canal, an infection in the disc at this
joint, trauma, a spinal tumour or instability at this joint. What
are the clinical signs? When
instability exists along the spine, abnormal movement occurs.
This causes inflammation to the nerves leaving the spinal cord and to the
muscles in the immediate area. Affected
dogs are in pain and exhibit it in various ways.
When pressure is applied to the muscles in the lower back, many dogs will
cry or move away. Some dogs may be
very slow to rise from a lying position because this movement aggravates the
inflamed nerves and muscles. Some
will literally fall to their knees when the tail is lifted sharply.
Occasionally, dogs develop weakness or lameness in the rear legs with
muscle atrophy Others have
faecal or urinary incontinence, and some will mutilate their feet or tail with
incessant chewing. As
the problem progresses, the disc that is located between the last lumbar
vertebrae and the sacrum may rupture. If
this happens, the dog will be uncoordinated when it walks, or it may be
paralysed in the rear legs. How
is it diagnosed? Radiographs
(x-rays) will generally reveal arthritic changes at the lumbosacral junction.
However, this is common in many dogs and may not cause any clinical
signs. If the disc ruptures, there
may be evidence of a narrowed disc space or disc material against the spinal
cord. However, these offer only
indirect evidence. If
the clinical signs are correct and the initial radiographs are suggestive of the
cauda equina syndrome, a special radiographic study, called a myelogram, is
performed. This is the injection of contrast material around the spinal
cord so that pressure on the spinal cord can be detected on subsequent
radiographs. What
is the treatment? If
your dog is overweight, weight reduction will be an important part of the
treatment. Any disorder of the back
is aggravated by excessive body weight. Strict
rest is also an important part of treatment for any back problem.
Cage rest is preferable, but confinement in a small fenced run or small
room is acceptable. Anti-inflammatory
drugs and pain relievers will often give temporary relief.
Although
infection in the disc is not a common cause, it should be treated with
appropriate antibiotics if it is present. An
infection of this nature usually requires 4-8 weeks of therapy. If
the disc ruptures, many dogs will become uncoordinated when they walk, or they
may even become paralysed in the rear legs.
If this occurs, surgery is indicated.
The surgical procedure, called a dorsal laminectomy, is to relieve the
pressure of a bulging or ruptured disc from the spinal cord.
It also permits identification of a spinal tumour or a narrowing of
the spinal canal due to traumatic injury. Once
the pressure is relieved, return of function of the rear legs is expected. However, permanent damage to the spinal cord will not be
reversed, and the surgery does not relieve inflammation around the spinal nerves
or the muscles. Continued pain
relievers or anti-inflammatory drugs may be needed until this aspect of the
problem finally resolves. |