Lumbosacral Dz (PKenny) Flashcards Preview

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Flashcards in Lumbosacral Dz (PKenny) Deck (22):
1

What is lumbosacral disease?

Not specifically a disease, several diseases affect the lumbosacral spine
- several disease may cause cauda equina syndrome

2

What is cauda equina sydnrome?

- dysfunction of tail, urinary and anal sphincters, (pudendal n.) bladder and sciatic n. of pelvic limb
- L7 -> caudal nerve roots affected

3

Which pelvic lib nerves are not affected by cauda equina syndrome?

- femoral as leaves @ L4-L5

4

When localising the lesion within the SC what is the extra segment to remember?

L4-S3 cauda equina

5

Ddx for cauda equina syndrome

- DLSS
- IVDD
- Discospondylitis (another site)
- Myelitits
- Neoplasia
- Iliopsoas muscle injury

6

Which animals is DLSS seen in?

(Degerative lumbosacralstenosis)
- older large breed dogs
- GSD
- active working dogs
- LS malformations

7

What is DLSS? Aetiology?

> multifactorial disorder
> combination of soft tissue and/or bony changes causing LS vertebral canal stenosis
- IVD protrusion
- ligamentous hypertrophy
- articular process hypertrophy
- osteophyte formation
- vertebral misalongment
- telescoping dorsal lamina
- transitional vertebrae
- lumbosacral osteochondrosis
> resulting in cauda equina +_ L7 nerve root compression

8

Specific clinical signs of DLSS?

- lumbosacral pain (reluctance to jump, run, stairs, etc)
- paraparesis/ataxia
- pelvic limb lamness ("root signature")
- flaccid tail and low tail carriage
- urinary and fecal incontinence (LMN signs to penineum)

9

Ddx DLSS?

- hip pain d/t resenting hip extension

10

What do femoral and sciatic n. control?

- femoral = hip flexion [patella reflex]
- sciatic = distal limb [gastroc reflex]

11

Neuro findings with DLSS?

- poor/absent postural reactions
> r/o OA or stifle dz will usually have good postural reactions unless extrememly painful

12

What other factors are commonly associated with lumbosacral dz?

Orthopeadic comorbidities are common

13

How can limbosacral stenosis (cauda equina syndrome) be diagnosed?

- imaging AND clinical signs +- electrodiagnostics

14

Does spondylosis deformans correlate with clinical signs?

NO

15

What may predispose to cauda equina syndrome in the dog?

Lumbosacral transitional vertebra

16

What is myelography? Is myelography useful in diagnosing cauda equina syndrome?

- injection radiopaque contrast into subarachnoid space
- thecal sac generally arrows and ends near LS
- may see attenuation of contrast over LS if severe midline compression
> Rarely

17

IS CT useful for dx of cauda equina syndrome?

> yes (??)
- epidural fat surrounds cauda equina nerv and thecal sac, providing natural source of soft tissue contrast
- in DLSS epidural fat is displaced
- confuses differentiation compressive soft tissues and adjecent neural structures

18

Gold standard diagnostics for dx of cauda equina syndrome?

MRI
+- electrodiagnostics

19

Tx of DLSS?

> medical
- activity restriction
+- NSAIDs
+- analgesia
+- neuromodulatory drugs eg. Gabapentin for nerve root pain
- topical coritcosteroids (epidural)
> Surgical
- decompressive laminectomy most common
+- discectomy (excision of protruding annulus fibrosis)
- foraminotomy
- stabilization
- distraction + stabilisation

20

Prognositc indicator for decompressive laminectomy?

Urinary continence prior to surgery

21

Signs of cauda equina syndrome in horses?

- tail paralysis
- dilated anus
- loss of perineal sensation
- feacal retention

22

Ddx for cauda equina syndrome in horses ? *FURTHER READING*

> trauma
- sacral fx (common)
> infectious
- EHV1 myeloencephalopathy (highly infectious and fatal)
> inflammatory
- polyneuritis equi