The lumbosacral syndrome

Question 1

Primary Nerves

Answer 1

Femoral Nerve
Sciatic Nerve
Pudendal Nerve

Question 2

femoral nerve vertebrae

Answer 2

L4-5

Question 3

sciatic nerve vertebrae

Answer 3

L6-7

Question 4

pudendal nerve vertebrae

Answer 4

S1-3

Question 5

femoral nerve reflex

Answer 5

patella

Question 6

sciatic nerve reflex

Answer 6

withdrawal

Question 7

pudendal nerve reflex

Answer 7

perineal

Question 8

Presenting signs

Answer 8

Pain - scream, Reluctant to jump, stand up or sit
Nerve root signature - Crouched posture, Low tail carriage
Urinary / Faecal incontinence

Question 9

Neurological findings - L4-S3 - motor deficits

Answer 9

LMN paresis/paralysis of pelvic limbs and/or tail

Question 10

Neurological findings - L4-S3 - sensory deficits

Answer 10

Proprioceptive deficits in pelvic limbs
Reduced perianal reflex
Hypoesthesia perineal area, pelvic limbs or tail
Reduced bulbocavernosus reflex

Question 11

Lumbosacral stenosis

Answer 11

Older large breed dogs e.g. GSDs
Bladder dysfunction
L4-S3 spinal cord segments
Dynamic Static

Question 12

pathogenesis

Answer 12

Motion
Anatomic conformation
Congenital/developmental abnormalities

Question 13

pathogenesis - Anatomic conformation

Answer 13

Articular joint tropism
Straighter facet joints
Change of plane

Question 14

pathogenesis - Congenital/developmental abnormalities

Answer 14

Transitional vertebrae

Lumbosacral Osteochondrosis Dissecans

Question 15

diagnosis

Answer 15

neuro exam

imaging

Question 16

treatment - conservative

Answer 16

Restricted excercise 6-8 weeks
Anti-inflammatories
Pain relief

Question 17

treatment - surgical

Answer 17

Dorsal Laminectomy

Question 18

Post surgical complications - Immediate

Answer 18

Seroma – haemorrhage

Often due to too much movement after surgery

Question 19

Post surgical complications - Delayed

Answer 19

Discospondylitis

Lamina formation / Fibrosis - Secondary compression

Question 20

polyneuritis equi

Answer 20

Tail paralysis 
Dilated anus 
Faecal retention 
Perineal loss of sensation 
Muscle atrophy-some chronic cases

Question 21

polyneuritis equi - DDx

Answer 21

Trauma – e.g. sacral fracture - common
Equine herpes virus 1 (EHV1) myeloencephalopathy
Primary/secondary cystitis

Question 22

polyneuritis equi - pathogenesis

Answer 22

Immune mediated damage to peripheral nerves of cauda equina
May follow previous viral infection
Occasionally seen in outbreaks

Question 23

polyneuritis equi - diagnosis

Answer 23

Tail head muscle biopsy

Lymphocytic infiltrate seen in / around the intramuscular nerves

Question 24

polyneuritis equi - treatment

Answer 24

Usually supportive

Immunosuppressive steroids not usually effective

Question 25

polyneuritis equi - prognosis

Answer 25

OK for life Poor for return to normal function Requires long term owner support