Lumbosacral Stenosis
(Cauda Equina)
Oudry, Jean-Bapiste
(1686-1775); 1723
Image courtesy
PicturesNOW!.
Suzanne Stack, DVM
As our greyhounds age, quite a few of
them, especially the males, become weak, wobbly, and/or painful in
the rear end. Many of these are affected by lumbosacral stenosis
(LS), a narrowing of the last part of the spinal canal, which causes
compression of the nerve roots.
Signs are rear end pain, lameness,
weakness, "shuffling," knuckling over, foot dragging, and muscle
wasting. Both urinary and fecal incontinence are possible and carry
a worse prognosis. Greyhounds may even lose their appetite from the
pain and "waste away."
The difficulty in diagnosing LS is
twofold. Many veterinarians simply do not recognize the signs. LS
looks neurologic, and technically, it is. But a rare and obscure
neurological disease, it is not. Beware a diagnosis of "hip
dysplasia" in a greyhound - greyhound hips are by and large
excellent. The second problem is that unless your greyhound is
"lucky" enough to have visible arthritis on lumbosacral x-rays, the
only techniques to confirm LS are pretty high tech - CT, MRI,
discography, etc.
Not only can LS be difficult to "nail
down," the other problem is that oral medications such as Rimadyl,
Etogesic, glucosamine, aspirin, prednisone, etc. do little for LS
since it is not arthritis, but rather, "doggy sciatica" i.e.,
pinching of the nerve roots.. It presents a sad problem. The "cure"
is referral spinal surgery to free up the trapped nerve roots, not
something many owners will consider in a geriatric greyhound. Many
if not most greyhounds simply get worse and worse until euthanasia
becomes necessary.
The good news is that there is a simple
palpation technique to detect LS and a way to inject Depo-Medrol
intralesionally to help it, similar to what is done in humans. It
was taught to me by Dr. Mike Herron, a professor of small animal
orthopedic surgery at Texas A & M for 32 years, owner of racing
greyhounds, and all around "greyhound guru." You may want to clip
this out for your vet to see should one of your greyhounds begin
showing signs of LS.
This is an easy
procedure that you do with the dog standing up, basically an
intramuscular injection into the lumbosacral area. There is
absolutely no danger of hitting the spinal cord or any important
structures. The worst thing that can happen is that it doesn't help
the dog.
******************
First, look at the diagram to see where
the L-S joint lies in relation to the iliac crests so that you hit
the right spot both with your thumbs for palpating and with the
needle for injecting.
Put all your fingers on the ventral ridge of the greyhound's iliac crest. Put each thumb just medial to each iliac crest about halfway down its ridge. Your thumbs should be between the iliac crest and the vertebrae. Be sure to look at the diagram so you can see where the L-S joint lies in relation to the iliac crests. Try to "crack" (move) the L-S joint. If it hurts (or he falls to the ground!), chances are he has LS.
Draw up 20 mg of Depo-Medrol and using a
1" needle, inject half of this into each side. Go about halfway down
the ridge of the iliac crest, go in (medially) 1", and inject just
off the midline (this is where you put your thumbs to try to "crack"
the L-S joint).
If the greyhound does not show
improvement within 48 hours, the problem is something else. Repeat
as needed as Depo-Medrol's effect wears off - usually every 3-6
months.
**************
A footnote worth mentioning for LS is
Ultram, a human "combination" drug with both a narcotic-like and an
antianxiety component. Used sometimes for bone cancer in dogs -
another very painful condition - I have tried it with good results
on two LS dogs when Depo-Medrol injections were not enough. A
greyhound dose is 50 mg Ultram as
needed for pain, given up to twice daily.
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