Lumbosacral stenosis, a form of spinal stenosis that affects the lower level of the canine spinal cord, is a painful condition that can impair movement, urination, and bowel function. You can be better prepared if your dog is diagnosed with this condition by understanding what it is, how it is identified, and the various treatment choices available.
How is canine spinal stenosis treated?
The majority of dogs and cats with lumbosacral stenosis can be successfully controlled without the need for surgery, just as people with back discomfort brought on by a “slipped disc” in the lower back. Exercise must frequently be modified to avoid severe tasks that require jumping, climbing, twisting, or turning. Dogs should first be taken for frequent, brief walks on a leash before progressively increasing their exercise over a few weeks. Patients who are overweight should be put on a calorie-restricted diet. The vast majority of the impacted animals will gain from taking painkillers. Muscle relaxants, neuropathic medications, and anti-inflammatory pharmaceuticals may all be helpful. A lumbar puncture can be used to administer a long-acting steroid (cortisone) to the compressed spinal nerves in order to treat lumbosacral stenosis. Some people may require further injections. The procedure demands a general anesthetic.
Surgery may be necessary for some lumbosacral stenosis individuals in order to treat their pain, hind limb lameness, and other clinical symptoms. The goal of many procedures that may be used is to stabilize the lumbosacral spine and/or release pressure on compressed nerves. Laminectomy refers to the removal of bone from the top of the spine, while foramenotomy refers to the enlargement of the vertebral foramen, the opening between the bones. Spinal nerves that are being compressed by a bulging disc and other soft tissues are removed. It is possible to stabilize the lumbosacral bones (vertebrae) by inserting screws or pins that are fastened with metal bars or cement.
During lumbosacral stenosis surgery, an X-ray reveals several pins that were used to stabilize the spine and were embedded in cement.
How is spinal stenosis treated?
The most effective method to treat spinal stenosis symptoms is surgery to decompress the affected area. According to research, spine procedures performed by highly skilled surgeons had less problems. Never be afraid to inquire about your surgeon’s background in spinal stenosis surgery.
What happens when spinal stenosis reaches its end stage?
We are all aware that your car is more prone to experience wear and tear issues the more miles you put on it. Our spines function similarly. The spine has crucial connections between its moving sections, just like an automobile. The car can be traded in for a new one, but we must take the best possible care of our spine for a number of years.
Leg pain when walking is a characteristic of spinal stenosis, which is frequently the final stage of the degenerative process of the spine. Rest will make the pain go away, but you might need to sit down specifically to relieve leg pain. The signs of spinal stenosis can occasionally appear suddenly, but more frequently, they appear gradually over a period of years. Leg pain will get worse if a person walks or stands for extended periods of time. Because they serve to widen the spinal canal, bending forward or sitting will make the discomfort go away, but standing up straight will bring the symptoms back. You may also have tingling and numbness, but weakness is less frequent.
Our cervical spine (neck) and lumbar spine (low back) are made up of several bones that are joined together by tiny joints and separated from one another by cushions (discs). Our spine’s anatomy enables it to support our weight, absorb stress, and place our body in space. Degenerative changes are more likely to occur naturally as we age and eventually lead to symptoms. Narrowing of the canal through which the nerves pass to reach their final location is referred to as spinal stenosis (arms or legs).
Discs, joints (facets), and ligaments are the three major anatomical structures that surround our spinal canal. The discs can expand, dry, and lose height with time, which might obstruct the anterior part of the canal. The canal may get narrower from the sides as a result of the small facet joints degenerating and developing bone spurs at the same time. Last but not least, the ligaments (ligamentum flava) that surround the posterior part of the canal may enlarge and aid in the canal’s general narrowing. It can take several years for the general degenerative process that causes spinal stenosis to narrow enough to create symptoms.
Patients frequently complain about weariness and a loss of stamina in their lower extremities. Although back discomfort frequently coexists with symptoms in the legs, it is quickly relieved when the patient sits. Reduced mobility, a preference for flexed positions (such as sitting and sleeping in the fetal position), and leaning over a shopping cart are common signs of stenosis. The spinal canal is at its broadest when bending as opposed to standing upright, hence the body prefers this position.
A CT scan with a myelogram or an MRI scan are examples of tests to confirm a diagnosis of spinal stenosis. These tests will validate the suspected nerve compression and constriction (s). A spinal physician can confirm the diagnosis with imaging and a physical examination since spinal stenosis at one or two levels of the spine might impact a single exiting nerve.
The term “non-operative therapy” refers to methods used to lessen stenosis symptoms without changing the anatomy (surgery). Physical treatment is a mainstay because it improves the strength and endurance of our neck and trunk muscles, which in turn supports the spine’s bony architecture and reduces irritation of deteriorated anatomical structures. Non-steroidal anti-inflammatory medications (NSAIDS) alleviate pain by reducing inflammation, but they have no effect on how a disease develops. Finally, epidural steroid injections can lessen the irritation and swelling of pinched nerves to provide pain relief. Conservative approaches are effective because they frequently result in significant relief. In essence, by reducing symptoms without addressing the fundamental problem of the aging spine, these non-operative methods gain time.
Modifying one’s behavior can be beneficial. Instead of walking for endurance workout, consider using a stationary bicycle because the forward bend helps to lessen soreness. Leaning over a walker or shopping cart is also helpful, and sitting in a recliner rather than a straight chair can be more comfortable.
The level of incapacitating pain or impairment brought on by spinal stenosis is the major factor in selecting whether or not to have surgery. When you are unable to take care of yourself or move as you once did, it may be time to think about what surgery can do for you.
If no discernible improvement has been made after at least 6 to 12 weeks of conservative therapy, surgery can be addressed. The posterior bony section (lamina) of the constricted canal is removed during the laminectomy treatment in order to “decompress the pinched nerves.” Depending on how many levels of the spine need to be removed, a laminectomy might last anywhere from one to three hours. There are not many limitations following surgery. The majority of patients return home unrestricted the following day.
Leg problems are promptly relieved by a decompressive laminectomy. With the aid of physical therapy, patients quickly recoup lost strength and walking distance, barring any irreversible nerve alterations brought on by persistent compression. Stenosis occasionally coexists with spondylolisthesis, or sliding vertebra. Following a laminectomy at the same level, this slide may deteriorate further. In situations like this, a spinal fusion is added during the same procedure to reduce any potential back discomfort brought on by spine instability.
Decompressive surgery carries risks similar to those of most surgical treatments. The anesthetic presents the highest risk. Prior to surgery, patients must receive a medical clearance from their primary care doctor or cardiologist in order to lower this risk. Other dangers include developing stenosis at other levels, getting infected, and experiencing dural tears (when the nerve sack tears, releasing spinal fluid that is corrected during surgery).
Typically, after five years, 70-80% of surgical outcomes are successful. As a result, you will be able to walk farther, be more functional, experience less leg discomfort, and take fewer medications. If stenosis forms at levels above or below the first surgical site, that is the primary reason for a second surgery.
To sum up, spinal stenosis is a chronic degenerative condition that gradually worsens over time. Until one believes their quality of life is seriously hampered, conservative approaches are offered to control symptoms. Then, surgery can be taken into consideration. Decompression frequently yields very satisfying results, enabling the individual with spinal stenosis to resume their preferred hobbies.
Should a dog with IVDD be put to sleep?
Dogs with severe IVDD might force their owner to make challenging choices. For some dogs and owners, spinal surgery is not an option. There are non-surgical treatments that can be tried, but if they don’t work or if they do, what more options are there? Some dogs are permanently crippled, and they live happy lives utilizing wheels to get around. Whether this is a viable choice for your dog relies on his general health, physical make-up, and personality, as well as on whether you are available to look after him during the day.
You may regrettably have to think about euthanasia as a last choice if your dog is severely afflicted by IVDD and there is no appropriate, practical, or successful treatment. Having access to euthanasia when necessary can be a blessing.
If you find yourself in this situation, it is important to talk to your vet about the possibility of euthanasia. Do your research and don’t make a decision hastily. Weighing all the many factors before determining whether to euthanize a dog includes:
- What are the dog’s prospects of recovering a decent quality of life if you provide the necessary care? Your veterinarian can assess your dog’s condition and provide you advice on his prognosis for recovery.
- Will you be able to take care of your dog while you’re recovering, and if not, are there any reliable persons who could assist you? Learning the fundamentals of nursing and care will make it commonplace in no time. However, some dog owners lack the time to take care of a healing dog, for instance because of long workdays. Having physical limitations that prevent you from bending over or squatting down to assist your dog could potentially be a serious issue.
- Could managing your dog in wheels as permanently crippled be a fair alternative if the vets are confident that he won’t be able to walk again? He might possibly be dealing with chronic incontinence issues in this situation. When thinking this through, take into account both your way of life and the nature of your dog.
Euthanasia is always the best option for a small subset of IVDD dogs: Very few seriously affected dogs have the misfortune to experience PMM (progressive myelomalacia) at the initial stages of their illness. Euthanasia is the sole humane option and ought to be carried out as soon as possible for dogs with PMM because there is no treatment for this painful and unpleasant condition.
In other situations, euthanasia may be the only humane option due to a number of factors involving the owner and the dog. It’s possible that the dog has very severe symptoms and has very little chance of recovering. It’s also possible that treatment has already been tried and failed, leaving no further options. Perhaps the owner is unable to care for a healing dog because they are unwell themselves or are juggling taking care of a sick family member and cannot afford either surgery or non-surgical treatment. But it’s definitely crucial to take your time when making such a significant and permanent decision. Take your time, explain your condition to the veterinarian, and ask for their opinion.
Can a dog heal from spinal damage?
The Canine Spinal Cord Injury Program is researching and testing new techniques to help dogs with both partial and total spinal cord injuries recover more quickly. Our initiatives include:
- minimizing nerve damage
- repairing nerves damaged to function
- rehabilitation optimization
- reducing pain
To produce movement, sensation, urination, and defecation, the spinal cord transmits information to and from the brain. Dogs frequently suffer from spinal cord injuries, which account for about 2% of all cases seen by veterinarians. Weakness or paralysis, discomfort, and incontinence are all effects of spinal cord damage. The first is traumatic spinal cord damage, the second is more chronic degenerative injuries, including neurodegenerative diseases similar to ALS, and the third is disorders that result in pain syndromes. These three topics are the focus of our curriculum.
Herniated discs, trauma, spinal stenosis and instability, and vascular (stroke-like) events are the most frequent causes of injury. Since spinal cord tissue does not efficiently heal, the effects of an injury may be catastrophic. If the spinal cord is only partially (incompletely) damaged, dogs can make a full recovery because the remaining nerves can take over the function of the lost ones. Although full injuries that result in transection of the spinal cord, which cuts off all connection between the spinal cord and the brain, result in permanent paralysis, rehabilitation is less effective the more severe the injury.
Paraplegia is the medical term for the full loss of motor function in the hind limbs that this dog has.
This dog can just slightly move her rear limbs on her own and cannot put any weight on them. Her hind limbs can be seen moving when provided weight support (in this video, the tail holding). Non-ambulatory paraparesis is what it is.
Although this dog can walk and bear weight on both rear limbs, he is ataxic and feeble, shifting his weight forward (his hind limbs are uncoordinated). Ambulatory paraparesis is the medical term for this.
Simply put, ataxia refers to an uncoordinated stride. Although this dog has strong hind limbs, they cross and overstep when she walks. Ataxia affects her hind limbs.
Canine Paralympics
The biennial NCSU College of Veterinary Medicine Canine Paralympics promotes understanding of canine spinal cord injury and highlights how dogs with serious spinal cord injuries can have happy lives. By following us on Facebook, you can find out more about this occasion and the advancements in the treatment of canine spinal chord injuries.
