Page 1184 - Cote clinical veterinary advisor dogs and cats 4th

592 Lumbosacral Stenosis, Degenerative

TREATMENT • Infiltrative lipomas have high rate of local masses because the prognosis for lipomas is
recurrence with incomplete excision and generally better than the prognosis for other,
Treatment Overview
VetBooks.ir Surgical excision is recommended if masses surgery, and/or radiation therapy. Technician Tips
may necessitate multiple surgeries, aggressive
more commonly encountered masses.
interfere with function or mobility or are
rapidly growing. The majority of tumors are
or mascara or can shave the hair in the area
asymptomatic and do not necessitate surgical PEARLS & CONSIDERATIONS Owners can mark skin masses with a marker
removal. Comments at home, making locating the mass in ques-
• Creation of a body map in the patient’s tion easier when having it evaluated by the
Acute and Chronic Treatment medical record is recommended to monitor veterinarian.
Infiltrative lipomas require aggressive initial the size and appearance of subcutaneous
surgery and may necessitate amputation; recur- lipomas. SUGGESTED READING
rence rate for incompletely excised tumors is • Occasionally, different tumor types can Spoldi E, et al: Comparisons among computed
> 50%. Radiation therapy should be considered develop within a lipoma (e.g., mast cell tomographic features of adipose masses in dogs
for incompletely resected infiltrative lipomas to tumors, soft-tissue sarcomas). and cats. Vet Radiol Ultrasound 58:29-37, 2017.
delay recurrence or for nonresectable tumors • Re-evaluation of lipomas should be done AUTHOR: Erin K. Malone, DVM, DACVIM
to delay progression. periodically, and re-aspiration or removal EDITOR: Kenneth M. Rassnick, DVM, DACVIM
with histopathologic evaluation is suggested
PROGNOSIS & OUTCOME if the tumor’s physical appearance is changing
(e.g., rapidly growing or different feel on
• Subcutaneous, intermuscular, necrotic, palpation).
intraabdominal, or intrathoracic lipomas • Lipoma should remain on the differential
can be cured with surgery. diagnosis for abdominal and intrathoracic

Lumbosacral Stenosis, Degenerative Client Education
Sheet

BASIC INFORMATION • Tail paresis, low carriage, decreased sensation • Cranial cruciate disease
• Atrophy of caudal thigh/leg muscles • Fibrotic myopathy
Definition • Reduced/absent pelvic limb reflexes • Iliopsoas injury
Progressive stenosis of the lumbosacral (LS) ○ Patellar reflex may appear increased: • Prostatic disease
vertebral canal, leading to nerve root compres- pseudohyperreflexia
sion, dysfunction, and pain • Reduced/absent perineal reflex, anal tone Initial Database
• Lower motor neuron bladder • CBC, serum biochemistry and urinalysis
Synonyms • Pain on tail manipulation, LS palpation, hip often unremarkable
Cauda equine syndrome, LS disease extension • Radiographic changes
• Pain on palpation of vertebral bodies during ○ LS disc space narrowing
Epidemiology rectal exam ○ LS endplate sclerosis and spondylosis
SPECIES, AGE, SEX ○ Misalignment of sacrum with L7
Mature, large breed, male dogs Etiology and Pathophysiology ○ NOTE: these changes can also be seen in
One or more of the following reduce the clinically unaffected dogs, and they may
GENETICS, BREED PREDISPOSITION diameter of the vertebral canal: not be evident in affected dogs.
German shepherds overrepresented • Intervertebral disc protrusion
• Articular remodeling Advanced or Confirmatory Testing
RISK FACTORS • Hypertrophy of interarcuate and dorsal • MRI and CT (p. 1132) provide the most
Transitional LS vertebrae longitudinal ligaments detailed information of LS soft-tissue and
• Vertebral malalignment/instability osseous structures, respectively. It can be
Clinical Presentation • Osteophytes and foraminal stenosis helpful to pursue both modalities in a single
HISTORY, CHIEF COMPLAINT patient.
Owners may report one or more of the DIAGNOSIS • Discography/epidurography can be helpful
following: but are technically demanding and uncom-
• Pelvic limb lameness (unilateral or bilateral) Diagnostic Overview monly used.
• Altered tail carriage/function LS stenosis is suspected in dogs with sig- • Electromyography (EMG) and nerve
• Fecal/urinary incontinence nalment, clinical signs, and radiographic conduction velocity (NCV) may suggest
• Back pain findings consistent with this disease, espe- demyelination and/or an axonopathy.
• Exercise intolerance and reluctance to stand, cially if lower motor neuron signs to the
climb stairs, and jump pelvic limbs are noted. However, advanced TREATMENT
• Licking, chewing perineum or a limb imaging (MRI, CT) is necessary to confirm
diagnosis. Treatment Overview
PHYSICAL EXAM FINDINGS Surgical treatment is recommended if pain
One or more may be noted: Differential Diagnosis is refractory to medical management and/or
• Pelvic limb lameness, paresis, proprioceptive • Discospondylitis neurologic signs are deteriorating. Goals of
deficits • Intervertebral disc extrusion treatment are pain relief and return to function,
• Pacing gait • Neoplasia of nerve roots, nerves or vertebrae although return to complete normalcy may not
• Plantigrade stance • Hip osteoarthritis be possible.
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