Lumbosacral Disease (for Pet Carers)December 20, 2017 6:50 pm
What is Lumbosacral Disease (LSD)?
(Other names include: degenerative lumbosacral stenosis; cauda equine syndrome.)
‘Lumbosacral’ refers to the area where the base of the spine (lumbar vertebra) meets part of the pelvis (sacrum).
There is an intervertebral disc at the joint between the lumbar vertebra and the sacrum. Quite a lot of movement occurs at this joint (‘high motion joint’). This makes it vulnerable to arthritis in older age as ‘wear and tear’ sets in.
Lumbosacral disease is basically osteoarthritis of the joint where the spine meets the pelvis.
Which dogs does lumbosacral disease affect?
LSD is most commonly diagnosed in older dogs, sometimes middle-aged dogs.
It is more common in larger breeds (e.g. German shepherd, Labrador retriever). It is also seen in dogs such as Collies who tend to run around a lot! It can be diagnosed in smaller dogs who, for whatever reason, have more stress going through their lumbosacral joint. We discussed such a case of a Yorkshire terrier in episode 29 of the VetPhysioLife podcast.
Aside from breed size, body weight is another relevant factor. Overweight dogs are more at risk because there is more stress on their joints, including the lumbosacral joint.
Does lumbosacral disease affect cats too?
Yes, it can. Cats tend to do a lot of jumping and extending from their back legs. It makes sense that this would put more stress on their lumbosacral joint.
What are the consequences of lumbosacral disease?
What signs might a dog or cat show?
LSD can cause a spectrum of signs from mild to severe. Some animals will start with mild signs which then deteriorate over time.
Signs of lower back pain are usually most obvious:
- The animal may look stiffer when rising or sitting down. Of he/she may be reluctant to do so.
- Reluctance to jump (e.g. onto the sofa/bed, into the car) is another possible sign.
- It is important to realise that these signs are not specific to LSD. They could be due to any type of pain in the back legs, whether due to arthritis or another cause.
One of the consequences of osteoarthritis is that new bone forms in places where it should not be. This may include areas where the new bone then presses on nerves running to and from the back legs and the back half of the body.
Nerve compression can cause pain. Dogs and cats can get a similar problem to ‘sciatica’ in people due to LSD. The animal may be walking along and then suddenly lift one of their back legs up. Or he/she may look startled as if they have had some sort of electric shock.
Severe nerve compression may lead to urinary and/or faecal incontinence. The animal may have a floppy tail that he/she is reluctant to move.
How is lumbosacral disease diagnosed?
A vet should make the diagnosis. Often the diagnosis is presumptive on the basis of the animal’s age and size, the signs he/she is showing at home, and what the vet finds on examination.
In some cases, your vet may recommend further tests. These may include x-rays, an MRI scan and/or EMG (electromyography). Further tests are usually reserved for animals with more severe signs of nerve compromise (e.g. incontinence). This is to make sure that the diagnosis is correct. And to determine if surgery may be appropriate.
How is lumbosacral disease managed?
1) Pain relief:
This is an essential part of the management. Your vet will prescribe what they feel is indicated. In some cases, this is a non-steroidal anti-inflammatory drug (NSAID). But the nerve (neuropathic) pain in LSD often does not respond well enough to NSAIDs. An agent such as gabapentin may be more appropriate.
Especially when it is first started, gabapentin may cause drowsiness. This will often pass as the animal becomes used to the drug. But you must liaise with your vet so they can guide you through this process and help you to adjust the dose as needed.
Also, note that it can take 3-4 weeks for gabapentin to reach its full effect.
Physiotherapy can be very helpful in some animals with LSD. Strategies include:
- Strengthening the muscles around the lumbar spine and the hips to support the lumbosacral joint.
- Ensuring the good range of movement in the surrounding bones and joints to try to take some of the stress off the lumbosacral joints.
- Muscle release to reduce the tightness around the lumbosacral joint, treat trigger points and increase comfort.
- Hydrotherapy on an underwater treadmill (not swimming!)
- Other strategies used for arthritis management such as laser therapy, heat, pacing/controlled exercise.
- Environmental modifications, e.g. steps to climb onto the sofa; a ramp for getting into the car.
Please note that every dog or cat with LSD needs to be treated as an individual. A veterinary physiotherapist should assess the animal to determine which techniques and strengthening exercises are suitable. As always, it is possible to do more harm than good if physical therapy is not provided under qualified guidance and supervision.
What does having lumbosacral disease mean for my pet’s quantity of life? Will he/she be euthanised because of it?
LSD may be a function-limiting condition, i.e. it may prevent your dog or cat from carrying out normal daily functions/activities. In some cases, their function may be so reduced that it is decided that the kindest thing to do is to euthanise him/her. This is one way in which LSD can be life-limiting. Another way is when pain from LSD cannot be adequately controlled and again euthanasia is performed on welfare grounds.
But this is definitely not always the case and for many animals with LSD a lot can be done to help them have a good quality of life for a long period of time. Like people, older animals will often have several concurrent problems. It may be one of these rather than the LSD which eventually ends their life.
Please click here for an accompanying podcast episode on lumbosacral disease.
Thanks as always for reading,