Diagnosis of Cauda Equina Abnormalities By Using Electromyography, Discography, and Epidurography in Dogs

Electromyography (EMG), L7-S1 discography and epidurography were investigated in 15 dogs with clinical signs of cauda equina dysfunction and in 7 control dogs without such clinical signs. Electromyography of paraspinal and pelvic limb muscles was done in 13 of 15 affected dogs. An L7-S1 discogram followed by an epidurogram was performed in all 22 dogs using 20% iopamidol. Results of discograms, epidurograms, and gross necropsy examinations were normal in six of seven control dogs. The one dog in which these studies were abnormal had a mild L7-S1 disc protrusion that did not result in nerve root compression at necropsy. Electromyographic analysis was 100% accurate in predicting the presence or absence of cauda equina disease. None of the results of discograms were falsely negative. Twelve of 15 discograms in clinically affected dogs indicated dorsal disc protrusion, but 2 of these protrusions were found to be noncompressive at surgery (13% error). Abnormal epidurograms occurred in 9 of 15 clinically affected dogs. There was one false positive and two false negatives (20% error). Electromyography was a sensitive screening technique for the presence of cauda equina disease. Discography may be more sensitive for detection of L7-S1 disc protrusion than epidurography. An abnormal radiographic contrast study of the cauda equina may only be useful when combined with an abnormal EMG.     

A SACRAL LESION RESEMBLING OSTEOCHONDROSIS IN THE GERMAN SHEPHERD DOG

More than 30% (21 of 65) of German Shepherd dogs with clinical signs of cauda equina compression had radiographic and pathologic abnormalities compatible with osteochondrosis of the sacral endplate. Most of these dogs had a defect in the dorsal part of the sacral endplate and a detached bone fragment in the vertebral canal. Similar lesions were also found in growing and young adult dogs without clinical signs. The dogs with clinical signs of cauda equina compression also had severe degenerative disc disease with protrusion of the lumbosacral disc and compression of the cauda equina, suggesting that the signs of cauda equina compression more likely were related to the secondary degenerative changes (disc protrusions) rather than the primary disease. Clinically normal German Shepherds with sacral osteochondrosis usually were younger than 18 months, the dogs with cauda equina compression and sacral osteochondrosis older than 18 months (mean age 4.8 years). On the average, these dogs were two years younger as compared to dogs with cauda equina compression without sacral osteochondrosis. Male dogs are more often affected than females (5:1). There is a breed predisposition: in dogs other than German Shepherds, osteochondrosis of the sacral endplate seems to be extremely rare.     

Review and retrospective analysis of degenerative lumbosacral stenosis in 156 dogs treated by dorsal laminectomy.

The medical records of 156 dogs with degenerative lumbosacral stenosis (DLS) that underwent decompressive surgery were reviewed for signalment, history, clinical signs, imaging and surgical findings. The German Shepherd Dog (GSD) was most commonly affected (40/156, 25.6%). Pelvic limb lameness, caudal lumbar pain and pain evoked by lumbosacral pressure were the most frequent clinical findings. Radiography showed lumbosacral step formation in 78.8% (93/118) of the dogs which was associated with elongation of the sacral lamina in 18.6% (22/118). Compression of the cauda equina was diagnosed by imaging (epidurography, CT, or MRI) in 94.2% (147/156) of the dogs. Loss of the bright nucleus pulposus signal of the L7-S1 disc was found on T2-weighted MR images in 73.5% (25/34) of the dogs. The facet joint angle at L7-S1 was significantly smaller, and the tropism greater in GSD than in the other dog breeds. The smaller facet joint angle and higher incidence of tropism seen in the GSD may predispose this breed to DLS. Epidurography, CT, and MRI allow adequate visualization of cauda equina compression. During surgery, disc protrusion was found in 70.5% (110/156) of the dogs. Overall improvement after surgery was recorded in the medical records in 79.0% (83/105) of the dogs. Of the 38 owners that responded to questionnaires up to five years after surgery, 29 (76%) perceived an improvement.     

FLEXION-EXTENSION MYELOGRAPHY OF THE CANINE CAUDA EQUINA

The radiographic appearance of the canine dural end-sac and its behavior during flexion and extension of the spine is described in a myelographic study in 22 normal dogs and 26 dogs with cauda equina compression syndrome. In more than 80% of the dogs, the dural sac ended at the level of the sacrum. There were relatively large individual differences in shape and size of the dural end-sac. In contrast, shape, length, position, and diameter of the dural end-sac at the level of the lumbosacral articulation is extremely constant during flexion and extension in normal individuals. In the 26 dogs with lesions affecting the cauda equina and nerve roots between L6 and the first caudal vertebra, myelography was diagnostic in 21 dogs. Myelographic diagnosis of cauda equina compression was possible in seven dogs with spine in flexion. In 14 dogs, overextension of the spine and imaging in lateral and dorsal recumbency was necessary to establish a diagnosis. The five dogs with nondiagnostic myelograms had either a dural end-sac ending cranially to the lesion (two dogs), diseases not associated with compression (two dogs), or only slight indentations of the contrast medium column (one dog).     

MAGNETIC RESONANCE IMAGING OF ARTICULAR PROCESS JOINT GEOMETRY AND INTERVERTEBRAL DISK DEGENERATION IN THE CAUDAL LUMBAR SPINE (L5–S1) OF DOGS WITH CLINICAL SIGNS OF CAUDA EQUINA COMPRESSION

The geometry of the lumbosacral region has been suspected to play a role in the development of degenerative lumbosacral stenosis in the dog. In this study, 50 dogs (21 German Shepherd dogs and 29 dogs of other breeds) with clinical signs of cauda equina compression were studied by magnetic resonance (MR) imaging. The orientation of the articular process joints in the L5-S1 region and the angle difference between two adjacent motion segments were calculated. Intervertebral disc degeneration of the same region was identified and classified in four stages. A positive association between MR-imaging stage and articular process joint angle difference in the transverse plane was found in the two groups of animals. German Shepherd dogs and dogs of other breeds had different geometry of the lumbosacral region with different articular process joint angles in the transverse plane and statistically different stages of disc degeneration.     

Synovial cysts associated with cauda equina syndrome in two dogs

OBJECTIVE: To report synovial cysts associated with cauda equina syndrome in 2 dogs. STUDY DESIGN: Clinical cases. ANIMALS: Two German Shepherd dogs. METHODS: After magnetic resonance imaging detection, cysts were surgically removed via dorsal laminectomy. RESULTS: Six and 8 months after surgery, both dogs were free of clinical signs and no pain was elicited on lumbosacral joint manipulation. CONCLUSION: Although described in dogs, cysts at the lumbosacral joint might cause compression of the cauda equina nerve roots. Radical excision of the cyst capsule can result in resolution of clinical signs. CLINICAL RELEVANCE: Synovial cysts should be considered in the differential diagnosis of dogs with cauda equina compression syndrome when lumbosacral degenerative joint disease is present.     

Surgical treatment of lumbosacral discospondylitis by a distraction-fusion technique

Lumbosacral discospondylitis was diagnosed in three adult dogs by radiography and the isolation of Staphylococcus aureus from the affected intervertebral space. The predominant clinical findings of severe spinal pain and marked hindlimb lameness suggested entrapment of the seventh lumbar spinal nerve roots. In addition, the presence of hindlimb ataxia, proprioceptive deficits, perineal analgesia and paresis of the tail were consistent with compression of the cauda equina. Despite medical therapy with analgesics, antibiotics and strict confinement the clinical and radiographic signs progressed. A lumbosacral distraction-fusion procedure was employed to decompress the spinal nerve roots and cauda equina and to stabilise the affected vertebrae. In all cases there was an immediate marked reduction in spinal pain and a long term resolution of clinical signs. In two cases the affected vertebrae progressively fused within four months. The third case required removal of the implants due to pin migration and breakage.     

Laminectomy for treatment of cauda equina syndrome in a cat

A 16-year-old spayed female Siamese cat was presented with a history of paraparesis and obstipation. The cat's impaired function was attributed to malalignment of the L7-S1 spine (cauda equina syndrome) and to traumatic fracture of the left femoral neck, with severe degenerative arthritis. Laminectomy resolved the cauda equina problem, and the hip joint was not treated.     

Alternative classification and screening protocol for transitional lumbosacral vertebra in German shepherd dogs

Background

Lumbosacral transitional vertebra (LTV) is a common congenital and hereditary anomaly in many dog breeds. It predisposes to premature degeneration of the lumbosacral junction, and is a frequent cause of cauda equina syndrome, especially in German shepherd dogs. Ventrodorsal hip radiographs are most often used in diagnosis of LTV in screening programs. In this study, value of laterolateral lumbar spine radiographs as additions to ventrodorsal radiographs in diagnosis of LTV, and characteristics of LTV and the eighth lumbar vertebra (L8) in laterolateral radiographs were studied. Additionally, computed tomography (CT) features of different types of LTV were elucidated.

Methods

The ventrodorsal pelvic and laterolateral lumbar spine radiographs of 228 German shepherd dogs were evaluated for existence and type of LTV. Morphology of transverse processes was used in classification of LTV in ventrodorsal radiographs. The relative length of sixth (L6) and seventh (L7) vertebrae (L6/L7) was used in characterization of these vertebrae in laterolateral radiographs. CT studies were available for 16 dogs, and they were used for more detailed characterization of different types of LTV. Non-parametric χ² statistics, generalized logit model for multinomial data, and one-way analysis of variance was used for statistical analyses.

Results

In all, 92 (40%) dogs had a LTV, the most common type being separation of first spinous process from the median crest of the sacrum in 62 dogs (67% of LTV). Eight dogs had eight lumbar vertebrae. Those dogs with LTV had longer L7 in relation to L6 than dogs with normal lumbosacral junctions. When L6/L7 decreased by 0.1 units, the proportion of dogs belonging to the group with L8 was 14-fold higher than in the group with normal lumbosacral junctions. L8 resembled first sacral vertebra (S1) in length and position and was therefore classified as one type of LTV. With CT it was shown that categorizing LTV, based on shape and visibility of transverse processes seen in ventrodorsal radiographs, could be misleading.

Conclusions

We suggest that L8 be included as a part of the LTV complex, and the laterolateral radiographs of the lumbar spine be considered as an addition to ventrodorsal projections in the screening protocols for LTV.     

The lumbosacral junction in working german shepherd dogs -- neurological and radiological evaluation

The clinical and radiological incidence of lumbosacral (LS) disease was studied on 57 German Shepherd dogs (GSDs) used in active service. The study included a clinical history, a neurological examination, and plain radiographs of the caudal lumbar vertebrae. The neurological examinations revealed lower back pain and/or neural deficits in 21 dogs, of which 14 had a history of pain or pelvic gait abnormalities. Radiographic findings were spondylosis at L7-S1, degeneration of L7-S1 disc, LS malalignment, transitional LS vertebrae and/or primary spinal canal stenosis in 15 dogs with neurological abnormalities and/or back pain and in 18 dogs with no clinical signs. No correlation between the neurological and the radiographic findings were found. This study demonstrates that even prominent radiographic LS abnormalities are of minimal value in the evaluation of LS disease in the GSD.     

COMPARISON BETWEEN COMPUTED TOMOGRAPHIC AND SURGICAL FINDINGS IN NINE LARGE-BREED DOGS WITH LUMBOSACRAL STENOSIS

In a three-year prospective study, computed tomographic (CT) and surgical findings were compared for nine large breed dogs with lumbosacral stenosis. Surgically-excised tissue was examined histologically in seven dogs and additional necropsy evaluation was performed in one dog. The CT abnormalities observed at sites of confirmed cauda equina compression were: loss of epidural fat, increased soft tissue opacity, bulging of the intervertebral disc margin, spondylosis, thecal sac displacement, narrowed intervertebral foramen, narrowed vertebral canal, thickened articular process, articular process subluxation, articular process osteophyte, and telescoped sacral lamina. The CT characteristics of lumbosacral degenerative disease and discospondylitis were similar to those described in humans. In three dogs, CT findings at the site of cauda equina compression were consistent with congenital or developmental spinal stenosis, but the method of surgical exposure precluded confirmation. Epidural fibrosis (eight dogs) and multi-level CT abnormalities (six dogs) were identified but the cause(s) and significance were unknown.     

Measurements on the lumbosacral junction in normal dogs and those with cauda equine compression

Comparative measurements on lateral plain radiographs of the lumbosacral junction in neutral position, in flexion, and in extension, were made of 41 clinically and radiographically normal dogs (21 German shepherd dogs [GSDs], 12 Bernese mountain dogs, eight labrador retrievers) and 58 GSDs with clinical signs of cauda equina compression due to malformation and, or, malarticulation. The comparison of these measurements between sexes, between normal and affected GSDs and between normal GSDs and the two other breeds of dogs showed several statistically significant results. One was that the affected GSDs showed a reduced flexion ability at this junction compared to the normal ones. However, no difference was observed in the degree of sub-luxation of the sacrum between normal and affected GSDs. It was concluded that plain radiographs of the lumbosacral junction in flexion could help in determining a reduced flexion ability, which could be a characteristic of the GSD with cauda equina compression.     

Association of cauda equina compression on magnetic resonance images and clinical signs in dogs with degenerative lumbosacral stenosis

Magnetic resonance imaging (MRI) was used to examine the lumbosacral spine of 27 dogs with degenerative lumbosacral stenosis. Four normal dogs were also similarly imaged. Compression of the soft-tissue structures within the vertebral canal at the lumbosacral space was assessed in two ways: by measuring dorsoventral diameter on T1-weighted sagittal images and cross-sectional area on transverse images. The severity of the clinical signs was compared to the severity of cauda equina compression. No significant correlation was found. It is concluded that degree of compression as determined by MRI at time of presentation is independent of disease severity.     

Somatosensory evoked potentials produced by stimulation of the dorsomedial nerves innervating the tail in dogs

To record the somatosensory evoked potentials (SEPs) produced by stimulation of tail nerves and determine the effects of acute compression of the cauda equina on SEPs. The subjects were 10 adult Beagles. SEPs were recorded after stimulating the dorsomedial nerves (DMN) innervating the tail. The cauda equina was compressed using a balloon catheter inserted into the vertebral arch. In SEPs, two negative and one positive peak were often observed. The compression of the cauda equina caused significant depression of the positive component. The SEPs produced by stimulation of the DMN reflect the activities of ascending neuronal pathways above the coccygeal spinal segments and may be a useful tool for examining cauda equina syndrome.     

Electromyography and spinal evoked potentials in cauda equina syndrome of dogs

In order to investigate usefulness of electrodiagnostic methods in Cauda Equina-Compression, 26 dogs with this disease were subjected to electromyography and spinal evoked potentials. 16 normal dogs served as controls. It was found that--after stimulation of the Nn.tibialis, peronaeus, pudendus and coccygeales and recording at the lumbosacral junction--latencies and nerve-conduction velocities were largely normal. However the amplitudes were decreased and--depending on the severity of the compression--the morphology of the potentials was altered although considerable standard deviations were obtained. Electromyographically, increased spontaneous activity with fibrillations and positive sharp waves were found in the myotomes of the lumbosacral nerves. Their number increased according to the severity of the cauda equina compression and they had a centrifugal distribution pattern. Based on these results it appears indicated to perform an electromyographic exam before applying myelography. The technique of spinal evoked potentials will need more refinement and standardisation before being useful in a clinical situation.     

Paraparesis as initial manifestation of a Prototheca zopfii infection in a dog

A case of protothecosis causing non‐ambulatory paraparesis in a dog without clinical evidence of disseminated infection is described. A five‐year‐old female Labrador retriever was referred with a 10‐day history of progressive non‐ambulatory paraparesis and lumbar pain as the only physical and neurological abnormalities. Lumbar myelography revealed severe extradural spinal cord compression extending from L4 to L7 vertebrae, and a right hemilaminectomy was performed. Surgical findings included an adherent whitish hard ill‐defined mass. Cytology and biopsy results disclosed the presence of algae enclosed in a matrix of chronic inflammatory infiltrate. Culture confirmed the presence of Prototheca species. Neurological improvement occurred within a month, and the dog received antifungal treatment without evidence of clinical disseminated disease for 6 months, but died after a generalised tonic–clonic seizure. Post‐mortem examination revealed multiple foci of inflammatory granulomatous infiltrate and algae‐like structures in the brain, lumbar intumescence and cauda equina. Prototheca zopfii was identified using molecular biology methods.     

X-ray studies of the cauda equina of dogs

This article reviews the radiologic examination of the canine cauda equina. The radiographic technique and interpretation of survey radiographs, radiographs with the spine in flexion and extension, tomography and contrast procedures, the diagnostic value and limits of these methods are discussed. The diseases which may cause cauda equina compression and the radiographic findings are described and illustrated.     

Lumbosacral stenosis and injury of the cauda equina

Idiopathic (congenital) L/S stenosis, acquired (degenerative) L/S stenosis, and traumatic injury to the vertebral column caudal to L6 often produce signs of neurologic dysfunction attributed to compression, displacement, entrapment, or trauma of the cauda equina. Clinical signs vary from animal to animal and depend upon which roots of the cauda equina are involved and the nature of the compromise. An understanding of the anatomy of the area and an appreciation for the functional relationship between the cauda equina and structures innervated are essential for accurate evaluation, workup, diagnosis, treatment, and outcome.     

IMAGING DIAGNOSIS—PARAGANGLIOMA OF THE CAUDA EQUINA: MR FINDINGS

The magnetic resonance imaging features of a cauda equina paraganglioma in a 5‐year‐old dog are described. Imaging revealed a well‐defined, strongly contrast‐enhancing mass invading the adjacent vertebral body and infiltrating the intervertebral foramen bilaterally. Flow void, compatible with increased drainage veins around the mass, and macroscopically visible neovessels in contrast‐enhanced magnetic resonance angiography, as reported in numerous human studies, were not visible in this single case. The tumor recurred despite aggressive surgery and radiotherapy. This neoplasm should be considered in the differential diagnosis of cauda equina abnormalities in dogs.