Clinical signs and outcome of dogs treated medically for degenerative lumbosacral stenosis: 98 cases (2004–2012)

• Autores: Steven De Decker
• Localización: JAVMA: Journal of the American Veterinary Medical Association, ISSN-e 0003-1488, Vol. 245, Nº. 4, 2014, págs. 408-413
• Idioma: inglés
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• Resumen

  • Objective—To compare clinical signs of dogs treated medically or surgically for degenerative lumbosacral stenosis (DLSS) and assess outcome after medical treatment.

    Design—Retrospective case series.

    Animals—Client-owned dogs treated medically (n = 49) or surgically (49) for DLSS.

    Procedures—Medical records from 2004 to 2012 were reviewed. Dogs were included if they had clinical signs, clinical examination findings, and MRI abnormalities consistent with DLSS. Several variables were compared between surgically and medically treated dogs: age, sex, duration of clinical signs, presence or absence of neurologic deficits, urinary and fecal incontinence, concurrent medical conditions, and medical treatment before referral. Medical treatment after obtaining a final diagnosis of DLSS consisted of restricted exercise in combination with anti-inflammatory and analgesic drugs. Surgical treatment consisted of dorsal lumbosacral laminectomy. Outcome for medically treated dogs was obtained via a standardized questionnaire.

    Results—Neurologic deficits were observed significantly more often in surgically treated dogs. Surgically treated dogs had unsuccessful medical treatment before referral significantly more often than did medically treated dogs. Thirty-one of 49 (63.3%) medically treated dogs were available for follow-up evaluation. Of these 31 dogs, 17 (55%) were managed successfully, 10 (32.3%) were managed unsuccessfully and underwent surgical treatment, 3 (9.7%) were euthanized because of progression of clinical signs, and 1 (3.2%) was alive but had an increase in severity of clinical signs after medical management.

    Conclusions and Clinical Relevance—Clinical signs differed in dogs treated medically or surgically for DLSS. Medical treatment for dogs with DLSS was associated with a fair prognosis.

    Degenerative lumbosacral stenosis is a multifactorial disorder in which a combination of bony and soft tissue abnormalities causes progressive stenosis of the lumbosacral region of the vertebral canal with subsequent compression of the cauda equina.1,2 Vertebral canal stenosis can be caused by a combination of Hansen type-II intervertebral disk protrusion, ligamentous and articular process hypertrophy, osteophyte formation, and vertebral misalignment. Degenerative lumbosacral stenosis generally affects mature large-breed dogs, in particular German Shepherd Dogs.1–9 Clinical signs are variable and include signs of pain in the lumbosacral region without neurologic deficits, unilateral or bilateral pelvic limb lameness, paraparesis, difficulty jumping or climbing stairs, abnormal tail carriage, and urinary and fecal incontinence.1–9 Several surgical procedures have been described for the treatment of DLSS, with variable (although generally favorable) success rates.5–11 Although medical treatment has been suggested for dogs with mild to moderate clinical signs without neurologic deficits,1,2,12 little is known about the clinical signs and outcome of dogs treated medically for DLSS. Therefore, the objectives of the study reported here were to characterize the population of dogs treated medically for DLSS at a referral institution (by comparing the signalment and clinical signs of dogs treated medically or surgically for DLSS) and investigate the outcome for dogs after medical treatment for DLSS.