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Degenerative Lumbosacral Stenosis: Knowing the Options

Clinician's Brief (Capsule)

Orthopedics

|February 2015

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This retrospective case series compared clinical signs of 98 dogs treated medically or surgically for degenerative lumbosacral stenosis (DLSS) and assessed outcomes. DLSS is a multifactorial process in which progressive stenosis of the lumbosacral vertebral canal causes compression of the cauda equina. Surgical treatment yields variable success rates. Medical treatment has been suggested for dogs with mild to moderate signs without neurologic deficits, but little is known about outcomes. Medical treatment for study dogs consisted of restricted exercise for 4–6 weeks in combination with antiinflammatory and analgesic drugs. Surgical treatment consisted of dorsal lumbosacral laminectomy.

Dogs treated medically and surgically had significant differences with regard to clinical signs; thus, outcome between these two groups was not compared. Surgically treated dogs were significantly more often male, had neurologic deficits, and had received previously unsuccessful medical treatment. Medical management yielded a favorable success rate of 54.8%; 32.3% were managed unsuccessfully and underwent surgical treatment, 9.7% were euthanized because of clinical sign progression, and 3.2% were alive but had increased clinical signs. This outcome was deemed a fair prognosis. Failure of medical management can be followed by successful surgical decompression. Further studies are necessary to develop a clinical grading system for DLSS dogs, prospectively compare medical and surgical treatment, and to investigate prognostic indicators for medical treatment of DLSS.

Global Commentary

Just over half of dogs with lumbosacral disc disease can be successfully managed with rest and antiinflammatory and analgesic medications. 

It is not unreasonable to want to consider a more conservative option than surgery when we, or our dogs, are experiencing pain from spinal disease. Intuitively we would probably also think it’s not unreasonable to consider a surgical option more logical for spinal disease if it results in an inability to move or even incontinence. Unfortunately, we can never predict what the outcome will be with any treatment decision, so the risk of deterioration beyond the point of no return often forces our hand to opt for surgery. Although perceived as a more likely quick fix, surgery comes with both cost and risk. This study helps us understand that just over half of dogs with lumbosacral disc disease can be successfully managed with rest and antiinflammatory and analgesic medications, which is a reasonable option for those with absent or mild neurological deficits. It’s a case of picking your poison; however, it is always worth knowing how that poison tastes before we do—this article helps us with this regard.—Simon Platt, BVM&S, MRCVS, DACVIM (Neurology), DECVN (Athens, Georgia, USA)

This capsule is part of the WSAVA Global Edition of Clinician's Brief.

References

For global readers, a calculator to convert laboratory values, dosages, and other measurements to SI units can be found here.

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