Cauda Equina Syndrome

Anne E. Chauvet, DVM, DACVIM (Neurology)


Anatomy:

The lumbar and sacral spinal cord segments and the nerve roots caudal to the conus medullaris

  • Sciatic nerve L6-S2
  • Pudendal nerve S1-S3
  • Pelvic nerve S1-S2
  • Caudal nerves Cd1-5

Clinical signs

  • Difficulty rising, reluctant to jump
  • Pelvic limb lameness
  • Low tail carriage
  • Lumbosacral pain
  • Need to differentiate from orthopedic disease
  • Lower motor neuron signs: sciatic/perineal/pudendal/ caudal
  • Urinary and fecal incontinence
  • Loss of tail tone
  • Loss of anal tone
  • Loss of proprioception

Chronic circumferential constriction of 50% or more is necessary before significant neurological signs and electrodiagnostic abnormalities are noted.

Orthopedic versus Neurological

  • Pain LS – SUPPORT THE PATIENT
  • Pain upon lifting tail
  • Proprioceptive deficits
  • Hip extension??

Etiologies

  • Degenerative- lumbosacral stenosis
  • Anomalies
  • M
  • Neoplasia – cancer
  • Infection-Discospondylitis
  • Trauma

Diagnosis

  • Clinical signs
  • Radiography
  • Spinal fluid analysis
  • Myelography
  • Discography/épidurography
  • CT and/or MRI
  • Electrodiagnostic  

1.  Lumbosacral Stenosis - Degeneration

= Progressive narrowing of the spinal canal

  • Disc herniation – Type II
  • Hypertrophy of the ligaments
  • OCD – GSD
  • Ligamentous proliferation at the articulations
  • Instability

Clinical Presentation

  • Middle age animal/dog
  • Large dogs: German Shepherd Dogs, Labradors, Golden Retrievers

Non Contrast Radiography

Myelography

Discography/Epidurography

MR Imaging

Electrophysiology

Treatment

  • Surgery recommended in all cases
  • Mild cases: cage rest and anti-inflammatories

2. Vertebral Anomalies

  • Anomalies – LS

3. Discospondylitis/Spondylitis

  • Infection of the vertebral body or the end plates
  • Pain and fever

Neurological signs due to:

  • Compression by the inflammed tissue
  • Pathological fracture
  • Extradural abscess

Causes

  • Hematogenous dissemination
  • Foreign body – “foxtail”
  • Surgery
  • Wound
  • Urinary Tract infection
  • Dental disease
  • Staph, Strep, Pateurella, Proteus, Corynebacterium, Actinomyces, Nocardia, Bacteroides, Mycobacterium, Aspergillus and Paecilomyces

Diagnosis

  • CBC
  • Blood and urine culture
  • Radiography
  • CT or/and MRI
  • Bacterial culture of the disc/lesion
  • Histopath of the disc/lesion
  • Non Contrast Radiography Treatment
  • Antibiotics: long term, Based on culture results or cephalexin, Bone penetration
  • Surgery is necessary in some cases

4.  Neoplasia

Primary cancer of the vertebral body

  • Osteosarcoma
  • Fibrosarcoma
  • Chondrosarcoma
  • Multiple myeloma

Primary cancer of the CNS

  • MPNST
  • Ependymoma

Metastatic cancer

  • Carcinoma  - Prostate/Mammary/Transitional

5.  Vascular accidents

  • FCE
  • Hemorrhage

6. Immune/viral meningomyelopathies

  • Viral, parasitic, rickettsial, fungal, idiopathic.  

Surgical notes:

Urinary and fecal incontinence are a poor prognostic indicator