Download PDF
Vet Comp Orthop Traumatol 2009; 22(06): 486-491
DOI: 10.3415/VCOT-08-07-0055
Clinical Communications
Schattauer GmbH

Lumbosacral degenerative stenosis in the dog

The results of epidural infiltration with methylprednisolone acetate: a retrospective study
L. Janssens
1   Anubis Veterinary Clinic for Companion Animals, Aartselaar-Antwerp, Belgium
,
Y. Beosier
1   Anubis Veterinary Clinic for Companion Animals, Aartselaar-Antwerp, Belgium
,
R. Daems
1   Anubis Veterinary Clinic for Companion Animals, Aartselaar-Antwerp, Belgium
› Author Affiliations
Further Information

Publication History

Received: 13 July 2008

Accepted: 20 May 2009

Publication Date:
17 December 2017 (online)

Also available at
    Permissions and Reprints

Summary

Thirty-eight dogs with Hansen type II lumbosacral disc protrusion were treated with epidural infiltration of methylprednisolone acetate between the seventh lumbar vertebra and the sacrum. Epidural infiltration was carried out under C-arm fluoroscopic guidance at standardised intervals for the first three treatments and later on demand. Retrospective evaluation by owner questionnaire found that 79% of the animals were considered to have improved, and 53% were totally cured. Epidural infiltration with methylprednisolone acetate has a clinical outcome comparable to decompressive surgery and can be safely used as a less invasive alternative.

Keywords

Lumbosacral disc protrusion - dorsal laminectomy - epidural infiltration - methylprednisolone acetate - dog
 

  • References

  • 1 Denny H, Gibbs C, Holt P. The diagnosis and treatment of cauda equina lesions in the dog. J Small Anim Pract 1082; 23: 425-443.
    PubMedGoogle Scholar
  • 2 Kornberg M, Bichsel P, Lang J. Electromyography and spinal evoked potentials in cauda equina syndrome of dogs. Schweiz Arch Tierheilkd 1989; 131: 287-298.
    PubMedGoogle Scholar
  • 3 Ness MG. Degenerative lumbosacral stenosis in the dog: a review of 30 cases. J Small Anim Prac 1994; 35: 185-190.
    CrossrefPubMedGoogle Scholar
  • 4 Watt PR. Degenerative lumbosacral stenosis in 18 dogs. J Small Anim Prac 1991; 32: 125-134.
    CrossrefPubMedGoogle Scholar
  • 5 Palmer R, Chamber J. Canine lumbosacral diseases, part 1 – anatomy, pathophysiology and clinical presentation. Comp Contin Educ Prac Vet 1991; 13: 61-69.
    PubMedGoogle Scholar
  • 6 Moore R, Vernon-Robert B, Fraser R. et al The origin and fate of herniated lumbar intervertebral disc tissue. Spine 1996; 21: 2149-2155.
    CrossrefPubMedGoogle Scholar
  • 7 Janssens LAA, Vandekerckhove P, Moens Y. et al Lumbosacral degenerative stenosis in the dog – the results of dorsal decompression with dorsal anulectomy and nuclectomy. Vet Comp Orthop Traumatol 2000; 13: 91-103.
    PubMedGoogle Scholar
  • 8 Suwankong N, Voorhout G, Hazewinkel HA. et al Agreement between computed tomography, magnetic imaging and surgical findings in dogs with degenerative lumbosacral stenosis. J Am Vet Med Assoc 2006; 229: 1924-1929.
    CrossrefPubMedGoogle Scholar
  • 9 Sisson AF, LeCouteur RA, Ingram JT. et al Diagnosis of cauda equina abnormalities by using electromyography, discography, and epidurography in dogs. J Vet Intern Med 1992; 6: 253-263.
    CrossrefPubMedGoogle Scholar
  • 10 Mayhew PD, Kapatkin AS, Wortman JA. et al Association of cauda equina compression on magnetic resonance images and clinical signs in dogs with degenerative lumbosacral stenosis. J Am Anim Hosp Assoc 2002; 38: 555-562.
    CrossrefPubMedGoogle Scholar
  • 11 Jones JC, Shires PK, Inzana KD. et al Use of computed tomographic densitometry to quantify contrast enhancement of compressive soft tissues in the canine lumbosacral vertebral canal. Am J Vet Res 2002; 63: 733-737.
    CrossrefPubMedGoogle Scholar
  • 12 Morgan J, Bailey C. Cauda equina syndrome in the dog: radiographic evaluation. J Small Anim Pract 1990; 31: 69-77.
    CrossrefPubMedGoogle Scholar
  • 13 Inzana KD, Parent JM. Lumbosacral degenerative stenosis (Cauda Equina Syndrome). In Five-minute Veterinary Practice, Canine and Feline 2nd ed Tilly PL, Smith FWK. 2002: 904-905.
    PubMedGoogle Scholar
  • 14 LeCouteur RA, Grandy JL.. Lumbosacral vertebral canal stenosis. In Textbook of Veterinary Internal Medicine, Diseases of the Dog and Cat 5th ed. Ettinger SJ, Feldman EC. 2001: 636-637.
    PubMedGoogle Scholar
  • 15 Sjöstrom L.. Lumbosacral disorders. In Textbook of Small Animal Surgery 3rd ed. Slatter D. 2003: 1235.
    PubMedGoogle Scholar
  • 16 Seim III HB. Surgery of the lumbosacral spine: Cauda equina syndrome. In Small Animal Surgery. (3rd ed.) Fossum TW. (eds.) 2007; 1497
    PubMedGoogle Scholar
  • 17 Wheeler SJ. Lumbosacral disc disease. Vet Clin North Am Small Anim Pract 1992; 22: 937-950.
    CrossrefPubMedGoogle Scholar
  • 18 Indrieri RJ. Lumbosacral stenosis and injury of the cauda equina. Vet Clin North Am Small Anim Pract 1988; 18: 697-710.
    CrossrefPubMedGoogle Scholar
  • 19 Danielsson F, Sjöström L. Surgical treatment of degenerative lumbosacral stenosis in dogs. Vet Surg 1999; 28: 91-98.
    CrossrefPubMedGoogle Scholar
  • 20 De Risio L, Sharp NJ, Olby NJ. et al Predictors of outcome after dorsal decompressive laminectomy for degenerative lumbosacral stenosis in dogs: 69 cases (1987–1997). J Am Vet Med Assoc 2001; 219: 624-628.
    CrossrefPubMedGoogle Scholar
  • 21 Suwankong N, Meij BP, Voorhout G. et al Review and retrospective analysis of degenerative lumbosacral stenosis in 156 dogs treated by dorsal laminectomy. Vet Comp Orthop Traumatol 2008; 21: 285-293.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Gödde T, Steffen F. Surgical treatment of lumbosacral foraminal stenosis using a lateral approach in twenty dogs with degenerative lumbosacral stenosis. Vet Surg 2007; 36: 705-713.
    CrossrefPubMedGoogle Scholar
  • 23 Linn LL, Bartels KE, Rochat MC. et al Lumbosacral stenosis in 29 military working dogs: epidemiologic findings and outcome after surgical intervention (1990–1999). Vet Surg 2003; 32: 21-29.
    CrossrefPubMedGoogle Scholar
  • 24 Leneham TM. Canine cauda equine syndrome. Compend Contin Educ Pract Vet 1983; 5: 941-951.
    PubMedGoogle Scholar
  • 25 Sharp NJH, Wheeler SJ. Lumbosacral disease. In Small Animal Spinal Disorders: Diagnosis and Surgery (2nd ed). Sharp DJH, Wheeler SJ. (eds). Edinburgh: Elsevier Mosby; 2005: 181-209.
    Google Scholar
  • 26 Oliver , Jr. JE, Selcer RR, Simpson S. Cauda equine compression from lumbosacral malarticulation and malformation in the dog. J Am Vet Med Assoc 1978; 173: 207-214.
    PubMedGoogle Scholar
  • 27 Kinzel S, Koch J, Stopinski T. et al Cauda equina compression syndrome (CECS): retrospective study of surgical treatment with partial dorsal laminectomy in 86 dogs with lumbosacral stenosis. Berl Munch Tierartzl Wochenschr 2004; 117: 334-340.
    PubMedGoogle Scholar
  • 28 van Klaveren NJ, Suwankong N, De Boer S. et al Force plate analysis before and after dorsal decompression for treatment of degenerative lumbosacral stenosis in dogs. Vet Surg 2005; 34: 450-456.
    CrossrefPubMedGoogle Scholar
  • 29 Wang JL, Wu TK, Lin TC. et al Rest cannot always recover the dynamic properties of fatigue-loaded intervertebral disc. Spine 2008; 33: 1863-1869.
    CrossrefPubMedGoogle Scholar
  • 30 Vorsanger GJ, Xiang J, Gana TJ. et al Extended-release tramadol (tramadol ER) in the treatment of chronic low back pain. J Opioid Manag 2008; 4: 87-89.
    PubMedGoogle Scholar
  • 31 Roelofs PD, Deyo RA, Koes BW. et al Nonsteroidal anti-inflammatory drugs for low back pain: an updated Cochrane Review. Spine 2008; 33: 1766-1774.
    CrossrefPubMedGoogle Scholar
  • 32 Postacchini F. Spine update. Results of surgery compared with conservative management for lumbar disc herniations. Spine 1996; 21: 1383-1387.
    CrossrefPubMedGoogle Scholar
  • 33 Friedman BW, Esses D, Solorzano C. et al A randomized placebo-controlled trial of single-dose im corticosteroid for radicular low back pain. Spine 2008; 33: 624-629.
    CrossrefPubMedGoogle Scholar
  • 34 Deyo RA. Drug therapy for back pain. Which drugs help which patients?. Spine 1996; 21: 2840-2849.
    CrossrefPubMedGoogle Scholar
  • 35 Imamura M, Furian AD, Dryden T. et al Evidence-informed management of chronic low back pain with massage. Spine 2008; 8: 121-133.
    CrossrefPubMedGoogle Scholar
  • 36 Gatchel RJ, Rollings KH. Evidence-informed management of chronic low back pain with cognitive behavioral therapy. Spine 2008; 8: 40-44.
    CrossrefPubMedGoogle Scholar
  • 37 Ammendolia C, Furian Ad, Imamura M. et al Evidence-based management of chronic low back pain with needle acupuncture. Spine 2008; 8: 160-172.
    CrossrefPubMedGoogle Scholar
  • 38 Dagenais S, Yelland MJ, Del CMar. et al. Prolotherapy injections for chronic low-back pain. Cochrane Database Syst Rev 2006; DOI: Issue 4. Art. No.: CD004059. 10.1002/14651858.CD004059.pub3..
    CrossrefPubMedGoogle Scholar
  • 39 Korhonen T, Karppinen J, Malmivaara T. et al Efficacy of Infliximab for disc herniation-induced sciatica: one-year follow-up. Spine 2004; 29: 2115-2119.
    CrossrefPubMedGoogle Scholar
  • 40 Autio RA, Karppinen J, Niinimäki J. et al Determinants of spontaneous resorption of intervertebral disc herniations. Spine 2006; 31: 1247-1252.
    CrossrefPubMedGoogle Scholar
  • 41 Bonetti M, Fontana A, Cotticelli B. et al Intraforaminal O(2)-O(3) versus periradicular steroidal infiltrations in lower back pain: randomized controlled study. AJNR Am J Neuroradiol 2005; 26: 996-1000.
    PubMedGoogle Scholar
  • 42 Gallucci M, Limbucci N, Zugaro L. et al Sciatica: treatment with intradiscal and intraforaminal injections of steroid and oxygen-ozone versus steroid only. Radiology 2007; 242: 907-913.
    CrossrefPubMedGoogle Scholar
  • 43 Oder B, Loewe M, Reisegger M. et al CT-guided ozone/steroid therapy for the treatment of degenerative spinal disease-effect of age, gender, disc pathology and multi-segmental changes. Neuroradiology 2008; 50: 777-785.
    CrossrefPubMedGoogle Scholar
  • 44 Becker C, Heidersdorf S, Drewlo S. et al Efficacy of epidural perineural injections with autologous conditioned serum for lumbar radicular compression: an investigator-initiated, prospective, double-blind, reference-controlled study. Spine 2007; 32: 1803-1808.
    CrossrefPubMedGoogle Scholar
  • 45 Staal JB, Bie R, de Vet HCW. et al Injection therapy for subactue and chronic low-back pain. Cochrane Database Syst Rev 2007; DOI: Issue 1. Art. No.: CD001824. 10.1002/14651858.cd001824.pub3..
    CrossrefPubMedGoogle Scholar
  • 46 Stolke D, Sollmann W, Seifert V. Intra- and postoperative complications in lumbar disc surgery. Spine 1989; 14: 56-59.
    CrossrefPubMedGoogle Scholar
  • 47 Karppinen J, Malmivaara A, Kurunlahti M. Periradicular infiltration for sciatica: a randomized controlled trial. Spine 2001; 26: 1059-1067.
    CrossrefPubMedGoogle Scholar
  • 48 Ng L, Chaudharry N, Sell P. The efficacy of corticosteroids in periradicular infiltration for chronic radicular pain: a randomized, double blind, controlled trial. Spine 2005; 30: 857-862.
    CrossrefPubMedGoogle Scholar
  • 49 Ackerman WE, Ahmad M. The efficacy of lumbar epidural steroid injections in patients with lumbar disc herniations. Anesth Analg 2007; 104: 1217-1222.
    CrossrefPubMedGoogle Scholar
  • 50 Muto M, Ambrosanio G, Guarnieri G. et al Low back pain and sciatica: treatment with intradiscalintraforaminal 0(2)-O(3). Our experience. Radiol Med (Torino) 2008; 113: 695-706.
    CrossrefPubMedGoogle Scholar
  • 51 Andreula CF, Simonetti L, De Santis F. et al Minimally invasive oxygen-ozone therapy for lumbar disk herniation. Am J Neuroradiol 2003; 24: 996-1000.
    PubMedGoogle Scholar
  • 52 D’Erme M, Scarchilli A, Artale AM. et al Ozone therapy in lumbar sciatic pain. Radiol Med (Torino) 1998; 95: 21-24.
    PubMedGoogle Scholar
  • 53 Gallucci M, Limbucci N, Zugaro L. et al Sciatica: treatment with intradiscal and intraforaminal injections of steroid and oxygen-ozone versus steroid only. Radiology 2007; 242: 907-913.
    CrossrefPubMedGoogle Scholar
  • 54 Gomez RS, Gusmão S, Silva JF. et al Interlaminal epidural corticosteroid injection in the treatment of lumbosciatic pain: a retrospective analysis. Arg Neuropsiguiatr 2007; 65: 1172-1176.
    PubMedGoogle Scholar
  • 55 Bilir A, Gulec S. Cauda equine syndrome after epidural steroid injection: a case report. J Manipulative Physiol Ther 2006; 29 492 e1-e3.
    CrossrefPubMedGoogle Scholar
  • 56 Karppinen J, Ohinmaa MalmivaaraA. et al Cost effectiveness of periradicular infiltration for sciatica: subgroup analysis of a randomized controlled trial. Spine 2001; 26: 2587-2595.
    CrossrefPubMedGoogle Scholar
  • 57 van Zundert J, van Kleef M. Low back pain: from algorithm to cost-effectiveness?. Pain Pract 2005; 5: 179-189.
    CrossrefPubMedGoogle Scholar
  • 58 Price C, Arden N, Coglan L. et al Cost-effectiveness and safety of epidural steroids in the management of sciatica. Health Technol Assess 2005; 9: 1-58.
    CrossrefPubMedGoogle Scholar
  • 59 Carette S, Leclaire R, Marcoux S. et al Epidural corticosteroid injections for sciatica due to herniated nucleus pulposus. N Engl J Med 1997; 336: 1634-1640.
    CrossrefPubMedGoogle Scholar
  • 60 Arden NK, Price C, Reading I. et al A multicentre randomized controlled trial of epidural corticosteroid injections for sciatica: the WEST study. Rheumatology (Oxford) 2005; 44: 1399-1406.
    CrossrefPubMedGoogle Scholar
  • 61 Cyteval C, Fescquet N, Thomas E. et al Predictive factors of periradicular corticosteroid injections for lumbar radiculopathy. AJNR Am J Neuroradiol 2006; 27: 978-982.
    PubMedGoogle Scholar
  • 62 Gibson JNA, Waddell G. Surgical interventions for lumbar disc prolapsed. Cochrane Database Syst Rev 2007; DOI: Issue 1 Art. No.: CD001350. 10.1002/14651858.CD001350.pub4..
    CrossrefPubMedGoogle Scholar
  • 63 Fritsch E, Heisel J, Rupp S. The failed back surgery syndrome: reasons, intra-operative findings, and long-term results: a report of 182 operative treatments. Spine 1996; 21: 626-633.
    CrossrefPubMedGoogle Scholar
  • 64 Fraser R, Sanhu A, Gogan W. Magnetic resonance imaging findings 10 years after treatment for lumbar disc herniation. Spine 1995; 20: 710-714.
    CrossrefPubMedGoogle Scholar
  • 65 Nachemson A, Zdeblick T, O’Brien J. Lumbar disc disease with discogenic pain. Spine 1996; 21: 1835-1838.
    CrossrefPubMedGoogle Scholar
  • 66 Kang J, Georgescu H, MycIntyre-Larkin L. et al Herniated lumbar intervertebral discs spontaneously produce matrix metalloproteinases, nitric oxide, interleukin-6, and prostaglandin E2. Spine 1996; 20: 271-277.
    PubMedGoogle Scholar
  • 67 Cizkova D, Lukacova N, Marsala N. et al Experimental cauda equina compression induces HSP70 synthesis in dog. Physiol Res 2005; 54: 349-356.
    PubMedGoogle Scholar
  • 68 Fanciullo GJ, Hanscom B, Seville J. et al An observational study of the frequency and pattern of use of epidural steroid injection in 25,479 patients with spinal and radicular pain. Reg Anesth Pain Med 2001; 26: 5-11.
    CrossrefPubMedGoogle Scholar
  • 69 Buttermann GR. The effect of spinal steroid injections for degenerative disc disease. Spine J 2004; 4: 495-505.
    CrossrefPubMedGoogle Scholar
  • 70 Weinstein S, Herring S, Derby R. Contemporary concepts in spine care – epidural steroid injections. Spine 1995; 20: 1842-1846.
    CrossrefPubMedGoogle Scholar
  • 71 Gibson JNA, Waddell G. Surgery for degenerative lumbar spondylosis. Cochrane Database of Systematic Reviews 2005; DOI: Issue 3 Art. No.: CD001352. 10.1002/14651858.CD001352.pub3..
    CrossrefPubMedGoogle Scholar