Cauda equina syndrome

What is cauda equina syndrome?

Cauda equina syndrome (CES) is also known as degenerative lumbosacral stenosis (DLSS) or lumbosacral stenosis. It is a neurological disorder caused by compression of the nerve roots at the end of the spinal cord. These nerve roots form the so-called cauda equina, which looks like a horse's tail and is responsible for supplying the muscles and organs at the back of the body.

Compression of the nerve roots is usually caused by degenerative changes in the spine, particularly at the transition from the last lumbar vertebra (L7) to the first sacral vertebra (S1). This transition is particularly mobile and susceptible to signs of wear and tear such as osteoarthritis, herniated discs or bone spurs. These changes cause the spinal canal, in which the nerve roots run, to narrow, resulting in mechanical pressure on the nerve fibers. This can damage the nerves and impair their function.

Which dogs are affected?

Cauda equina syndrome mainly occurs in older dogs that weigh more than 20 kg. An exception is the poodle, which is also frequently affected. Of the large dog breeds, German Shepherds, Giant Schnauzers, Siberian Huskies, Dobermans, Rottweilers and Boxers are particularly affected. Genetic factors can also play a role, for example if a dog has a so-called transitional vertebra, which shows structural characteristics of two different sections of the spine.

How do you recognize cauda equina syndrome?

Cauda equina syndrome manifests itself through various symptoms, which can vary depending on the severity and progression of the disease. The most common signs are

• Pain in the lumbar spine, which increases when standing up, jumping or climbing stairs
• Loss of performance, fatigue and listlessness
• Toe dragging or stumbling with the hind paws
• Weakness or paralysis of the hind legs
• Incontinence of urine or feces
• Loss of tail wagging or tail paralysis
• Muscle loss on the hind legs
• Raised back or hunched posture

The symptoms can occur gradually or suddenly and can improve or worsen from time to time. They are often misinterpreted as signs of ageing or confused with other diseases such as osteoarthritis or a slipped disc.

How is cauda equina syndrome diagnosed?

To diagnose cauda equina syndrome, a vet must carry out a thorough clinical examination. This includes checking the reflexes, sensitivity to pain and muscle strength of the hind legs. The dog is also examined for signs of incontinence or nerve damage.

To confirm the diagnosis, imaging procedures such as X-rays, computer tomography (CT) or magnetic resonance imaging (MRI) are usually necessary. These can visualize the changes in the spine and the compression of the nerve roots.

How is cauda equina syndrome treated?

The treatment of cauda equina syndrome depends on the severity of the disease and the general condition of the dog. There are two options: conservative or surgical therapy.

Conservative therapy consists of the administration of painkillers and anti-inflammatory medication to alleviate the symptoms. Physiotherapy can also help to improve the mobility and musculature of the hind legs. Weight reduction in overweight dogs and adjusting activity levels are also important to reduce the strain on the spine.

Surgical therapy aims to remove the compression of the nerve roots and widen the spinal canal. There are various surgical techniques for this, such as laminectomy, in which part of the vertebral arch is removed, or foraminotomy, in which the openings for the nerve roots are enlarged. In some cases, the lumbar-cruciate junction is also stiffened to prevent further instability.

Surgical treatment usually has a better chance of success than conservative treatment, especially if the symptoms are already advanced. However, it is also associated with a higher risk and higher costs. It is therefore necessary to decide which treatment method is most suitable for each individual dog.

What is the prognosis for cauda equina syndrome?

Cauda equina syndrome is a chronic disease that cannot be cured. However, treatment can improve the dog's quality of life and slow down the progression of the disease. The prognosis depends on various factors, such as age, health status, severity of symptoms and the form of treatment chosen. As a rule, dogs with surgical therapy have a better prognosis than dogs with conservative therapy. However, complications can occur or symptoms can recur even after surgery.