Lumbo-Sacral Stenosis

[silverfish]

Tell me about your experiences with lumbo-sacral stenosis - early signs, what was done, etc.

 

Jeffie (12 yrs) is wobbly on his back end. Vet thinks it's just aging and perhaps neurological involvement (LS? Though he didn't call it that), but I'm not sure. He's been a tad wobbly since he lost an outer toe - it's as if he still doesn't remember it's gone and tries to use it for balance and then his foot goes over.

 

Two reasons I'm not sure it's LS. Firstly, if I press on each of the individual vertebrae in his lower back - enough to make him brace against it and bounce just a tad - he is solid as a rock, provided his feet are well apart and he's balanced. Secondly, if I rub the back of his thighs he literally sinks to the ground, and he's more sensitive on one side than the other.

 

He's fallen on his back end twice within the past few weeks. The first he seemed to 'miss' the front door step (a matter of about three inches) and his right hind leg gave way, then his left hind tripped over that and he was down. Once lifted to his feet, he jumped into the car with no problem. The second time he was crossing the road with DH and he says that there was nothing in the road (no bumps or dips) and as far as he knows nothing happened to make him fall. I have to say he does have a habit of letting the dogs walk behind him across the road, so he didn't actually see it happen. Again, he had to be lifted to his feet but then trotted off as if nothing had happened.

 

I've never had an LS dog, though Jim got a bit saggy when he was thirteen and up. He never fell or tripped though.

Edited June 24, 2014 by silverfish

[DocsDoctor]

Doc - who will be 13 in August - has been weakening in his back end over the last couple of years. Like you I don't have a formal diagnosis of lumbo-sacral stenosis but I will tell you what I can about his issues and treatment, in the hope it will be useful for Jeffie.

 

Initially the problem seemed to come on very suddenly - I was walking him one morning as usual in the park, back in spring 2012. Suddenly he stopped and I could see he was in severe pain, barely able to walk. Our vet was quick to diagnose a lower back issue and did some x-rays (which he lay quite still for, without sedation - good boy Doc!). Sure enough there were a couple of compressed disk spaces, near the junction with the hips. Some associated osteo-arthritis was also visible, so although the pain appeared to come on so suddenly, we believed the problem had been coming on for a while, with him just being stoical about it in that classic greyhound way, until it just got to be too much. We also believed it to be the result of general wear and tear, rather than any specific trauma - this area is after all the 'hinge' for a greyhound's double suspension gallop so it gets a lot of hard work. The right hip was more painful, nothing showed up on the xrays so most likely something was pressing on a nerve.

 

We put him on Metacam as an anti-inflammatory, and Tramadol for the pain. Did some sessions of hydrotherapy with him walking on an underwater treadmill, which he didn't enjoy but it did help him build up muscle again in his back legs. I also found via our greyhound rescue a veterinary physio who would come to the house and give him massage and manipulation, which definitely helped, and cold laser therapy. She also gave us various exercises to do daily which we still keep up and which again definitely help - knuckling over his back feet for him to pick up, side stretches for treats, etc etc. He responded really well and we were able to stop the Tramadol for six months or so.

 

Other things that my vet recommended at this stage and which would be good practice anyway for any arthritic hound are: plenty of soft bedding, keeping up a regime of gentle walks to prevent him seizing up, stopping him from coming upstairs ('dogs are not designed to do stairs' was her comment and in any case mine are particularly steep and narrow) and appropriate dietary supplements - Doc takes fish oil, green-lipped mussel, turmeric and a liquid joint aid supplement with glucosamine, chondroitin and MSM.

 

However over time there has still been an inevitable process of continuing deterioration. After the six months we could see his left shoulder getting increasingly sore, partly as it was working harder to compensate for the issues in the right hip, but when we did another x-ray we could see that there was also some arthritis in the spine in that area. So he went back on the Tramadol and had some more visits from the physio. We also tried acupuncture but though that had some immediate effect the physio always seemed to give him more lasting relief.

 

Unfortunately our old vet left the practice last November, so when I saw he was beginning to struggle again this spring we had to see the new one. Initially we just added Gabapentin to the Tramadol, I also asked her about the possibility of a corticosteroid injection to the lumbosacral region which often gets mentioned here on Greytalk and which you can find discussed in the Suzanne Stack article: http://www.greyhound-data.com/dir/397/Lumbosacral_Stenosis.pdf

 

I have to say that she had never heard of this, and was somewhat horrified by the idea, commenting that 'it's the equivalent of an epidural'. I don't think it is commonly done in the UK - the kennel manager of our greyhound rescue hadn't ever heard of it either. The vet practice would have done it, after I showed them the article, but only with Doc under general anaesthetic, while the physio commented that Doc's shoulder seemed to give him more pain than his hip.

 

So we didn't pursue that, but what the kennel manager at the rescue did suggest was to try taking him off the Metacam, and giving him a short course of orally-administered steroids - something she has often done with her oldies in the kennels, and at home. As she said ' it's all about keeping them comfortable at this stage.' (I must say it is great to have the rescue to talk to about this sort of thing - they are always very helpful and practical!)

 

The vet agreed this would be good to try, so we put him on a 10-day course of prednoleucotropin the other week. I must say this worked really fast - you could see even in the first few hours that he was feeling more comfortable - and he tolerated it very well, though it is not something you want to administer long-term. He can however have topups later as needed using what the vet called 'pulse dosing'. So right now he is on just the painkillers and we will go back to the vet's in 2 weeks to see how he is doing.

 

Sorry, this has turned into something of an essay! To sum up I think the important thing is to keep Jeffie comfortable, and to be prepared to try different things to do that. It's important to keep him moving meanwhile, too, so he doesn't lose too much muscle. You can't stop time but you can help prevent deterioration, if you're prepared to work at it. With Doc goodness knows how much longer Doc will be with me but although he certainly can't walk as far or as fast as he used to, for the moment he's still a very happy boy - eating well, wanting to go to walks, and romp with his teddy bear. Considering that 2+ years ago I can remember standing with him in front of the old vet and saying 'Look at him - he's wretched - if we can't sort this out PDQ it's time to say goodbye' I feel privileged to still have him here, really.

 

And now I really will stopping as he's squeaking about it being time for his afternoon walk downstairs!

[Remolacha]

My first greyhound developed some back end weakness when she was about 11.5 Based on the standard LS test, it wasn't that, but x-rays showed (layman's terms ) the cushiony stuff in several of her vertebrae had worn away, so that when she moved the wrong way, the bone rubbed/pinched a nerve. Hers came on very suddenly, she had had some minor arthritis and suddenly one day she was in pain and could barely walk. Steroid injections gave her immediate but temporary relief. She was put on Metacam which helped, but a couple of months later she had another "episode" where she suddenly couldn't walk at all, could barely stand. I was sure I would lose her, but the steroid shot worked again, and I started her on acupuncture. That saved her life. In about 6weeks, she was 80%-90% normal. We did do Adequan shots as well, the first one helped while the acupuncture was kicking in, after that they seemed less effective, so we stopped. She also had a heart condition, and I lost her at 12.5 to complications from that, but right up to the end, she was walking just fine.

 

So, not information about LS like you asked, but I hope this helps!

[Guest Annie_Bon_Annie]

Check on Wikipedia for Wobbler's disease. Doesn't sound right at first but by the end of the column, it fits pretty well.

The steroids do help a lot, but you have to weigh the complications against the positive sides of the drug.

Sue

Ye Dogs!!! I've advanced to "wet behind the ears" Gettin' there!!!!

[scullysmum]

I think you need to get a more definitive diagnosis of what kind of spinal problem you are dealing with.

 

Many of Jeffie's symptoms you describe like not appearing to know where his feet are (propriorception sp?) sound very similar to what Sadi was like, she didn't have LS she had Spondylosis of the lower spine, which is basically when bone spurs grow from the vertebrae and can restrict movement in the spine and impinge on nerves in the area too. I used to joke that her front legs and back legs were on a different planet! but that is sometimes what it seemed like, they weren't working as a team anymore. From what I have read (but I am sure others with more experience will correct me if wrong) LS tends to be painful, whereas Spondylosis less so, in fact Sadi did not seem to be in pain at all, she just had an increasing loss of sensation and control of her back end.

 

When my vet diagnosed Sadi he said he would put her on a course of Prednoleucotropin (PLT) and if it worked for her I would notice an improvement in a couple of days, but if not then nothing else would really help her, sadly it did not help her.

 

I hope that you can get to the bottom of what is causing Jeffie's wobbles so you can find something to make him more comfortable.

[silverfish]

Thanks for the replies so far!

 

Clare, thanks for the very full description of the problem and treatment. It seems very similar to what Jeffie is suffering except that this did not come on suddenly. He has always 'not known where his back feet were' as we put it. I took him to agility when we first got him to try to help with this and it did help, quite a lot. But now he's worse than he ever was. Trouble is, we didn't get him till he was almost ten and I have no idea what he was like before - I can ask his trainer, but basically, for years he was just another adoptable waiting to be homed. He was cared for properly, but down in the kennels, not in someone's lounge under their eye.

 

I've asked about the Adequan type injections before, for a previous dog, and got pretty much the same response as you did! I think we'd need a referral to get anywhere with that one. Jeffie used to do hydrotherapy, but we've lost our pool (Sid misses it, too!). He does have the soft beds and the warm jackets and the painkillers (just rimadyl at the moment) but I've had to stop his supplements for the moment because he is not eating well and losing weight fast, poor old boy, and anything odd in his dish makes him leave his dinner. He does get two short daily walks, he gets massage (I have an electric massager the same as some of the trainers use), and he doesn't do stairs.

 

You've done remarkably well with Doc - he's so lucky to have you caring for him!

 

Annie-Bon-Annie - I honestly don't think it's Wobbler's. I'll mention it to the vet when I go next, but reading on the vet sites it doesn't really seem to fit. He's had spine x-rays - last year for all of it, and just recently for the chest/neck area because we were checking his lungs. No evidence of compression.

 

Mel - yes, I think so too. I'll try to see a different vet next time, but he does see one of the two 'greyhound' vets at the practice. Sadi's symptoms do sound very much like what Jeffie is experiencing. You're right, it's probably a problem of proprioception, as much as anything. He had some x-rays done (see above) but though he does have a few bone spurs in the thoracic region they don't think they're severe enough to cause problems and there's no evidence of compression.

 

I'm going to ask about the prednoleucotropin. Maybe that would help Jeff! Thank you!

 

I should just add that quite a lot of the time, especially around the house, Jeffie appears to have no problems at all. But he does have a very strange walk these days. Watching him come towards me (when DH gets a bit left behind and I'm waiting for them to catch up) his legs are all over the place. He looks almost as if he's dancing. From the back, you can see that each time he puts weight on a back leg, his foot rotates inward on the last part of the step and this causes his leg to 'fall' outwards. It's most odd. The vet who saw him last took him out back for me to walk and trot him and he called it an 'old man's walk'.

[NeylasMom]

I would get a consult with a specialist to try to figure out what you're dealing with. You may not be pressing on the right spot to dx LS - you don't really press ON the vertebrae, but a specialist who's knowledgeable about LS should be able to get an idea through an exam and x-rays whether it's that or something else.

[silverfish]

I would get a consult with a specialist to try to figure out what you're dealing with. You may not be pressing on the right spot to dx LS - you don't really press ON the vertebrae, but a specialist who's knowledgeable about LS should be able to get an idea through an exam and x-rays whether it's that or something else.

 

As far as I understand it, pain over the lumbar region is almost invariably present with lumbo-sacral disease and this he does not have, wherever his spine is pressed - and this has been done by vets as well as by me.

 

However, I do agree that we aren't going to get too far without a consultation with a specialist. We've been very impressed with the guys at Cambridge, at Newmarket and at Davis Whites - the three referral centres we've been referred to so far. I'm a long way from being unwilling to go that route.

[tbhounds]

Ya you just beat me to it--with the absence of a pain response I would tend to think he doesn't have LS. He does sound neurological though. Have you tried medications -specially Gabapentin to see if it's beneficial??

[EllenEveBaz]

Nutmeg, whose 13th birthday is coming up in less than 2 weeks, has what her vet thinks is a combination of arthritis, possible LS, and "maybe something neurological." She has had x-rays, which couldn't detect the LS, and since I wouldn't opt for back surgery for her at age 12, we didn't have the more definitive but expensive MRI. She seemed to lose muscle mass in her legs earlier than my other hounds -- around age 9 -- but other than that there didn't seem to be any noticeable symptoms until 8-9 months ago. She has a difficult time getting up, and when she stands still for a while, her hind legs start to sink down. Unlike Jeffie, once she starts walking, her gait looks relatively ok. She does not replace her right rear paw when we turn it under, until she takes a step.

 

She started on tramadol, and then we added gabapentin. Her vet had never heard of the depo-medrol shot, either, but was willing to follow the directions in the Stack article and those have helped her a lot. She just had her 2nd. Her appetite has been pretty good, but now she sometimes doesn't want much breakfast. She enjoys short walks, being out in the back yard with me, and my amateur leg massages. Her spirit is ever-willing, but her back is weak.

Edited June 25, 2014 by EllenEveBaz

[silverfish]

Ya you just beat me to it--with the absence of a pain response I would tend to think he doesn't have LS. He does sound neurological though. Have you tried medications -specially Gabapentin to see if it's beneficial??

 

Thanks - no we haven't tried Gabapentin yet, we're still on a trial of Rimadyl. If we don't see a difference in the next week or two he'll be going back and I'll ask about it then. We still have some from when Sid was on it.

 

Nutmeg, whose 13th birthday is coming up in less than 2 weeks, has what her vet thinks is a combination of arthritis, possible LS, and "maybe something neurological." She has had x-rays, which couldn't detect the LS, and since I wouldn't opt for back surgery for her at age 12, we didn't have the more definitive but expensive MRI. She seemed to lose muscle mass in her legs earlier than my other hounds -- around age 9 -- but other than that there didn't seem to be any noticeable symptoms until 8-9 months ago. She has a difficult time getting up, and when she stands still for a while, her hind legs start to sink down. Unlike Jeffie, once she starts walking, her gait looks relatively ok. She does not replace her right rear paw when we turn it under, until she takes a step.

 

She started on tramadol, and then we added gabapentin. Her vet had never heard of the depo-medrol shot, either, but was willing to follow the directions in the Stack article and those have helped her a lot. She just had her 2nd. Her appetite has been pretty good, but now she sometimes doesn't want much breakfast. She enjoys short walks, being out in the back yard with me, and my amateur leg massages. Her spirit is ever-willing, but her back is weak.

 

This sounds much like Jeffie, too. I've noticed once or twice lately that he'll fail to pick his left hind up enough when walking and start to knuckle, then stumble just a tiny bit and correct himself (DH who had his lead didn't notice but I was behind and watching carefully).

 

When he walks, he looks dreadful, but when he trots, he's perfectly normal, you'd never know there was anything wrong at all. Galloping is another story - he looks like a windmill. Legs everywhere! He sometimes has trouble getting up, other times he leaps up as if he's been hot-wired.

 

He's very odd. And he jumps into the car as if he's been thrown up on a spring - he nearly hits the back of the compartment, and the rear of my car is huge, like a small van. That's another thing which doesn't sound so much like LS to me.

 

So that's another vote for Gabapentin. I'll definitely speak to them about that. Thank you - both of you!

 

I will also mention the Suzanne Stack shots, but I believe I won't get anywhere with that without a firm diagnosis of spurs, compression or stenosis of the lumbar spine.

[tbhounds]

Just as an FYI--Gabapentin is more effective when given in combo with an NSAID.

[silverfish]

Thanks, yes, Sid had it in combination with Onsior. Now he's just taking the Onsior - but it was for a different issue.

[GeorgeofNE]

The "test" for LS involves lifting the tail--I'm not sure of the details--but any competent vet should know how to do it. The only definitive way to diagnose it is via MRI, which is cost prohibitive for most of us since it doesn't change the treatment unless you want to spend thousands and thousands of dollars on surgery--which at your hound's age would be pretty crazy IMHO.

 

Gentle regular exercise to keep his hind end muscles strong is key. Twice a day walks are better than one long walk. Try to avoid jumping up on things, and try to keep him from doing crazy butt tuck zoomies and such. Otherwise, there isn't anything you can do except deal with the symptoms. As others have said, Gabapentin is the medication that seems to help most hounds. It's what George takes. He also takes Deramaxx. He's doing well. Occasionally his back legs give out going up the stairs and he falls, and it breaks my heart, but generally he is doing well. He'll be 12 in Sept.

[Hubcitypam]

Having been in the office with Dr. Mike Herron (who invented the "thumb test") when he diagnosed my Rex I can assure you that it does not involve lifting the tail...and doesn't just consist of placing pressure on the backbone.

I do think Rex had LS and that is why the shots helped but also think it was more complex than that - in the end the neuros decided that he either had a smore's nodule or it was GME that was finally getting him but they couldn't tell without an MRI. My vet said "they both have a horrible prognosis - he's in pain and do you want to spend $1,000 to find out exactly what is?"

Hugs to you and Jeffie. I wonder if, like Rex, there might be more than one thing going on.

http://www.greythealth.com/lumbosacral.html

Edited June 25, 2014 by Hubcitypam

[FiveRoooooers]

Have you tried depo injections? There are threads here discussing it. My angel Pal's initial LS symptoms were manged quite well with depo.

[silverfish]

 

 

Gentle regular exercise to keep his hind end muscles strong is key. Twice a day walks are better than one long walk. Try to avoid jumping up on things, and try to keep him from doing crazy butt tuck zoomies and such. Otherwise, there isn't anything you can do except deal with the symptoms. As others have said, Gabapentin is the medication that seems to help most hounds. It's what George takes. He also takes Deramaxx. He's doing well. Occasionally his back legs give out going up the stairs and he falls, and it breaks my heart, but generally he is doing well. He'll be 12 in Sept.

 

Good to hear George is doing well!

 

Jeffie gets short twice-daily walks. The only place he has to do any jumping is into my car, which was bought for an old greyhound and the floor pan is only 15 inches off the ground. He manages it with absolutely no apparent effort at all. If anything he overdoes the jump as if he's on a trampoline. He doesn't do zoomies - even when we take them to a fenced field he just trots and mooches about.

 

Having been in the office with Dr. Mike Herron (who invented the "thumb test") when he diagnosed my Rex I can assure you that it does not involve lifting the tail...and doesn't just consist of placing pressure on the backbone.

 

I do think Rex had LS and that is why the shots helped but also think it was more complex than that - in the end the neuros decided that he either had a smore's nodule or it was GME that was finally getting him but they couldn't tell without an MRI. My vet said "they both have a horrible prognosis - he's in pain and do you want to spend $1,000 to find out exactly what is?"

 

Hugs to you and Jeffie. I wonder if, like Rex, there might be more than one thing going on.

http://www.greythealth.com/lumbosacral.html

 

 

Thanks for that. Yes, I think there's definitely more going on than just LS, if it is that. Jeffie is 'made wrong', bless him and he also has a back toe missing. He has just half an extra 'floating' rib on one side which sticks out and seems to have the effect of making him feel that one side of him is longer than the other - he has always walked slightly on the diagonal. Neither of those can be helping him now.

 

 

 

Have you tried depo injections? There are threads here discussing it. My angel Pal's initial LS symptoms were manged quite well with depo.

 

No, but I'm more than willing to consider them IF I can get my vets to play along. I'll probably print out the Suzanne Stack page and take it along when I take him in next. As she says, can't hurt, might help.

 

Thanks everyone! Any more comments or ideas welcome, of course!

[Guest lgmaddox]

Reading this thread late at night - my 13.5 yr old female's rear weakness is getting increasingly worse. Unfortunately she has been staying with someone else the past few months while I try to rebuild my life post lay-off. So I am limited in what I've been able to do for her. Our vet did put her on 50mg tramadol 2x/day, if I can get her caretaker to give it to her. That's the tricky part, she doesn't believe much in intervening medically. Trying to find a place to live where I can keep her and treat her the way I see fit instead of having to negotiate with her.

 

She has significant muscle wasting in the hindquarters. I am going to see if I can get her to a vet here for depo injections. I do suspect LS, but we have no xrays at this point, etc. Her rear sinks when standing, and she fell today trying to get up a very short flight of stairs. Weird thing is, she's perfectly capable of running around the back yard, and jumping up in to the rear car seat.

 

If anyone has any additional thoughts/insights here I'd appreciate it. Unfortunately I can only do so much until I get her back, which I am hoping is soon. Thanks.

[silverfish]

This sounds much like Jeffie. He too can jump into the car with absolutely no trouble at all - he sails in like a springbok - but he can stumble and fall on his backside going down our front door step if he misses his footing. The odd thing about Jeffie, though, is that he doesn't seem to have significant muscle wasting in his hindquarters. He's as thin as a rake, but it's a generalised thinness and he still has fairly solid muscles in that area.

 

I'm disturbed at what you say about your fosterer not wanting to give your girl treatment. Surely she understand that she is still your dog and she must do whatever you wish to do in that regard? I know there's delicate ground to tread since she's doing you a favour and you don't want her to simply say she won't care for her anymore but it seems very high-handed of her to say that if she has her she won't 'intervene' medically.

[Echobelly1]

A few years ago, one of our greyts developed LSS, to the point where she could hardly walk. I found this article: http://www.greyhound-data.com/dir/397/Lumbosacral_Stenosis.pdf

I printed it out and brought it to my vet. She agreed to give a depo injection, even though she wasn't familiar with this treatment. She said the dosage was low, she'd given more to a cat. Three hours after the injection the dog was running around the yard. It lasted about 6 months. Each injection was slightly less effective, but we were able to keep the dog pain-free for about a year. I recommend this treatment to anyone, it doesn't do any harm and is relatively cheap.