Lumbosacral disease in dogs remains a challenging condition without a definitive treatment
Epidural Injections For Lumbosacral Disease In Dogs: A Good Intermediate Treatment Before Surgery
4 days ago 
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Lumbosacral disease in dogs remains a challenging condition without a definitive treatment. World-renowned Neurology Specialist Dr Nicolas Granger has been highlighting the use of epidural injections of methylprednisolone acetate as a non-invasive option for pain management, offering relief through single or multiple doses. This is a possible method to provide pain relief before spinal surgery, in those cases where the call to go ahead with surgery is tricky to make.
Degenerative lumbosacral stenosis (DLSS) is a progressive condition in dogs characterised by the narrowing of the spinal canal at the lumbosacral junction. This narrowing compresses nerves, leading to pain and, less commonly, neurological issues. The condition’s exact causes are not entirely clear but may involve factors such as congenital abnormalities, past infections, breed predisposition, and high-impact physical activities.
DLSS presents primarily as pain, with common symptoms including pelvic limb lameness (in one or both legs) and back pain. Since neurological deficits, like weakness, are rare, the condition can be difficult to diagnose accurately. This variability often results in over- or under-diagnosis, complicating treatment plans. Despite these challenges, one certainty is the condition's progressive nature, requiring long-term management, often through pain relief techniques.
A common and relatively non-invasive treatment for DLSS is the epidural injection of methylprednisolone acetate, a long-acting corticosteroid. This injection reduces inflammation around the nerves compressed at the lumbosacral junction. The technique involves delivering the medication into the epidural space, typically between the L7 and S1 vertebrae, where it diffuses around the affected nerves, ligaments, and joint capsules.
Epidural injection of pain medications (other than corticosteroids) is done daily at Bristol Vet Specialists by the anaesthesia team and this is well known and safe technique that has been used in humans and dogs alike for a long time.
A couple of studies have explored the effectiveness of long-acting corticosteroid epidural injections. Janssens et al. (2009) developed a protocol involving multiple injections at set intervals, finding that 79% of dogs improved, with 53% considered pain-free by their owners over a median follow-up period of 46 months. However, the study excluded cases with severe neurological symptoms or concurrent orthopaedic conditions, which could affect the outcomes. In contrast, a study by Gomes et al. (2020) investigated the impact of a single injection. Their findings showed that 84.4% of dogs improved after just one injection, with a subset of dogs experiencing long-term relief without the need for additional injections. For dogs that experienced a relapse, surgery was an option, so this approach suggests that for some dogs, a single injection may provide lasting relief.
In conclusion, epidural injections of methylprednisolone acetate can provide an effective and minimally invasive treatment option for DLSS in dogs. Some dogs benefit from a single injection, while others may require multiple treatments. It certainly offers an alternative for managing this challenging condition in cases where surgery may not be straight away an option for various reasons.
A more detailed paper can be found by clicking here.
Dr Nicolas Granger, DVM, PhD, DipECVN, FHEA, FRCVS, graduated from the National Veterinary School of Alfort, France, in 2002 and is a diplomate of the European College of Veterinary Neurology. He previously worked at Cambridge University, where he obtained a PhD in neuroscience for work on cell transplantation for spinal cord injury repair. Nicolas is currently head of the neurology/neurosurgery service at Bristol Veterinary Specialists, providing state-of-the-art diagnostics and advanced treatments for neurological patients with a team of 4 senior neurologists, 2 neurology residents and 3 specialist neurology nurses. His research focuses on spinal cord injury treatments and the use of neuroprosthesis for urinary incontinence control.
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