Prognostic Factors Associated with Recovery of Ambulation and Urinary Continence in Dogs with Acute Lumbosacral Spinal Cord Injury

Abstract

BackgroundLimited information is available about prognostic factors for recovery after spinal cord injury (SCI) to the L4‐S3 segments. Previous research suggests that L4‐S3 SCI does not have a worse prognosis than T3‐L3 SCI.Hypothesis/ObjectivesTo elucidate prognostic factors for regaining urinary continence and ambulation in dogs with L4‐S3 SCI and compare prognosis to T3‐L3 SCI.Animals/MethodsA retrospective study on 61 nonambulatory dogs with L4‐S3 SCI, matched to dogs with T3‐L3 SCI, compared 3 weeks after onset. Prognostic factors explored using logistic regression and used for matching: nonchondrodystrophic dogs >15 kg versus dogs that were chondrodystrophic or <15 kg; compressive versus noncompressive lesions; presence versus absence of conscious pain perception (CPP); and lower vs upper motor neuron (LMN/UMN) incontinence.ResultsFewer L4‐S3 dogs regained continence compared to T3‐L3 dogs (64 vs 85%, P = .0033), but no difference existed for regaining ambulation (66 vs 75%, P = .1306). In L4‐S3 SCI dogs, fewer dogs regained continence with loss of CPP (P < .001), LMN incontinence (P = .004), and noncompressive lesions (P = .006). Negative prognostic factors for regaining ambulation included absent CPP (P < .001) and large nonchondrodystrophic breed (P = .022).Conclusions and Clinical ImportanceDogs with L4‐S3 SCI have a poorer short‐term prognosis than do dogs with T3‐L3 SCI. Dogs with L4‐S3 SCI had a poor prognosis with loss of CPP, or noncompressive lesions combined with LMN incontinence. Small‐breed or chondrodystrophic dogs with retained CPP, compressive lesions, and UMN incontinence had an excellent prognosis. These findings may help guide decision‐making in L4‐S3 SCI.

Prognostic Factors in Canine Acute Intervertebral Disc Disease

“…Several studies have compared outcome in dogs with Hansen type 1 IVDE and found no difference in dogs with T3-L3 vs. L4-S3 localization ( Table 7). One study found a worse prognosis in dogs with lower motor neuron (LMN) signs of incontinence (57). Perhaps the most important prognostic detail in this category is the increased risk of development of PMM with discs located in the caudal lumbar vertebrae in dogs that are paraplegic with no pain perception (47,48).…”

Bladder and Bowel Management in Dogs With Spinal Cord Injury

“…In some instances of focal sacral lesions, sphincter tone can be preserved resulting in a combination of flaccid detrusor muscle with sphincter tone that is difficult to overcome and resulting bladder distension. While this is most commonly seen in cats with “tail pull” injuries that damage the pelvic and pudendal nerve roots, it can occur with dogs that have suffered a focal sacral lesion due to acute non-compressive nucleus pulposus extrusions or fibrocartilaginous emboli ( 17 ). The exact mechanisms causing this type of dysfunction remain unclear, although there is a suggestion that this could be mediated by the preserved hypogastric structures and internal urethral function.…”

“…With intervertebral disc herniation causing compression within the T3-L3 spinal cord segments (upper motor neuron lesions) and when dogs have present (intact) deep pain sensation in the pelvic limbs, recovery of urination usually occurs concomitantly with return of motor function ( 5 , 22 , 23 ) and the prognosis for recovery of urinary continence is good ( 17 ). When deep pain sensation is absent at the time of injury, the prognosis for recovery is less certain ( 4 , 27 ) and ~50–60% of dogs eventually regain urination along with deep pain and walking.…”

Urological Sequelae to Acute Spinal Cord Injury in Pet Dogs: A Natural Disease Model of Neuropathic Bladder Dysfunction

“…15,45,48 In one report of 61 dogs with acute lumbosacral SCI, most due to IVDE, 64% regained urinary continence. 49 Bladder Management in Dogs with SCI UMN and LMN bladder dysfunction must be managed with manual expression or urinary catheterization, either intermittent or indwelling, for as long as urinary retention is present. For dogs with severe SCIs, this can mean lifelong bladder management.…”