1. AVC Class of 2013 Faculty Advisor1
Robert Gracia Dr. Art Ortenberger2
Degenerative lumbosacral stenosis in a dog: medical management using acupuncture, non-3
steroidal anti-inflammatories, and steroid epidural injection.4
Abstract: A fourteen-year-old male castrated Border Collie (BC) mix was presented to the5
Atlantic Veterinary College for evaluation of hind-limb lameness, pain, and spontaneous6
vocalization. Orthopedic exam and radiography identified evidence of degenerative lumbosacral7
stenosis (DLSS). Over the following weeks a multimodal approach to medical management was8
initiated. Included were non-steroidal anti-inflammatories, acupuncture, and steroidal epidural9
injection; throughout the course of treatment, the patient demonstrated marked improvement,10
returning to almost full functionality.11
It was noted that a fourteen year old Border Collie mix was losing hind limb function and12
collapsing during attempts at climbing stairs. Later overexertion while exercising on a walking13
trail led to progressive dysfunction of both hind-limbs. Episodes of shifting non-weight bearing14
hind-limb lameness occurred later that day resolving to bilateral weight bearing lameness a week15
later. The dog was given tramadol at 5mg/kg body weight by the owner, which did little to16
alleviate the pain seen. Seven days after onset, the dog was restless at night, not able to sleep for17
more than an hour before spontaneously vocalizing. The dog was brought to the Atlantic18
Veterinary College to identify the cause of the hind-limb dysfunction, vocalization, and pain.19
At the time of presentation, the dog was bright, alert, responsive, and very anxious. He20
was slightly under conditioned (body condition score = 2.75/5, body weight = 21.5 kg) and had21
generalized muscle atrophy. His mucous membranes were pink and moist, and a grade IV/VI22
systolic heart murmur was auscultated. His resting heart rate was 100 beats per minute, and a23
resting respiratory rate could not be determined due to panting. His pulse was strong and24
synchronous. There was moderate enlargement of his left popliteal lymph node.25
Upon orthopedic examination it was noted that he had a stiff hind-limb gait, and there26
was evidence of a mild to moderate left hind-limb weight bearing lameness. Circumduction of27
both hind-limbs was evident during walking and running. He had no signs of ataxia and a wide28
based hind-limb stance. He had normal range of motion on all joints. He had normal to increased29
patella reflexes bilaterally, and decreased sciatic reflexes bilaterally. He had decreased tail tone30
and a low tail carriage. He had a normal rectal exam, but decreased anal tone was noted. Pain31
was elicited on lumbosacral palpation.32
Lateral and ventro-dorsal projections of the lumbar spine, including the lumbosacral33
junction, were performed. There was moderate narrowing of the intervertebral disk space of L3-34
L4. A moderate amount of spondylosis deformans was noted near the thoracolumbar junction.35

2. The results of the complete blood count, serum biochemical profile, urinalysis, and lymph node36
fine needle aspirates were within normal limits.37
Further diagnostic testing to confirm degenerative lumbosacral stenosis (DLSS) was38
discussed with the owner, and it was opted to try a more conservative medical management39
approach. The dog was placed on meloxicam 1.5 mg/ml (Metacam, Boehringer Ingelheim,40
Ontario, Canada) at a dose of 0.1 mg/kg BW orally once daily for pain and inflammation for one41
week, and two weeks of restricted activity. After the first week, the dog displayed moderate signs42
of improvement.43
During the second week he began acupuncture therapy for lumbosacral pain. Specific44
acupuncture points pertaining to the dog’s affliction were used to provide analgesia and relief45
from anxiety. Acupuncture was repeated weekly for three sessions and then every other month.46
Acupuncture points were added and removed from the original protocol, but basically remained47
similar throughout treatment. On the initial treatments electro-stimulation over bilateral48
acupuncture points was done in order to provide a longer lasting effect. The acupuncture points49
consisted of: Stomach (ST) 36 (Hou-san-li) reduces stifle pain and hind-limb weakness. It is50
located on the craniolateral aspect of the pelvic limb, 0.5 cun lateral to the cranial aspect of the51
tibial crest, in the belly of the cranial tibialis muscle (1). Spleen (SP) 6 (San-yin-jiao) reduces52
pelvic limb paresis and is located on the medial side of the pelvic limb 3 cun proximal to the tip53
of the medial malleolus in a small depression on the caudal border of the tibia (1). Bladder (BL)54
40 (Wei-zhong) reduces pain associated with thoracolumbar disc disease, coxofemoral joint pain,55
and pelvic limb paresis. This point is located in the center of the popliteal crease (1). BL-54 (Ba-56
shan or Zhi-bian) reduces coxofemoral joint pain, osteoarthritis, pelvic limb paresis, lameness,57
muscle atrophy, and perianal disorders. This point is located at the coxofemoral joint at the level58
of the sacrococcygeal hiatus, just dorsal to the greater trochanter of the femur, around the59
coxofemoral joint (1). Gallbladder (GB) 29 (Ju-liao) reduces pain associated with osteoarthritis60
of the coxofemoral joint, pelvic limb paresis, and gluteal muscle pain. This point is located at the61
coxofemoral joint, in a depression just cranial to the greater trochanter of the femur (1). GB-3062
(Huan-tiao) reduces pain associated with osteoarthritis of the coxofemoral joint, pelvic limb63
paresis or paralysis, and gluteal muscle pain. It is located in a depression midway between the64
greater trochanter of the femur and the tuber ischii (1). GB-34 (Yang-ling-quan) provides general65
pain relief, and strengthens tendons and ligaments. This point is located on the lateral side of the66
pelvic limb at the stifle, in a small depression cranial and distal to the head of the fibula (1).67
Governing vessel (GV) 20 (Bai-hui) provides sedation for acupuncture therapy. It is located on68
the dorsal midline on a line drawn from the tips of the ears level with the ear canals (1).69
Later, the following acupuncture points were added to better address anxiety issues70
caused by lumbosacral pain. The acupuncture points were as follows: ST-45 (Li-dui) ameliorates71
behavioral problems and is located on the lateral side of the third digit of the pelvic limb at the72
nail bed (1). Heart (HT) 7 (Shen-men) reduces anxiety and restlessness and is located on the73
lateral transverse crease of the carpal joint and approached via the large depression lateral to the74

3. tendon of the flexor carpi ulnaris muscle although the point is medial to this tendon (1). BL-1075
(Tian-zhu) reduces cervical and shoulder pain, as well as pain associated with intervertebral disc76
disease, it is located on the dorsolateral aspect of the cervical spine, in a depression just caudal to77
the wings of the atlas (at the junction of C1-C2), 1.5 cun from the dorsal midline (1). BL-1578
(Xin-shu) improves cognitive function and is located on the dorsolateral aspect of the spine, 1.579
cun lateral to the caudal border of the dorsal spinous process of T5 (1).80
Seven weeks after the initial presentation, the dog was markedly improved in pain control81
and functionality. He had been receiving consecutive acupuncture treatments which allowed for82
the discontinuation of his meloxicam. He was examined and pain was still elicited on palpation83
of his lumbosacral region. His sciatic reflexes seemed mildly improved, and his tail tone was84
moderately improved with normal tail carriage. A new treatment option was discussed with the85
owner which was the infiltration of the epidural space with a long acting steroid. The following86
day the dog was sedated and then placed under general anesthesia and a 21 gauge 7 cm spinal87
needle was placed in the L7-S1 space by the anesthesia personnel. The epidural space was88
infiltrated with methylprednisolone acetate 40 mg/ml (Depo-Medrol, Pfizer Canada Inc, Quebec,89
Canada) at a dose of 1 mg/ kg BW. The dog recovered uneventfully and was discharged later that90
day.91
Two weeks after the epidural injection the dog returned for reevaluation and examination.92
The dog had returned to near full functionality with a marked increase to activity. Pain was no93
longer elicited on lumbosacral palpation, or during exercise. The owner was advised to continue94
to monitor and schedule another epidural injection of steroid if felt needed.95
Degenerative lumbosacral stenosis is caused by degeneration of the lumbosacral disc96
resulting in a Hansen Type II disc protrusion. There is also a variable degree of subluxation,97
instability, soft tissue proliferation, and spondylosis deformans that may contribute to98
compressive radiculopathy of the cauda equina. This eventually leads to nerve root compression99
or ischemia which then leads to neurological signs (5). The causes for degeneration of the L7-S1100
disc are malformation of lumbosacral vertebrae or the sacroiliac joint, biomechanical factors,101
age, and osteochondrosis. Eventually a loss of stability leads to subluxation and then to a102
narrowing of the vertebral canal and osteophyte formation (6), (7). DLSS involves varying103
degrees of anatomical pathology, such as hypertrophy and ventral folding of the interarcuate104
ligament, osteoarthritis and subsequent joint capsule proliferation of the articular facets of L7-S1105
articulation, and occasionally osteochondrosis of the cranial sacral or caudal L7 end plate may be106
seen (2). The nerves most often affected by DLSS are the sciatic, pudendal, pelvic, sacral, and107
caudal; leading to the neurological signs seen on presentation such as hind-limb paresis and108
paralysis, decreased sciatic reflexes, decreased tail tone and anal tone, and incontinence (7).109
DLSS is mostly confined to middle aged to older, medium and large breed dogs. It is probably110
overrepresented in German Shepherds. Other breeds affected commonly include Great Danes,111
Airedale terriers, Irish setters, English springer spaniels, Boxers, Labrador retrievers, and Golden112
retrievers (2). DLSS is more common in working dogs that undergo rigorous activity. Males are113

4. twice as likely to have DLSS over females. Common findings for DLSS are pain in the caudal114
lumbar region and pelvic limb weakness that is manifested as a reluctance to jump, climb and115
rise (3). The severity of DLSS manifests itself in neurological deficits. These may be116
proprioceptive deficit, decreased hock flexion with a reduced Achilles tendon reflex, urinary or117
faecal incontinence, and root signature signs such as stamping, lifting of a hind-limb and lower118
back flea biting behavior (3).119
Treatment options for DLSS can be divided into two categories; medical management or120
surgical treatment. Medical therapy consists of exercise restriction for a minimum of 4 to 6121
weeks. Administration of anti-inflammatories can be used to control pain and inflammation122
throughout the restricted exercise period. For mild cases with little neurological signs, non-123
steroidal anti-inflammatories can be used (2). For moderate cases with more pronounced124
neurological signs, corticosteroids can be administered at anti-inflammatory doses (2). Epidural125
infiltration with a long lasting corticosteroid can also be undertaken for more moderate to126
marked severity cases. The results from one study demonstrated that 79% of the animals were127
considered to have improved, and 53% were totally cured. These results were comparable with128
percentage outcomes for surgical treatment (3). Acupuncture can be used as an adjunct therapy129
to help relieve pain along with the other medical management treatments previously discussed.130
Reduction of anxiety during the restricted activity period is a main benefit of acupuncture131
therapy. Surgical treatment is a consideration for animals that have a progressive decline in132
function or persistent pain in spite of medical therapy (2). Surgical techniques for DLSS include133
dorsal laminectomy, +/- discectomy, and +/- lumbosacral stabilization (2).134
135
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Resources137
1. Xie and Preast. Xie’s Veterinary Acupuncture. Blackwell Publishing Ltd. 2007138
2. Kent, Marc. Degenerative lumbosacral stenosis in dogs. DVM 360139
http://veterinarymedicine.dvm360.com/vetmed/article/articleDetail.jsp?id=16990140
2 July 1, 2005.141
3. Daems, Beosier and Janssens. Lumbosacral degenerative stenosis in the dog-the142
results of epidural infiltration with methylprednisolone acetate: a retrospective143
study. Vet Comp Orthop Traumatol 2009; 22:486-491.144
4. Lindley and Cummings. Essentials of Western Veterinary Acupuncture.145
Blackwell Publishing Ltd. 2006146
5. Fossum, Theresa. Small Animal Surgery. Mosby Year Book Inc. 1997147
6. Sharp and Wheeler. Small Animal Spinal Disorders Diagnosis and Surgery 2nd148
edition. Elsevier Limited 2005149
7. Slatter, Douglass. Textbook of Small Animal Surgery Volume 2. Saunders Co.150
1985151
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