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Tail, anal and bladder dysfunction

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Abstract

Lesions that cause tail, anal and bladder dysfunction can involve the S1 to caudal (also known as coccygeal) spinal cord segments and nerve roots; together with the L7 nerve roots these structures form the cauda equina. This chapter looks at clinical signs, lesion localization, pathophysiology, neurodiagnostic investigation, disorders of the tail, anus and bladder, normal and abnormal micturition

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Figures

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19.1 Pelvic limb of a 3-year-old Labrador Retriever showing decreased withdrawal reflexes and muscle tone.
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19.2 A dog showing signs of tail dysfunction and loss of ‘wag’.
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19.3 Palpation of the lumbosacral region in a 10-year-old neutered German Shorthaired Pointer bitch to elicit paraspinal hyperaesthesia.
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19.4 Lesion localization for disorders of the tail, anus and bladder; the sacral spinal cord segments and associated nerves (S1–S3) are highlighted. Dorsal (left) and lateral (right) overviews of the caudal lumbar and lumbosacral vertebrae and associated nerve tissue. Illustration created by Allison L. Wright, MS, CMI, Athens, Georgia, USA.
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19.6 Sagittal section of the L7 vertebra, the intervertebral disc space and the sacrum demonstrating disc protrusion and nerve root compression. Illustration created by Allison L. Wright, MS, CMI, Athens, Georgia, USA.
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19.7 A 6-year-old Rottweiler with degenerative lumbosacral stenosis. Note that the pelvic limbs are tucked under the caudal abdomen in order to flex the spine and lessen the nerve root compression.
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19.8 Neutral and extended lateral radiographs of a 7-year-old German Shepherd Dog with degenerative lumbosacral stenosis. Note the ventral spondylosis, proliferation of the articular processes and tunnelling of the dorsal lamina, which is accentuated on extension of the pelvis.
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19.9 Abnormal epidurogram showing >50% compression of the epidural space.
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19.10 CT images of degenerative lumbosacral stenosis. Transverse view of proliferative bony changes (arrowed). Sagittal view showing dramatic disc protrusion (arrowed). Serial transverse views demonstrating canal and foraminal stenosis (arrowed).
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19.11 Sagittal T2-weighted neutral and flexed MR images of a 7-year-old German Shepherd Dog with lumbosacral pain and dysuria. There is marked ventral compression of the nerve roots due to disc protrusion at L6–L7 and L7–S1 with loss of epidural fat and attenuation of the thecal sac. In addition, there is dorsal compression due to ligamentous hypertrophy at L6–L7 and L7–S1. On the flexion view, note the improvement in impingement by the ligamentous structures. This provides evidence of dynamic compression at the lumbosacral joint. The dog underwent surgery for dorsal decompression of L6–L7 and L7–S1 as well as stabilization of the lumbosacral joint.
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19.12 Postoperative lateral and ventrodorsal radiographs of a 7-year-old German Shepherd Dog with degenerative lumbosacral stenosis following dorsal decompression and articular process stabilization and fusion using an autogenous bone graft.
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19.13 Ventrodorsal radiograph of a 5-year-old German Shepherd Dog with lumbosacral pain and evidence of sacralization of L7. Note the absence of the left transverse process of L7.
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19.14 A young male Bulldog with spina bifida affecting the 12th thoracic vertebra. Note the butterfly vertebra at L4 (arrowed).
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19.15 Ventrodorsal radiograph of a 12-week-old Pug with paraparesis, flaccid anus with anaesthesia of the perineal region, and urinary and faecal incontinence. The dorsal spinous process of L7 is missing and the sacrum is hypoplastic.
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19.16 A 12-week-old Manx kitten with a meningocele on the tail. The meningocele was covered with a thin layer of epithelium and intermittently leaked CSF. The cat was normal on neurological examination. Intraoperative photograph showing the fistulous tract that extended into the thecal sac. The sacral and coccygeal nerves were unaffected.
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19.17 Infection of the L7 and sacral endplates (discospondylitis) and the associated vertebral bodies.
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19.18 Ophthalmic examination of a Domestic Shorthaired cat with feline dysautonomia. Note the dried nasal mucosa, the prolapsed nictitating membrane and the dilated pupil of the left eye. The pupil of the right eye is miotic following treatment with 0.1% pilocarpine.
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19.19 A young male mixed-breed dog with canine dysautonomia demonstrating a dilated anus. (Courtesy Dr D O’Brien)
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19.20 Ciliary ganglion from a dog with dysautonomia. Note the neuronal death. (H&E stain; original magnification X560) (Courtesy of Dr G Johnson)
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19.21 Lateral radiograph of a Golden Retriever that was hit by a trolley and presented with a decreased perineal reflex and tail tone. Note the L7 fracture with ventral displacement of the caudal fragment.
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19.22 Lateral and ventrodorsal radiographs of a mixed-breed dog with multiple fractures of the right pelvis and sacrum, luxation of the right sacroiliac joint, a compression fracture of the L3 vertebral body and fractures of the L3, L4 and L5 spinal processes. The dog was able to support weight on the left pelvic limb. The spine maintained alignment during flexion and extension on fluoroscopic evaluation. The sacral and pelvic fractures were repaired whilst the spinal fracture was managed medically.
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19.23 Radiographic confirmation of a complete caudal vertebral luxation in a cat with avulsion of the tail.
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19.24 Anatomy of the bladder and urethra. Illustration created by Allison L. Wright, MS, CMI, Athens, Georgia, USA.
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19.25 Overview of the neuroanatomy of the storage phase of micturition. Illustration created by Allison L. Wright, MS, CMI, Athens, Georgia, USA.
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19.26 Overview of the neuroanatomy of the voiding phase of micturition. Illustration created by Allison L. Wright, MS, CMI, Athens, Georgia, USA.
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19.29 Lateral abdominal radiograph of a well house-trained dog with osteoarthritis that was unable to ambulate outside. Note the over-distension of the bladder, which was presumed to be the result of detrusor muscle atony. The urinary bladder was catheterized and emptied for several days before the detrusor muscle regained function.

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Degenerative lumbosacral stenosis

An 8-year-old male German Shepherd Dog presented with a 2-month history of difficulty rising and lower back pain. The neurological examination determined that the spinal reflexes were intact. MRI revealed disc protrusion at L2, and ventral and dorsal compression of the cauda equina by proliferative tissue. Neutral and flexion radiographic views demonstrated a dynamic lesion, with improvement of the compression upon flexion. Treatment included a dorsal laminectomy and fusion of the L7 and S1 articular processes with screws and bone autografts. The dog recovered well and resumed a normal lifestyle. (See page 370 in the Manual)

Feline dysautonomia

A 2-year-old Domestic Shorthaired cat presented with acute progressive signs of dry mucous membranes, pupillary dilatation, anorexia and vomiting. The neurological examination demonstrated the maintenance of skeletal muscle strength. In this clip, 0.1% pilocarpine had been administered to the right eye to confirm the diagnosis of feline dysautonomia. The cat was subsequently euthanized. (See page 377 in the Manual)

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