When your pet first exhibits the symptoms associated with cauda equina syndrome, treatment should be started before irreversible damage to the cauda equina nerves has occurred. The decision for medical treatment or surgery will depend on the severity of the symptoms your pet experiences and his or her age.
Medical treatment includes exercise restriction for a period of four to six weeks. Anti-inflammatory medications, such as Rimadyl are commonly administered along with drugs that are specific for controlling pain such as tramadol, gabapentin or Lyrica. Never give your pet human ibuprofen or Aleve, as it is toxic to pets and can damage their organic systems.
Cortisone is commonly prescribed if your pet comes to the vet with severe neurological signs for a period of two to four weeks. Medical therapy results may only be seen in patients that have minimal neurological deficits. In general, about half of dogs may respond to medical treatment.
Surgery is commonly recommended in dogs that do not respond to medical treatment, have progressive clinical signs, or fecal/urinary incontinence. Surgery involves making an opening in the top of the spine over the area of nerve compression, called a laminectomy. The bulging disc and thickened ligaments are also removed. If the spine is unstable, a fusion surgery is performed to stabilize the spine.
After surgery, your dog will likely have a urinary catheter in place and will receive narcotics to control pain. Your pet may be hospitalized for a week or more depending on the severity of the problem. If permanent, irreversible damage has not already occurred, patients may begin to show improvement within a few days to a few weeks after surgery. If fecal or urinary incontinence has been present for >4 weeks then this does not typically improve even with surgery.
Strict crate or pen confinement and leash controlled walks to urinate and defecate are required for eight weeks. Physical therapy consisting of slings, standing exercises and swimming may be recommended, as they are important for recovery of strength and coordination. Patients may continue to show improvement for up to six months after treatment, so do not give up hope that the surgery was successful if your dog does not show immediate improvement.
The goal of surgery is to remove pressure on the compressed nerves in hopes of regaining function and reducing pain to the affects area. Talk to your vet about your pet’s treatment options, which will depend on your pet’s disease progression, the underlying cause of the cauda equina syndrome, and what will give your pet the best quality of life.