{"id":1226,"date":"2018-08-06T16:11:39","date_gmt":"2018-08-06T14:11:39","guid":{"rendered":"https:\/\/fachtierarzt-koenig.de\/foramenstenose\/"},"modified":"2020-11-13T22:44:45","modified_gmt":"2020-11-13T21:44:45","slug":"foramenstenose","status":"publish","type":"page","link":"https:\/\/fachtierarzt-koenig.de\/en\/foramenstenose\/","title":{"rendered":"Foraminal Stenosis"},"content":{"rendered":"

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FORAMINAL STENOSIS (DLSS)<\/h1>\n

[\/et_pb_text][et_pb_divider color=”#ffffff” divider_weight=”2px” _builder_version=”3.22.4″ width=”50%” module_alignment=”center”][\/et_pb_divider][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=”1″ admin_label=”section” _builder_version=”3.22.3″][et_pb_row _builder_version=”3.25″ max_width=”800px” custom_padding=”||8px|||”][et_pb_column type=”4_4″ _builder_version=”3.25″ custom_padding=”|||” custom_padding__hover=”|||”][et_pb_text _builder_version=”3.27.4″]<\/p>\n

Unclassified longstanding Lameness of the Hindlegs with a History of frustrating Diagnostic Workup<\/h2>\n

Foraminal Stenosis is a complex syndrome, that is why some speak about Nerve Root Compression Syndrome. It is related to the hindlegs and causes back pain. Furthermore, these patients feel nerve root pain in relation to movement (often jumping), like a filamentary pain sensation from the thigh down to the paw. We know this pain pattern from humans who can also suffer from this disease.<\/strong><\/p>\n

The medical history includes mostly \u201elameness since month\u201c. The orthopedical workup is mostly completed but without diagnosis. Usually prescribed pain medication (NSAIDs) are no longer effective, Cortisone is helpful only for some weeks.\u00a0<\/p>\n

[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”3.25″ max_width=”800px” column_structure=”1_2,1_2″][et_pb_column type=”1_2″ _builder_version=”3.25″ custom_padding=”|||” custom_padding__hover=”|||”][et_pb_image src=”https:\/\/fachtierarzt-koenig.de\/wp-content\/uploads\/DLSS2.jpg” align_tablet=”center” align_last_edited=”on|desktop” _builder_version=”3.23″][\/et_pb_image][\/et_pb_column][et_pb_column type=”1_2″ _builder_version=”3.25″ custom_padding=”|||” custom_padding__hover=”|||”][et_pb_text _builder_version=”3.27.4″]<\/p>\n

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Anatomy<\/h3>\n

Each nerve root of the spinal cord runs through a corresponding neuroforamen (little bony recesses between the vertebral bodies), to form the peripheral nerves, which guarantee limb innervation.
On pressure and traction these nerve roots react with induction of pain sensation (Nerve root pain).<\/p>\n<\/div>\n<\/div>\n

[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”3.25″ max_width=”800px” custom_padding=”||3px|||” column_structure=”1_2,1_2″][et_pb_column type=”1_2″ _builder_version=”3.25″ custom_padding=”|||” custom_padding__hover=”|||”][et_pb_text _builder_version=”3.27.4″]<\/p>\n

Typical Appearance of the Disease<\/h3>\n

Dogs and cats with Foraminal Stenosis are neurological cases, but their lameness is often confused with an orthopedic problem (movement related pain without paralysis).
The patients often express a short yelp while jumping upwards. Limb lifting can be painful, because the ischiadic nerve can be stretched with this maneuver. Work exaggerates, rest relieves this pain sensation. Lumbosacral stretching can be painful and intensify the lameness.<\/p>\n

[\/et_pb_text][\/et_pb_column][et_pb_column type=”1_2″ _builder_version=”3.25″ custom_padding=”|||” custom_padding__hover=”|||”][et_pb_image src=”https:\/\/fachtierarzt-koenig.de\/wp-content\/uploads\/DLSS1.jpg” align=”center” align_tablet=”center” align_last_edited=”on|desktop” _builder_version=”3.23″ width=”100%” max_width=”100%” module_alignment=”left” min_height=”100px” height=”378px” max_height=”288px”][\/et_pb_image][et_pb_text _builder_version=”3.27.4″]<\/p>\n

Show video (mpg-Format, 1,8 MB)<\/a><\/p>\n

[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”3.25″ max_width=”800px” custom_margin=”|auto|7px|auto||” custom_padding=”2px||23px|||”][et_pb_column type=”4_4″ _builder_version=”3.25″ custom_padding=”|||” custom_padding__hover=”|||”][et_pb_text _builder_version=”3.27.4″]<\/p>\n

The stance of the affected leg is less firm, advanced cases show less muscle tone in the limb or even signs of muscle loss (you can feel like \u201eempty trousers\u201c). Both-sided stenoses often shift weight from one side to another. 20% of the patients have additionally orthopedic hip- and kneeproblems.
Urinary and fecal incontinence are known comorbidities of foraminal stenosis, which can disappear after effective treatment.
A predisposition for foraminal stenosis can be seen in 2-11 year old hunting dogs or German Shepherds, Labrador Retrievers, Boxers, Great Danes, Hovawarths, Briards and Border Collies.<\/p>\n

Diagnostics of Foraminal Stenosis<\/h3>\n

X-ray signs are very discrete and the nerve does not show up in plain radiographs. That is why this syndrome is often undiagnosed for quite a while.
Because the nerve root is rarely completely compressed, so that its motoric function is still preserved, we won\u00b4t see typical paralysis, which we would expect in neurological disease.
Effective diagnostic workup has to include a thorough clinical and neurological examination, Radiography, Elektrodiagnostics and MRI \u2013 this generates also critical data for surgery. Existing comorbidities have to be assessed before treatment of Foraminal Stenosis!<\/p>\n

Spontaneous improvement is not to be expected in Foraminal Stenosis!
Without neurosurgery disease progression is predictable!<\/p>\n

 <\/p>\n

Surgery (Foraminotomy)<\/h3>\n

During Foraminotomy the affected Neuroforamen is dilated by surgical preparation in a matter that the nerve root postoperatively runs free from pressure or adhesions along the widened nerve root canal.<\/p>\n

Postsurgical care is important and includes physiotherapy. During 3-6 months compressive nerve damage is repaired by regeneration. Permanent pain relief and full functional recovery is reached in 80% of the cases.<\/p>\n

\n

Physiotherapy is important postoperative supportive Care<\/h3>\n

Efficient physiotherapy accelerates and improves regenerative processes in peripheral nerves. It helps to treat spastic and painful muscles and to attenuate postoperative or posture deficit related disorders of the affected limb, which in part might have been apparent presurgically due to the neurocompressive syndrome.<\/p>\n

The Physiotherapy Programme includes:<\/strong>
Weeks 1-2: passive training
Weeks 3-6: muscle training, leish walks only
Weeks 7-12: trot walks, water treadmill, terrain walks
Months 4-5: condition exercises
Working dogs are allowed the hurdle jump only after 6 months. Beforehand professional warming up is essential.<\/p>\n

[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"

FORAMINAL STENOSIS (DLSS)Unclassified longstanding Lameness of the Hindlegs with a History of frustrating Diagnostic Workup Foraminal Stenosis is a complex syndrome, that is why some speak about Nerve Root Compression Syndrome. It is related to the hindlegs and causes back pain. Furthermore, these patients feel nerve root pain in relation to movement (often jumping), like […]<\/p>\n","protected":false},"author":5,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"[:de]

Ungekl\u00e4rte Lahmheit der Hintergliedma\u00dfen bei Tieren<\/h2>\r\nDer Krankheitskomplex Foramenstenose, einige sprechen auch von Nervenwurzelkompressionssyndrom, betrifft die Hintergliedma\u00dfen des Tiers und l\u00f6st R\u00fcckenschmerzen sowie bewegungsabh\u00e4ngige Nervenwurzelschmerzen aus, die strangf\u00f6rmig durch den Oberschenkel \u00fcber die Wade bis hinunter in die Pfote ziehen. Beschreibungen dieses Schmerzmusters sind nicht nur bei Tieren, sondern auch vom Menschen bekannt, er kann ebenfalls an Foramenstenose leiden.<\/strong>\r\n\r\nUnsere Tier-Patienten kommen meist mit diesem Vorbericht in unsere Tierarzt-Praxis: \u201cHund (od. Katze) lahmt seit Monaten\u201c. Die orthop\u00e4dischen Voruntersuchungen sind in der Regel umfassend und gut, jedoch ohne Diagnose. Die g\u00e4ngigen Schmerzmittel (NSAID) sind meist unwirksam, Kortison hilft nur vor\u00fcbergehend (2-3 Wochen).\u00a0<\/strong>\r\n
\r\n
\r\n\r\n\"\"\r\n\r\n<\/div>\r\n
\r\n

Anatomie<\/h3>\r\nBei Menschen wie bei Tieren verlassen die Nervenwurzeln des R\u00fcckenmarks durch Neuroforamen (kleine Aussparungen zwischen Wirbelk\u00f6rpern) die Wirbels\u00e4ule, um sich au\u00dferhalb der sch\u00fctzenden Wirbels\u00e4ule zu Nerven zusammenzufinden, die dann in der Peripherie gelegene K\u00f6rperregionen versorgen.\r\nAuf Druck oder Zug reagieren diese Nervenwurzeln sehr schmerzempfindlich (Nervenwurzelschmerz).\r\n\r\n<\/div>\r\n<\/div>\r\n \r\n
\r\n
\r\n\r\n\"\"\r\n\r\nFilm anzeigen \/ herunterladen (mpg-Format, 1,8 MB)<\/a>\r\n\r\n \r\n\r\n<\/div>\r\n
\r\n

Erscheinungsbild der Krankheit<\/h3>\r\nTiere mit Foramenstenose sind neurologische Patienten, ihr Nervenwurzelschmerz stellt sich jedoch so dar, als habe der Hund oder die Katze ein orthop\u00e4disches Problem (Bewegungsschmerz ohne L\u00e4hmung).\r\nOft lassen die Tiere ein kurzes Aufjaulen oder eine Schmerz\u00e4u\u00dferung im Sprung nach oben h\u00f6ren, auch kann ein Anheben der Gliedma\u00dfe schmerzhaft sein, da der Ischiasnerv dabei gestreckt wird. Arbeit verschlimmert, Ruhe verbessert den Schmerz. Eine Streckung im \u00dcbergang der Lendenwirbels\u00e4ule zum Kreuzbein (wie dies bei einem Sprung nach oben geschieht) verst\u00e4rkt Schmerzen und\/oder die Lahmheit.\r\n\r\n<\/div>\r\n<\/div>\r\nDie Tiere stehen nicht so fest auf dem krankem Bein, fortgeschrittene F\u00e4lle zeigen eine verminderte Muskelspannung und sogar Muskelschwund (beim Abtasten Gef\u00fchl der \u201eleeren Hose\u201c). Patienten mit beidseitiger Foramenstenose stellen sich st\u00e4ndig von einem Bein aufs andere. 20% der Patienten haben unabh\u00e4ngig von der Foramenstenose zus\u00e4tzlich H\u00fcft- und Knieprobleme.\r\nInkontinenz und Harnabsatzst\u00f6rungen k\u00f6nnen in Verbindung mit der Foramenstenose auftreten und auch nach Behandlung derselben wieder verschwinden.\r\nIn underer Tierarzt-Praxis beobachten wir eine H\u00e4ufung bei 2-11-j\u00e4hrigen Jagdhunden bzw. Hunden der Rassen Deutscher Sch\u00e4ferhund, Labrador Retriever, Boxer, Dogge, Hovawarth, Briard, Border Collie.\r\n

Diagnostik der Foramenstenose<\/h3>\r\nDa sich ein Neuroforamen im R\u00f6ntgenbild unzureichend, der Nerv gar nicht darstellt, entgehen diese Patienten lange ihrer Diagnose.\r\nDie Nervenwurzel wird selten so stark eingeengt, dass ihre motorischen Funktionen betroffen sind. Daher sieht man selten L\u00e4hmungserscheinungen an der betroffenen Gliedma\u00dfe.\r\nF\u00fcr saubere Diagnose untersuchen wir das Tier sehr sorgf\u00e4ltig klinisch und neurologisch. Dabei wenden wir R\u00f6ntgen- und Elektrodiagnostik sowie Kernspintomographie an. Dies ist auch im Hinblick auf eine exakte Operationsplanung von herausragender Bedeutung. Begleitende Erkrankungen des Tieres m\u00fcssen zuvor erkannt werden!\r\n\r\nEs kommt nicht zu einer Spontanheilung der Foramenstenose!\u00a0Ohne Operation schreitet der Prozess sicher weiter voran!\r\n

Operation (Foraminotomie)<\/h3>\r\nIn der tier\u00e4rztlichen Operation wird das Neuroforamen so geweitet, dass die Nervenwurzel wieder druck- und verklebungsfrei durch die Wirbels\u00e4ule verlaufen kann. Anschlie\u00dfend ben\u00f6tigen die Tiere Physiotherapie und innerhalb von 3-6 Monaten wird bei ca. 80% der Patienten eine Beschwerdefreiheit erreicht (Bereiche, in denen die Nervenwurzel druckbedingt ihre Nervenscheide verloren hat, werden langsam wieder in funktionelle Strukturen regeneriert).\r\n

Physiotherapie bei Tieren nach Foraminotomie<\/h3>\r\nEinen beachtlichen Teil des Behandlungsergebnisses verdanken wir einer effizienten Physiotherapie. Der Tier-Physiotherapeut behandelt verspannte, schmerzhafte Muskeln, die operationsbedingt entstehen oder durch Fehlhaltung (Gewichtsverlagerung weg vom Schmerz nach vorn) krankheitsbedingt schon vor dem Eingriff vorhanden waren.\r\n\r\nDiese Programme beinhalten:<\/strong>\r\n1.-2. Woche passives Training\r\n3.-6. Woche Muskeltraining, Leinenzwang\r\n6.-12.Woche Traben, Wassertraining, Terraintraining\r\n4.-5. Monat Konditionstraining\r\nArbeitshunde bekommen den H\u00fcrdensprung erst nach (4)-6 Monaten nach gutem Aufw\u00e4rmen erlaubt.[:en]

Foraminal Stenosis (DLSS)<\/h1>\r\n

Unclassified longstanding Lameness of the Hindlegs with a History of frustrating Diagnostic Workup<\/h2>\r\nForaminal Stenosis is a complex syndrome, that is why some speak about Nerve Root Compression Syndrome. It is related to the hindlegs and causes back pain. Furthermore, these patients feel nerve root pain in relation to movement (often jumping), like a filamentary pain sensation from the thigh down to the paw. We know this pain pattern from humans who can also suffer from this disease.<\/strong>\r\n\r\nThe medical history includes mostly \u201elameness since month\u201c. The orthopedical workup is mostly completed but without diagnosis. Usually prescribed pain medication (NSAIDs) are no longer effective, Cortisone is helpful only for some weeks.\u00a0<\/strong>\r\n
\r\n
\r\n\r\n\"\"\r\n\r\n<\/div>\r\n
\r\n

Anatomy<\/h3>\r\n

Each nerve root of the spinal cord runs through a corresponding neuroforamen (little bony recesses between the vertebral bodies), to form the peripheral nerves, which guarantee limb innervation.\r\nOn pressure and traction these nerve roots react with induction of pain sensation (Nerve root pain).<\/p>\r\n\r\n<\/div>\r\n<\/div>\r\n \r\n

\r\n
\r\n\r\n\"\"\r\n\r\nShow Video\/ Download (mpg-Format, 1,8 MB)<\/a>\r\n\r\n \r\n\r\n<\/div>\r\n
\r\n

Typical Appearance of the Disease<\/h3>\r\n

Dogs and cats with Foraminal Stenosis are neurological cases, but their lameness is often confused with an orthopedic problem (movement related pain without paralysis).\r\nThe patients often express a short yelp while jumping upwards. Limb lifting can be painful, because the ischiadic nerve can be stretched with this maneuver. Work exaggerates, rest relieves this pain sensation. Lumbosacral stretching can be painful and intensify the lameness.<\/p>\r\n

<\/p>\r\n\r\n<\/div>\r\n<\/div>\r\nThe stance of the affected leg is less firm, advanced cases show less muscle tone in the limb or even signs of muscle loss (you can feel like \u201eempty trousers\u201c). Both-sided stenoses often shift weight from one side to another. 20% of the patients have additionally orthopedic hip- and kneeproblems.\r\nUrinary and fecal incontinence are known comorbidities of foraminal stenosis, which can disappear after effective treatment.\r\nA predisposition for foraminal stenosis can be seen in 2-11 year old hunting dogs or German Shepherds, Labrador Retrievers, Boxers, Great Danes, Hovawarths, Briards and Border Collies.\r\n

Diagnostics of Foraminal Stenosis<\/h3>\r\n

X-ray signs are very discrete and the nerve does not show up in plain radiographs. That is why this syndrome is often undiagnosed for quite a while.\r\nBecause the nerve root is rarely completely compressed, so that its motoric function is still preserved, we won\u00b4t see typical paralysis, which we would expect in neurological disease.\r\nEffective diagnostic workup has to include a thorough clinical and neurological examination, Radiography, Elektrodiagnostics and MRI \u2013 this generates also critical data for surgery. Existing comorbidities have to be assessed before treatment of Foraminal Stenosis!<\/p>\r\n

Spontaneous improvement is not to be expected in Foraminal Stenosis!\r\nWithout neurosurgery disease progression is predictable!<\/p>\r\n \r\n

Surgery (Foraminotomy)<\/h3>\r\n

During Foraminotomy the affected Neuroforamen is dilated by surgical preparation in a matter that the nerve root postoperatively runs free from pressure or adhesions along the widened nerve root canal.<\/p>\r\n

Postsurgical care is important and includes physiotherapy. During 3-6 months compressive nerve damage is repaired by regeneration. Permanent pain relief and full functional recovery is reached in 80% of the cases.<\/p>\r\n\r\n

Physiotherapy is important postoperative supportive Care<\/h3>\r\n

Efficient physiotherapy accelerates and improves regenerative processes in peripheral nerves. It helps to treat spastic and painful muscles and to attenuate postoperative or posture deficit related disorders of the affected limb, which in part might have been apparent presurgically due to the neurocompressive syndrome.<\/p>\r\nThe Physiotherapy Programme includes:<\/strong>\r\nWeeks 1-2: passive training\r\nWeeks 3-6: muscle training, leish walks only\r\nWeeks 7-12: trot walks, water treadmill, terrain walks\r\nMonths 4-5: condition exercises\r\nWorking dogs are allowed the hurdle jump only after 6 months. Beforehand professional warming up is essential.[:]","_et_gb_content_width":"","footnotes":""},"class_list":["post-1226","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/fachtierarzt-koenig.de\/en\/wp-json\/wp\/v2\/pages\/1226","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/fachtierarzt-koenig.de\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/fachtierarzt-koenig.de\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/fachtierarzt-koenig.de\/en\/wp-json\/wp\/v2\/users\/5"}],"replies":[{"embeddable":true,"href":"https:\/\/fachtierarzt-koenig.de\/en\/wp-json\/wp\/v2\/comments?post=1226"}],"version-history":[{"count":10,"href":"https:\/\/fachtierarzt-koenig.de\/en\/wp-json\/wp\/v2\/pages\/1226\/revisions"}],"predecessor-version":[{"id":1629,"href":"https:\/\/fachtierarzt-koenig.de\/en\/wp-json\/wp\/v2\/pages\/1226\/revisions\/1629"}],"wp:attachment":[{"href":"https:\/\/fachtierarzt-koenig.de\/en\/wp-json\/wp\/v2\/media?parent=1226"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}