Can Cats Get Lumbosacral Disease Too?

Lumbosacral disease is something I talk about often in dogs. It can cause lower back pain, trouble using the back legs, difficulty jumping, and sometimes changes in tail or bathroom function.

But what about cats?

This has actually been on my mind a lot lately because I have been seeing quite a few cats with lumbosacral problems in my own practice. In several of these cats, we have been able to confirm the problem with advanced imaging, either a CT scan or MRI, and then successfully treat them.

An older case report provides an interesting reminder that this problem in cats is not entirely new.

An 8-Year-Old Cat With Back and Leg Problems

In 2008, Cariou and colleagues reported a case of cauda equina syndrome caused by lumbosacral disease in an 8-year-old Burmese cat. At the time, the authors believed this was the first reported case of lumbosacral instability in a domestic cat.

The cat originally developed lameness in the right back leg. Rest helped temporarily, but the problem returned when the cat became active again. Over time, things got worse.

The cat developed trouble coordinating the back legs, a swaying gait, less tail movement and strength, lower back discomfort, decreased activity, and a reluctance to jump.

These are important signs because cats are very good at hiding pain. A cat may not cry or act obviously painful. Instead, the first clue may simply be that the cat stops jumping onto the bed or counter, becomes less active, or starts walking differently.

What Is Happening in the Lower Back?

The lumbosacral area is where the lower spine meets the pelvis. Important nerves travel through this area on their way to the back legs, tail, bladder, and bowel.

When these nerves become irritated or compressed, cats can develop cauda equina syndrome. Signs can include lower back pain, back-leg weakness or lameness, abnormal sensations, and, in more severe cases, problems controlling urine or stool.

In the cat described in the paper, radiographs showed severe changes at the L7–S1 joint. The disc space had collapsed, there was substantial new bone formation, and the position of the vertebrae suggested instability.

Today, we also have advanced imaging such as CT and MRI. These tests can give us a much better look at the lumbosacral area and help determine whether the lower spine and nerves may be responsible for a cat’s clinical signs.

How Was the Cat in the Study Treated?

The cat had severe instability and progressive neurological signs, so surgery was performed.

The surgeons decompressed the nerves and stabilized the L7–ºS1 area using screws and bone cement. The outcome was excellent. At six weeks, the cat had regained normal use of the affected leg and tail. By 18 months, the owners reported that the cat was completely back to normal.

The authors concluded that lumbosacral disease represents a true disease process in cats, even though it has traditionally been much better recognized in dogs.

Do All Cats With This Problem Need Surgery?

No.

This is where my recent clinical experience has been particularly interesting. I have seen a number of cats lately where the history and examination made me suspicious that their pain or mobility problems were coming from the lumbosacral area. We have then been able to confirm the problem with CT or MRI.

For appropriate cases, my preferred treatment regimen is a series of three epidural steroid injections given over six weeks. Each injection is performed under anesthesia.

The goal is to place an anti-inflammatory steroid medication around the irritated nerves in the lower spine. This is very similar to the treatment approach I prefer for many dogs with lumbosacral disease.

I have been very pleased with how some of these feline patients have responded.

It is important to point out that this protocol was not evaluated in the 2008 paper. The cat in that report underwent surgery. The three-injection epidural steroid protocol described here reflects my current clinical approach for appropriately selected feline patients.

What About Solensia?

There is another important point when treating these cats.

Lumbosacral disease with nerve involvement is a neurological condition. It is not simply osteoarthritis of a joint.

Because of that, this is not a condition I would treat with frunevetmab (Solensia). Solensia is approved for the control of pain associated with osteoarthritis in cats. It is not a treatment for compression or inflammation of the nerves in the lumbosacral spine.

That distinction is one reason getting the correct diagnosis matters. A cat that stops jumping or becomes reluctant to move may appear to have “arthritis,” but the source of the problem may actually be the lower spine and nerves.

Could Your Cat’s “Arthritis” Actually Be Coming From the Back?

A cat having trouble with its back legs or jumping does not automatically have hip, knee, or other limb arthritis.

Sometimes the problem may be coming from the lower spine and nerves.

If a cat stops jumping, hesitates before going upstairs, develops an unusual back-leg gait, becomes sensitive around the lower back, carries the tail differently, or simply seems less willing to move, I think the lumbosacral area deserves consideration.

We still have much less research on feline lumbosacral disease than we do in dogs. This paper is nearly 20 years old, yet it remains a useful reminder that cats can develop clinically important lumbosacral disease too.

Based on what I have been seeing lately, I suspect we may recognize this condition more often during a detailed musculoskeletal and neurological examination, followed by a CT scan or MRI to investigate the right feline patients.

Reference:
Cariou MP, Störk CK, Petite AF, Rayward RM. Cauda equina syndrome treated by lumbosacral stabilisation in a cat. Vet Comp Orthop Traumatol. 2008;21:462-466. doi:10.3415/VCOT-07-08-0083.