Introduction
Signs of back or neck pain in companion animals should be taken seriously and merit immediate veterinary attention. Early diagnosis and treatment can prevent permanent pain and paralysis in many cases. Veterinarians have a number of tools to help them diagnose intervertebral disk disease (IVDD) and localize the lesion to particular areas along the dog’s spinal cord. Once the affected disk has been located, the veterinarians can assess their options and come up with an effective treatment plan. The goals of treating IVDD are to reduce or eliminate pressure on the spinal cord, and to alleviate the inflammation caused by that compression, in order to restore the dog to normal pain-free neurological function if at all possible.
Treatment Options
Treatment options range from rest and conservative medical management to surgical intervention. The exact therapeutic protocol will vary depending upon the severity of the disease. In acute cases, pain management and control of inflammation are the first priorities. Corticosteroids or nonsteroidal anti-inflammatory medications (but not both at the same time), muscle relaxants, narcotics or other drugs to alleviate inflammation and pain may be recommended by the attending veterinarian, together with strict cage rest. When given together, glucocorticoids and nonsteroidal anti-inflammatory medications can cause severe gastrointestinal irritation and discomfort, possibly to the point of intestinal rupture. Authorities strongly suggest that these drugs not be administered to the same animal at the same time.
If medical management does not control the dog’s pain and other symptoms, or if the results of imaging suggest that surgery is necessary or appropriate, there are several available techniques that the surgeon may consider. These include a procedure called a dorsolateral hemilaminectomy, and another called a cervical ventral cervical slot. These can be done with or without fenestration (surgical perforation) of adjacent disks. Basically, surgery is designed to decompress the spinal cord at the site of the injury and herniation or protrusion of disk material. Another theoretical option is called chemonucleolysis. This involves using laser ablation or injecting enzymes directly into the affected disks. While this procedure has been described in the literature, it is considered controversial.
Whether or not surgery is undertaken, once a dog is stabilized to the point that its pain and neurological signs are well controlled, there are a number of additional management options to consider. Strictly enforced cage confinement for 3-6 weeks is absolutely essential to a dog’s successful recovery. Dogs receiving anti-inflammatory or pain medications may act as if their pain has subsided, when in fact the medication is only masking their symptoms. When this happens, many well-meaning owners see what they think is a marked improvement in their dog’s physical condition, and they become less conscientious about enforcing strict cage rest. Owners need to be consistent in confining their dogs for the full period recommended by their veterinarian. All dogs recovering from IVDD should be on well-padded beds, and recumbent dogs should be turned regularly (every few hours) to prevent development of pressure sores (decubital ulcers).
Prescription pain and anti-inflammatory medications typically will be reduced gradually over time. If the affected dog is overweight, it probably will be put on a weight-loss program under the supervision of its veterinarian, to reduce unnecessary future stress on the its spine. Owners should monitor their dog’s ability to urinate and defecate normally; manual expression of the bladder and/or manual evacuation of the bowel may be necessary during the recovery period. Affected dogs should get minimal exercise while recovering - walking on-leash only, using a harness instead of a neck collar depending upon the veterinarian’s recommendation - and should not be permitted to run or jump freely, as such activities can exacerbate spinal damage. Physical therapy (including swimming and other water exercises and passive range of motion exercises) is commonly used as well.
Other techniques that may be appropriate in addition to medical treatment might include massage therapy to stimulate blood flow to the affected area, and reduce overall pain and stress, possible application of acupuncture or acupressure techniques to alleviate pain, use of herbal or other non-regulated supplements or “remedies” and other forms of follow-up supportive care which may help to increase circulation, ease pain, speed healing and otherwise promote wellness, calmness and comfort. Some of these non-traditional adjunct approaches lack controlled studies of their effectiveness and may not have established quality control methods or ways to assess their benefit to dogs with Intervertebral disk disease. Chiropractic manipulation and “adjustment” of dogs with IVDD are highly controversial among veterinary professionals.
Prognosis
The prognosis for dogs with IVDD is generally quite good. Many dogs with intervertebral disk disease are managed well without surgery, especially if their disease is caught and treated early and if owners are consistent and conscientious about strict cage confinement during the entire recovery period. However, the symptoms of IVVD in dogs treated conservatively have a recurrence rate that approaches 50%, especially if they are allowed to jump freely without supervision and if they are obese. Regular physical therapy seems to reduce this recurrence rate. Dogs that have had surgical decompression have a good chance of full functional recovery within 3 to 6 weeks post-operatively. Dogs that have lost deep pain sensation and are unable to move their legs for several days or weeks before surgery have a much more guarded prognosis.