Effective drugs include diazepam, gabapentin, and nonsteroidal anti-inflammatory drugs (NSAIDs) or, alternatively, prednisone as short-course therapy.Īccording to Carnes, a 2007 study of medical management for thoracolumbar/cervical herniations in 200 ambulatory dogs, approximately 54/49% recovered with no recurrence, 30/33% recovered withrecurrence and 14/18% did not recover. This hinges on at least 2 weeks of strict cage rest, followed by a month or so of restricted activity. Most IVDD cases can be medically managed. Besides the absence of deep pain, the chief indications for surgery are nonambulatory paraplegia or paresis, recurring paresis, unrelenting spinal pain, or medical treatment failure.
To relieve compression and prevent spinal cord necrosis-which, in 10% of patients lacking deep pain, can culminate in the irreversible liquefactive condition known as myelomalacia-surgery may be necessary. “You’re getting secondary injury the longer that compression is there.” The absence of deep pain (assessed by compressing the digits) is the primary negative prognostic factor and signals the need to act fast. The clinical signs-which vary with the spinal level of the lesion-are back pain, proprioceptive deficits, and paresis/paralysis. secondary to sudden tear in the annulus fibrosus resulting from spinal trauma.Hansen Type III – acute, high-velocity, noncompressive extrusion of the nucleus pulposus.Hansen Type II – chronic bulging of the annulus fibrosus.Hansen Type I – acute extrusion of the nucleus pulposus from the annulus fibrosus.Chondrodystrophic breeds are predisposed, often presenting between 3 and 6 years of age. IVDD is the most common cause of myelopathy and back pain in dogs. A nonpainful dog, on the other hand, could be experiencing chronic IVDD, intradural neoplasia, fibrocartilaginous embolism (FCE), or degenerative myelopathy. For example, if pain is present, think spinal fracture, extradural neoplasia, or acute intervertebral disc disease (IVDD). The presence of spinal pain leads down a different path than its absence. If withdrawal reflexes are decreased or absent in all 4 limbs, the problem is neuromuscular, Carnes explained: “Make sure it’s spinal, because neuromuscular takes us on a very different pathway from a spinal cord problem.” For T3-元 and lower lumbar lesions, the thoracic limbs are unaffected but the hind limbs have abnormal withdrawal reflexes. However, if the withdrawal reflex is decreased/absent in the front limbs but normal in the hind limbs, the lesion is likely low cervical. The lesion is likely high cervical if the motor and/or proprioception are abnormal and withdrawal reflex is normal in all 4 limbs. This neurologic examination also assesses motor function, proprioception, spinal reflexes, and deep pain perception. The next step is localizing the lesion into one of the 3 main anatomic districts: cervical T3-元 and L4>caudad. “When something can’t walk, we need to first ask whether it is truly neurological and then, number two, if it is like this because of a problem in the brain or in the spine or if it is neuromuscular,” explained Michelle Carnes, DVM, MS, DACVIM, medical director at Specialists in Companion Animal Neurology in Naples, Florida. When managing “spinal” disease, the first step is ruling out an imposter such as a cruciate tear, immune-mediated polyarthritis (IMPA), and metabolic and vascular issues that produce weakness (ie, internal bleeding).
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