Surgery STAT: Managing IVDD
Second of two-part series
May 01, 2009
Early or mild cord compression may result in pain without neurologic impairment. Progressive cord compression and injury, however, result in a predictable course of neurologic deterioration. Proprioceptive fibers are first to be affected, resulting in conscious proprioceptive deficits and ataxia. Partial loss of motor function (paresis) follows, resulting in impaired ambulation and eventual loss of motor function (plegia). Sensory-motor plegia (loss of deep pain sensation) indicates severe, deep injury to the spinal cord. If the injury is severe enough to cause cord necrosis, ascending or descending myelomalecia may result.Medical management traditionally has been the initial treatment for any dog with IVDD. Pain management is essential and may be accomplished with opioids, anti-inflammatories and gabapentin.
Steroids for IVDD remain controversial, with recent studies suggesting a negative correlation to their use. Keeping a paraplegic IVVD dog on high-dose steroids is not recommended.
Strict rest is essential. Dogs recovering from IVDD should receive a minimum of three weeks' cage confinement.
Physical rehabilitation and acupuncture also are beneficial in dogs recovering from IVDD. Candidates for medical management include dogs that are ambulatory with early signs of pain and mild neurologic impairment; however, recent reports show the incidence of recurrence after medical management of disk herniation may be as high as 50 percent. For this reason and because of the risk of worsening neurologic status over time, many now recommend earlier surgical intervention.
Surgical management of dogs with IVDD often is required to alleviate cord compression and resolve clinical signs.
Dogs with persistent pain and/or neurologic deficits are candidates for surgery. Those with cervical pain and neurologic deficits likely have severe disk compression, luxation or fracture; advanced imaging and surgery should be recommended (Figure 1).
IVDD is a common problem, particularly affecting chondrodystrophic breeds. Proper diagnosis and localization as well as appropriate and timely intervention can result in satisfactory outcomes for these patients and their owners.
Dr. Jeff D. Brourman is an ACVS board-certified surgeon who is with WestVet Animal Emergency and Specialty Center in Garden City, Idaho. His research interests include cardiothorsic surgery and microvascular surgery.