IVDD non-surgical treatment

IVDD non-surgical treatment

IVDD non-surgical treatment

If your dog has IVDD, then the main treatment options are surgical and non-surgical. You might be starting non-surgical treatment if:

    • your dog has mild signs of IVDD and is able to walk
    • your dog has more severe signs, but an operation is out of the question (e.g. due to cost or availability, or perhaps the dog can’t have an anaesthetic for some reason)
    • you’re considering an operation, but want to try without it first
    • your dog is recovering from spinal surgery. Following an operation, most dogs take a couple of weeks (or sometimes longer) to learn to walk again1,2,3,4, and recovery continues over the following months. Therefore your dog may have had spinal surgery but still need non-surgical treatment to improve ongoing recovery. 

Above: Whether or not surgery is performed, IVDD dogs need to “practise” their natural postures in order to recover. Good exercises are an essential part of non-surgical treatment. Frankie is here practising her “down” position. 

What is non-surgical treatment?

For IVDD, non-surgical treatment is sometimes also called conservative treatment or management. The goals of non-surgical treatment are to help get the dog as comfortable and pain-free as possible, to get the dog standing and walking again, and to help restore bladder and bowel control. Non-surgical treatment also helps to prevent or treat other problems that the IVDD may cause, e.g. skin sores, behavioural issues and breathing problems. 

Above: A pen or large crate helps the recovering dog avoid risky activities, and prevents her from dragging herself about the house.

For all dogs showing clinical signs of IVDD, non-surgical treatment involves:

      • Pain relief (medication supplied by your dog’s vet). 
      • Activity-modification:
        • Avoid risky activities such as running and jumping. Click here for advice on how to keep your dog safe. 
        • Continue and support safe activities. Standing and a little slow walking are safe, but you may need to help your dog, e.g. by supporting him with your hands or with a hindquarter sling. Ask your dog’s physiotherapist to show you what to do. 
        • Safe basic exercises (e.g. “supported standing practice”) are supervised by your dog’s physiotherapist to start with.
        • Avoid fatigue. These dogs tire rapidly. Keep any exercise sessions and toilet-breaks very short.
        • As far as possible, prevent the dog from dragging his hindquarters. Dragging and other “compensatory movements” quickly become difficult habits to break, and can make it more difficult for your dog to learn to walk on four paws again.
      • Nursing care either in the hospital or by the owner at home (keep the dog clean and dry, regular turning if the dog is collapsed, sling-support for toilet breaks if the dog can’t walk, “TLC”). Click here for information on nursing your dog at home. 
      • Appropriate mental stimulation so that your dog doesn’t get too bored during recovery (the daily routine is important, and toys,  quiet games, and trips out in a dog pushchair/stroller may help).
      • Dietary care. A good quality diet is important. This may need to be calorie-counted to help avoid weight gain during recovery. 

In addition, some IVDD dogs also need the following:

        • If your dog has just been affected very suddenly by severe IVDD, then he may benefit from being admitted to a vet hospital to be given oxygen and intravenous fluids for a day or so. This helps to keep the recovering spinal cord well-supplied with nutrients and oxygen. 
        • Managing any loss of bladder control
        • Managing any loss of bowel control
        • Managing any breathing problems  (mainly for dogs hospitalised with severe neck IVDD)

Above: Recovering dogs need short amounts of outdoor time (always on the lead), and they need interesting things to see and do. Balance this out with keeping your dog safe. The lead was essential for preventing Frankie from disappearing underneath this chicken shed! She could stand but not walk at this stage, so the hindquarter sling was essential.

  • Up-to-date non-surgical treatment

In the past, dogs suffering from IVDD were either given surgery, or they were sent away with anti-inflammatory drugs and basic advice on nursing care. The hope was that time would heal the problem. Times have changed, and non-surgical treatment can now be offered as a positive recovery plan for dogs.

Leaving these dogs in a cage 24/7 is no longer considered best practice. Yes, a recovery crate or pen increases safety, and the dog should be on a lead or carried whenever outside this safe space. However, we now know that practising coordinated activities is key to recovery5 and, if safety guidelines are followed, this can be started from day one.

“Practising coordinated activities is key to recovery”

Steroids used to be given routinely to dogs presenting with IVDD. More recently, studies have shown that steroids are unhelpful in this situation and are generally best avoided for these dogs6,7,8,9,10.

Pain-relief medication for dogs has improved dramatically over the past couple of decades. Vets now have various medical options for helping IVDD dogs to feel better. These include the various NSAIDs (non-steroidal anti-inflammatory drugs), gabapentin and, in the hospital, various opiates, ketamine and lidocaine. Other types of pain medication are also available. For painful animals, we now tend to get best results with “multi-modal analgesia”, i.e. two or more types of painkiller medication are given at the same time11

Above: A dog needs to be able to stand well again before she can learn to walk. Frankie is doing “supported standing practice”

 

Above: Leaving these dogs in a cage 24/7 is no longer considered best practice. Trips out in a dog pushchair provide important mental stimulation for recovering patients.

Getting started with non-surgical treatment for IVDD

First arrange to see your dog’s vet who can assess your dog and start treatment. If surgical treatment is expected to improve your dog’s outcome and/or if you are keen to get the diagnosis confirmed, then the vet may refer your dog to a neurologist.

For those of you who are sticking with non-surgical treatment, the vet will either send your dog home with advice and prescribed painkillers, or may in some cases initially admit your dog to the clinic for fluids, stronger pain-relief and nursing care. If your dog goes home with you, then do arrange to see the vet again for regular rechecks. A next-day recheck is a good idea for severely-affected dogs. A few unlucky dogs deteriorate over the first few days and, if this starts to happen with your dog,  your vet might be prompted to offer surgical referral. Another important reason to keep in close touch with your vet is to ensure that your dog can pee okay and to address this issue if needed. Some dogs need to have their bladder expressed (squeezed out) and, if needed, your vet can show you how to do this.

Activity-modification is a key part of your dog’s recovery. This is best supervised by a canine physiotherapist who has good experience of neurological patients. Ask your vet for a physiotherapy referral at this early stage. 

Above: Exercises should be chosen to suit each individual dog and, for best effect, must be done correctly. Early referral to a physiotherapist is worthwhile.

 

Above: Once your dog can walk and is well on the way to full recovery, more advanced exercises can be used to improve balance, core strength and stamina. Video of Bella, courtesy of J.Austin.

Improvements with non-surgical treatment tend to happen over weeks to months of care, and you will need to help your dog through this time. For advice on how to care for your recovering dog at home, click here

There is plenty of other information on this website to get you started. Try the following links:

Crate rest summary
Choosing a recovery crate
Where to put the recovery crate
Room rest summary
Choosing a recovery room
Introducing your dog to the recovery crate or pen
Keeping your recovering dog calm and content
Crate rest: Bedding
Toys for recovering dogs
Keeping your dog safe outside the recovery crate
Keeping your dog safe outside the recovery room
Harness for recovering dogs
Choosing a lead for recovery
Walking with your recovering dog

References

  1. Aikawa, T., Fujita, H., Kanazono, S., Shibata, M., & Yoshigae, Y. (2012). Long-term neurologic outcome of hemilaminectomy and disk fenestration for treatment of dogs with thoracolumbar intervertebral disk herniation: 831 cases (2000–2007). Journal of the American Veterinary Medical Association241(12), 1617-1626
  2. Davis, G. J., & Brown, D. C. (2002). Prognostic indicators for time to ambulation after surgical decompression in nonambulatory dogs with acute thoracolumbar disk extrusions: 112 cases. Veterinary surgery31(6), 513-518.
  3. Ferreira, A. J. A., Correia, J. H. D., & Jaggy, A. (2002). Thoracolumbar disc disease in 71 paraplegic dogs: influence of rate of onset and duration of clinical signs on treatment results. Journal of small animal practice43(4), 158-163.
  4. Ito, D., Matsunaga, S., Jeffery, N. D., Sasaki, N., Nishimura, R., Mochizuki, M., … & Ogawa, H. (2005). Prognostic value of magnetic resonance imaging in dogs with paraplegia caused by thoracolumbar intervertebral disk extrusion: 77 cases (2000–2003). Journal of the American Veterinary Medical Association227(9), 1454-1460.
  5. Fouad, K., & Tetzlaff, W. (2012). Rehabilitative training and plasticity following spinal cord injury. Experimental neurology235(1), 91-99
  6. Levine, J. M., Levine, G. J., Johnson, S. I., Kerwin, S. C., Hettlich, B. F., & Fosgate, G. T. (2007). Evaluation of the success of medical management for presumptive thoracolumbar intervertebral disk herniation in dogs. Veterinary surgery36(5), 482-491
  7. Olby, N. J., Muguet‐Chanoit, A. C., Lim, J. H., Davidian, M., Mariani, C. L., Freeman, A. C., … & Longshore, R. (2016). A Placebo‐Controlled, Prospective, Randomized Clinical Trial of Polyethylene Glycol and Methylprednisolone Sodium Succinate in Dogs with Intervertebral Disk Herniation. Journal of Veterinary Internal Medicine30(1), 206-214.
  8. Hurlbert, R. J. (2000). Methylprednisolone for acute spinal cord injury: an inappropriate standard of care. Journal of Neurosurgery: spine93(1), 1-7.
  9. Mathews, K., Kronen, P. W., Lascelles, D., Nolan, A., Robertson, S., Steagall, P. V., … & Yamashita, K. (2014). Guidelines for recognition, assessment and treatment of pain. Journal of Small Animal Practice55(6).
  10. COATES, J. R., SORJONEN, D. C., SIMPSON, S. T., COX, N. R., WRIGHT, J. C., HUDSON, J. A., … & BROWN, S. A. (1995). Clinicopathologic effects of a 21‐aminosteroid compound (U74389G) and high‐dose methylprednisolone on spinal cord function after simulated spinal cord trauma. Veterinary Surgery24(2), 128-139.
  11. Mathews, K., Kronen, P. W., Lascelles, D., Nolan, A., Robertson, S., Steagall, P. V., … & Yamashita, K. (2014). Guidelines for recognition, assessment and treatment of pain. Journal of Small Animal Practice55(6).
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