IVDD decision-making

IVDD decision-making

IVDD decision-making

Options for IVDD-affected dogs

“Especially for dachshunds and their friends” (other breeds very welcome)

If your dog has been diagnosed with IVDD (intervertebral disc disease) then you may be wondering what to do next. There are surgical and non-surgical treatment options available. The first thing to do is to see your vet who can assess your dog, discuss options with you, give advice and start treatment or arrange referral.

As a dog owner, it’s important not to panic if your dog is suddenly affected by IVDD. Do listen to options offered by your vet, and do take care to weigh up all the options before making a decision to go for surgery or anything else. Information on this page is designed to help owners understand available options.

Above: Many dachshunds return to a happy and active lifestyle after treatment

For information on how IVDD is diagnosed, including clinical signs (symptoms) and further imaging, click here.

Is spinal surgery necessary?

When considering whether or not to send your dog for spinal surgery, several factors need to be taken into account. These include how severely your dog is affected, other problems that your dog may have, your available budget, and time/ability to care for the dog during recovery. 

If your dog has IVDD, then how badly he’s affected makes a big difference to his prognosis (how likely he is to feel better and to walk again after treatment). Severity of the disease is worked out from the results of the vet’s clinical examination, and a grading system is sometimes used for this.

Above: Clinical grading scheme chart for dogs with IVDD  (this is for back problems, not for neck problems). For a closer look at the chart, please click here. This will open up a larger, printable version in a new window. 

 

Dogs with IVDD in their back can be grouped into three main categories, each with a different prognosis:

a) Mildly-affected dogs who can walk a reasonable distance without falling over (grade 1-2; yellow on the chart above). For dogs that are able to walk, non-surgical treatment is usually a sensible option to start with. This is true even if the dog is quite ataxic (wobbly) when walking. If not referred for surgery, your dog should receive good-quality non-surgical treatment and should be checked regularly by the vet. If your IVDD dog can walk, then click here for more information and advice. 

b) A middle group of dogs who are more severely-affected and cannot walk unaided (grades 3-4; blue on the chart above). In general, if your dog cannot walk unassisted, then an operation will improve his chance of recovery. Referral to a neurologist is worthwhile for most of these dogs. If you cannot afford the cost of surgery, or if your dog cannot have an operation for any other reason, then the next best option is good quality non-surgical treatment (starting either on an in-patient or outpatient basis). Whether or not your non-walking dog has an operation, you’ll need to learn some special skills to help him through recovery, e.g. sling-walking and, in a few cases, bladder expression. Click here for more information and advice about this middle group of dogs. 

c) The most severely affected dogs (grade 5; pink on the chart above). These dogs cannot walk or make any deliberate movements of their affected legs, and they also no longer have pain sensation in their toes. For those who pursue treatment, an operation plus dedicated home aftercare will offer the best chance of recovery. Aftercare is likely to include lots of cleaning and TLC, sling-walking and, in many cases, expressing the dog’s bladder regularly. Even with surgery, we must warn you that a few of these worse-affected dogs deteriorate badly during the first few days. Some others seem to do okay at first but end up being managed as permanently disabled because they fail to walk again. With good home care, some dogs go on to live a happy life in wheels even if treatment fails. However, if there is no realistic treatment or means of care available, then euthanasia may unfortunately be the only kind option. Click here for more information about treatment and care of severely affected (grade 5) dogs. 

Above: Bella recovered well from very severe (grade 5) IVDD. Treatment was spinal surgery followed by dedicated home care, physiotherapy and hydrotherapy. During early recovery, she walked with support from a hindquarter sling as shown here. 

Before committing to surgery, there are a few points to bear in mind from the start:

  • Whether or not your dog has an operation as he will need dedicated home care during recovery.
  • Signs of IVDD may recur after treatment.
  • Full recovery is not guaranteed with any type of treatment, especially for dogs with severe IVDD. 

Having said all this, many dogs do make a fantastic recovery from this disease so don’t be disheartened.

Watch out for deteriorating dogs:  Some dogs start off with a milder grade of IVDD which gets worse over the first few hours to days. Therefore it’s important to keep a close eye on your dog and to return to the vet for regular rechecks in the early stages. Use a large cage or indoor pen to restrict your dog whenever he’s not either in your arms or on a lead. We occasionally hear of dogs who start off mildly affected, but who then suddenly lose the ability to walk just after jumping off a sofa or chasing across a room. On the other hand, most cases of deterioration are nobody’s fault. It’s just that the disc has herniated over hours to days rather than all at once. 

Important: If your dog seems to be getting worse and worse, then ask to speak to your vet immediately. There’s a possibility that urgent referral may be required. 

 

Above: If your dog starts showing signs of IVDD then, whenever he’s not in your arms on a lead, confine him to a pen or other safe space. Running or jumping may cause signs to get much worse in a few cases. 

Other options beyond surgical and non-surgical treatment

Spinal surgery is expensive and therefore not an option for every dog and owner. Non-surgical treatment is another option for most dogs but, if this is also out of the question, or if this fails, then what other options are available? If you find yourself in this situation and your dog is badly affected, then it is worthwhile discussing the option of euthanasia with your vet. Think it through carefully and don’t be rushed into a decision to put your dog to sleep. There’s further guidance regarding decision-making for euthanasia here.

Another option may be to try managing your dog as permanently disabled. For example, some dachshunds go on to to live a happy life using wheels to get about. If considering managing your dog as permanently disabled, then click here for more information. 

References

 

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. Out of 279 grade 1-2 dogs, 96.8% had a good long term outcome, but there was a non-ambulatory period after surgery in many dogs, with only 86.7% dogs walking within 14 days, and 3% of “successful” cases not walking until 2 months post-op. There was a 95% good outcome in 180 grade 3 81.9% of dogs walked within 2 wks. 2.3% of dogs took >61 days to walk again. Mean time to walking was 7.7 days (Aikawa et al 2012). Outcome was 98% successful in 161 grade 4 dogs. Approx 70% walked within 14 days, and about 8% dogs took >61days to walk again. Mean time to walking was around 11 days. 52% of 211 grade 5 dogs recovered ambulation. 36% of successful cases could walk within 14 days. 26% walked within 15-30 days, 18% walked at between 31-60 days. 11% walked at between 2-6 months. 3% walked at between 6-12 months. The remaining few dogs were lost to follow-up.

Davies, J. V., & Sharp, N. J. H. (1983). A comparison of conservative treatment and fenestration for thoracolumbar intervertebral disc disease in the dog. Journal of Small Animal Practice24(12), 721-729. Out of 8 grade 1 dogs managed non-surgically, 100% recovered. Out of 38 grade 2 dogs managed non-surgically, 84% recovered. Out of 10 grade 3 dogs managed non-surgically, 100% recovered. Out of 6 grade 4 dogs managed non-surgically, 3 recovered (50%). Out of 14 grade 5 dogs managed non-surgically, 1 recovered (7%). Mean average recovery times were 3 weeks (grade 1 dogs), 6 weeks (grade 2 dogs), 9 weeks (grade 3 dogs), 12 weeks (grade 4 dogs) and 4 weeks (grade 5 dog). Signs of IVDD recurred at a later date in some cases, though the severity of recurrence is not stated. Rate of recurrence was 28% (grade 1 dogs), 27% (grade 2 dogs), 66% (grade 3 dogs), 33% (grade 4 dogs).

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. Out of 112 grade 3 and 4 dogs, 96% were able to walk within 3 months of surgery. Mean time to ambulation was 12.9 days (range 1-55 days) and surgical decompression was performed within 6 days of onset of non-ambulatory status. There was an inverse relationship between “time between onset of clinical signs and surgery” and “time to ambulation following surgery”.

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. Out of 71 grade 3 and 4 dogs, 86% regained the ability to walk following surgical decompression. Mean time to ambulation was 10.8 days (range 1-60 days). NB: 17% of the 71 dogs regained the ability to walk but were left with ongoing paraparesis and/or pain. The authors looked at whether or not “time from start of clinical signs to surgery” affected outcome. On average (mean value), dogs that regained the ability to walk had spinal surgery at 6.7 days after onset of clinical signs. Within the study group, only 7 dogs had surgery within 2 days of onset of clinical signs, 31 dogs had surgery at 2-6 days after onset of clinical signs, 33 dogs had surgery at >6 days after onset of clinical signs (maximum delay to surgery is not stated). Dogs operated within 6 days recovered walking ability on average 4.5 days sooner than dogs operated after 6 days. However, time from start of clinical signs to surgery did not affect the dogs’ eventual outcome (i.e. whether or not they regained walking ability).

Fouad, K., & Tetzlaff, W. (2012). Rehabilitative training and plasticity following spinal cord injury. Experimental neurology235(1), 91-99

Hayashi, A. M., Matera, J. M., & de Campos Fonseca, A. C. B. (2007). Evaluation of electroacupuncture treatment for thoracolumbar intervertebral disk disease in dogs.Journal of the American Veterinary Medical Association231(6), 913-918. 16 out of 19 (84%) grade 3 and 4 dogs regained the ability to walk without surgery. Out of 14 grade 5 dogs managed non-surgically, 4 regained the ability to walk. According to the authors, “most” dogs in this study were only assessed over a period of three weeks. Therefore it may be possible that recovery continued beyond this point in some “unsuccessful” dogs, and also that recurrence may have occurred in “successful” dogs. Some of the dogs in this study had received electroacupuncture.

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 Out of 48 grade 3 and 4 dogs, 92% regained the ability to walk. For grade 3 and 4 dogs, surgery was performed at up to 30 days after onset of clinical signs and, within this group, time to surgery did not affect outcome. Mean time to ambulation with only slight ataxia was 45 days (range 7 to 180 days). Out of 28 grade 5 dogs, 18 (64%) regained the ability to walk. Mean time to ambulation for grade 5 dogs was 30 days (range 14 to 270 days). For grade 5 dogs, surgery was performed at up to 11 days after onset of clinical signs. Time from onset of clinical signs to surgery did not affect outcome.

Jeffery, N. D., Barker, A. K., Hu, H. Z., Alcott, C. J., Kraus, K. H., Scanlin, E. M., … & Levine, J. M. (2016). Factors associated with recovery from paraplegia in dogs with loss of pain perception in the pelvic limbs following intervertebral disk herniation.Journal of the American Veterinary Medical Association248(4), 386-394. Out of 78 grade 5 dogs managed with surgery, 58% had a successful outcome (walking within 3 months)). Dogs were not followed up beyond 3 months post-op. For recovered dogs, median time to ambulation was 27 days. Mean time and range not stated. Dogs in this study were first assessed at the referral centre at up to 48.1hours after loss of ambulation. Clinical signs started up to 4.9 days before treatment. Time between onset of clinical signs and surgery did not affect outcome.

Joaquim, J. G., Luna, S. P., Brondani, J. T., Torelli, S. R., Rahal, S. C., & de Paula Freitas, F. (2010). Comparison of decompressive surgery, electroacupuncture, and decompressive surgery followed by electroacupuncture for the treatment of dogs with intervertebral disk disease with long-standing severe neurologic deficits. Journal of the American Veterinary Medical Association236(11), 1225-1229. The study looked at 19 severely-affected dogs treated with conservative management including electroacupuncture (these were 9 grade 4 dogs and 10 grade 5 dogs). 15/19 (79%) improved to grade 1-2 within 6 months. 

Kazakos, G., Polizopoulou, Z. S., Patsikas, M. N., Tsimopoulos, G., Roubies, N., & Dessiris, A. (2005). Duration and severity of clinical signs as prognostic indicators in 30 dogs with thoracolumbar disk disease after surgical decompression. Transboundary and Emerging Diseases52(3), 147-152. 6/6 grade 3 dogs all did well after surgery. 8/11 (73%) grade 4 dogs had a “fair to good” outcome, ie. they could walk. Out of 8 grade 5 dogs, 4 regained the ability to walk after surgery (Kazakos et al 2005). Walking took 15 days -2 months.

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. A retrospective questionnaire-based study looking at non-surgical management. Out of 122 grade 1 dogs, 84 recovered (69%). Out of 63 grade 2 dogs, 35 recovered (56%). Out of 23 grade 3 dogs, 13 recovered (57%). Out of 12 grade 4 dogs, 6 recovered (50%). Out of 3 grade 5 dogs, none recovered.

Mann, F. A., Wagner‐Mann, C. C., Dunphy, E. D., Ruben, D. S., Rochat, M. C., & Bartels, K. E. (2007). Recurrence rate of presumed thoracolumbar intervertebral disc disease in ambulatory dogs with spinal hyperpathia treated with anti‐inflammatory drugs: 78 cases (1997–2000).Journal of Veterinary Emergency and Critical Care17(1), 53-60. A retrospective questionnaire-based study looking at non-surgical management. Out of 77 grade 1-2 dogs treated non-surgically, 100% recovered, but around 50% then experienced a recurrence of clinical signs. Most but not all recurrences happened within the first year (median 9 months after first episode). Recurrence rate was significantly higher in dogs treated with corticosteroids than in dogs treated with NSAIDs.

Olby, N., Levine, J., Harris, T., Muñana, K., Skeen, T., & Sharp, N. (2003). Long-term functional outcome of dogs with severe injuries of the thoracolumbar spinal cord: 87 cases (1996–2001). Journal of the American Veterinary Medical Association222(6), 762-769. 64 of 70 dogs with intervertebral disk herniation underwent surgery; 9 (14%) were euthanatized within 3 weeks after surgery (7 because of ascending myelomalacia), 37 (58%) regained DPP and the ability to walk, 7 (11%) regained the ability to walk without regaining DPP, and 11 (17%) remained paraplegic without DPP. Outcome was not associated with any of the factors evaluated, but speed of recovery of ambulation was significantly associated with body weight and age. 15 (41%) and 12 (32%) dogs that regained DPP had intermittent fecal and urinary incontinence, respectively.

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. A prospective clinical trial. 63 dogs with grade 5 thoracolumbar IVDD underwent spinal surgery within 24 hours of onset of clinical signs. 47.6% of these dogs regained the ability to walk by the end of the study at 12 weeks post-op. 17.5% of dogs developed progressive myelomalacia within the first week.

Penning, V., Platt, S. R., Dennis, R., Cappello, R., & Adams, V. (2006). Association of spinal cord compression seen on magnetic resonance imaging with clinical outcome in 67 dogs with thoracolumbar intervertebral disc extrusion. Journal of small animal practice47(11), 644-650. The degree of spinal cord compression documented with magnetic resonance imaging in dogs with
thoracolumbar Hansen type 1 intervertebral disc disease was not associated with the severity of neurological signs and was not
a prognostic indicator in this study.

Scott, H. W., & McKee, W. M. (1999). Laminectomy for 34 dogs with thoracolumbar intervertebral disc disease and loss of deep pain perception.Journal of small animal practice40(9), 417-422. Out of 34 grade 5 dogs, 62% recovered after surgery (Scott & McKee 1999). Dogs in this study had lost deep pain 0-72 hours before surgery. Time to recovery varied from 1 to 11 weeks, and was unaffected by how promptly the operation had been performed.

Further information and getting in touch

For further information about caring for your dog during recovery, try clicking on the various links on this webpage. 

Further questions or comments about recovery are best posted on the Recovery Space Facebook page by clicking here. You are welcome to include photos or a video clip of your dog along with your question.

Even if you prefer to avoid Facebook, then you can still share your question by posting it in any comments box on this website (e.g. the one at the foot of this page).

To book a physiotherapy session with The Rehab Vet (Herts, UK) or for other one-to-one support, please contact me here.

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