IVDD dogs with no deep pain: treatment options and home care advice

IVDD dogs with no deep pain: treatment options and home care advice

IVDD dogs with no deep pain: treatment options and home care advice

The worst-affected IVDD dogs are those who have “no deep pain” in their toes. These dogs are in the pink category (grade 5) of our clinical grading scale table and, unfortunately, they have a worse outlook than other IVDD dogs. Scroll down for information on how likely these dogs are to get better, available treatment and management options, practical advice on home care (including post-op advice), expected recovery times, and a few problems that owners may encounter during the recovery period. 

Does my dog have “no deep pain”?

If your dog has gone down with severe IVDD (and only then), your vet may include a deep pain test on toes and/or tail as part of the assessment. This test is only performed on dogs who are showing other very severe signs. “No deep pain” dogs also have the following set of problems:

  • Can’t walk at all with the hind legs (not even a step)
  • Can’t use the hind legs to push up from the floor at all, even if the body is supported.
  • Can’t make any deliberate movements with the hind legs.  

This last one can be tricky to judge. If your dog tries to step a bit when you support his body, then he’s almost certainly not in this “no deep pain” category. Note that dogs who can walk will not be in this “no deep pain” category, even if they can only walk for one step before falling over. If your dog is very badly affected as listed in the bullet points above, then ask your vet whether he’s in the “no deep pain” category. This will tell you more about his chances of recovery and may alter the best course of treatment.

Your vet will hopefully not even need to test your dog’s deep pain sensation: The deep pain test should only be performed on badly-affected dogs. It tends to be the last in a series of tests.

 

Above and below: This is lovely Louis who went down with grade 5 IVDD (a “no deep pain” dog). The photos show him just after spinal surgery, still not able to do much, and with a urinary catheter in place. Many thanks to John Cox for sharing these pictures. 

 

Prognosis for dogs with “no deep pain” (grade 5 dogs)

Though these dogs cannot feel their hind paws, they usually experience pain over their spine. They also tend to have no (or reduced) bladder and bowel control. Odds of recovery are not great even if an operation is performed promptly. Here are the statistics for these dogs: 

  • Following an operation, about 50-60% of grade 5 dogs recover to walk fairly normally and to have fairly good bladder and bowel control. Learning to walk can take 9 months or more after an operation, though most “successful” grade 5 dogs walk within 6-12 weeks of surgery.  
  • Unfortunately, grade 5 dogs are not expected to recover without an operation. Chances of walking again without surgery are probably less than 30%.
  • Out of all the grade 5 dogs, about one in six get a nasty untreatable condition called PMM (progressive myelomalacia) which causes them to get much worse. An operation won’t prevent or treat this problem. If PMM is going to happen, then it’ll start quite early on, during the first week of a dog’s collapse.

 My dog has “no deep pain” (grade 5). Should he have an operation? 

If your dog is in this worst-affected group (grade 5) then an operation will give him a better chance of recovery than any other option. However, surgery will not guarantee that he will walk again and, even for those grade 5 dogs who do learn to walk again following surgery, recovery will most likely be slow. In deciding whether or not to go for surgery, also consider the financial cost and whether or not you’ll be able to cope with nursing your dog at home during his recovery. 

Your dog will need to stay in the hospital for at least a few days after the operation, and then he’ll need weeks to months of quite intensive home care afterwards (scroll down for a guide to home care for these dogs). If he’s going to walk again, then he’s most likely to start doing so within about 6-12 weeks of the operation. A few dogs take as long as 9 months to start walking after the operation, and long term incontinence can be a problem. 

Above: Dave had spinal surgery for grade 5 (“no deep pain”) IVDD. Recovery involved time-consuming home care and was at times frustrating, but he eventually got up on his feet again. Here he is at 9 months after the operation. 

My dog has “no deep pain” (grade 5). Is there any rush to have an operation?

These severely-affected dogs used to be considered surgical emergencies, and most vets still prefer to operate sooner rather than later. However, studies show that waiting at least a couple of days before the operation will not affect the dog’s outcome. 

There are two main studies looking at the effect of delaying surgery in these “no deep pain” dogs. In one study Jeffery et al 2016, all dogs arrived at the referral centre within 48.1 hours of losing the ability to walk, but some turned up sooner than others. Dogs in this study turned out to have the same chance of recovery whether they had arrived at the referral centre within 12 hours or at just after 48 hours after losing the ability to walk. In the other study Ito et al 2005, surgery in “no deep pain” dogs was delayed in some cases for longer than this. Operating sooner rather than later did not improve chances of recovery, and the latest arrivals in this study all recovered well.

Spinal surgery therefore doesn’t have to be performed immediately, even for dogs with “no deep pain”. You should at least have time to consider available options and to check your financial situation before committing to going ahead with surgery. Having said this, these dogs are in a bad way and of course need immediate veterinary care involving good pain medication and nursing.

Might my dog recover without surgery? He has no deep pain. 

Some owners simply cannot afford surgery, and there can be other reasons preventing a dog from going through with a major operation. Non-surgical treatment is feasible for most dogs with IVDD but, unfortunately, dogs with “no deep pain” are considered very unlikely to walk again unless they have an operation.

It is certainly not an option just to do nothing and wait and see what happens. However, good non-surgical management aims to keep the dog comfortable and may offer a tiny chance of recovery: From the small number of studies available, the rate of non-surgical recovery in dogs with no deep pain ranges from 0% to 29% as observed over a period of 3 months. For these dogs, quite intensive long term home care would be essential, and an initial period in the hospital is usually best (for intravenous fluids, oxygen, pain medication, initial nursing care and placement of a urinary catheter). If your dog has no deep pain (grade 5) and you choose to try non-surgical treatment, then be prepared to switch tactic if there’s no improvement. “Unsuccessful” dogs who don’t learn to walk could then be managed as permanently disabled, or euthanasia may become the kindest option. 

My vet tells me that my dog has no deep pain. Should I be worried about PMM?

PMM (progressive myelomalacia) is a nasty condition that can affect dogs during the first five days of losing deep pain sensation. It’s quite unusual, affecting only up to one in six dogs who have no deep pain in their toes. Unfortunately, PMM is a painful and progressive condition with no available treatment so, if it happens, the only kind solution would be to put the dog to sleep. Neither spinal surgery nor any other treatment prevents this problem from occurring, so it’s a good idea to discuss any risk of PMM with the surgeon before agreeing to an operation. 

My vet has advised me to put my grade 5 dog to sleep. Is this necessary?

The answer to this question is different for each dog and each owner. Many factors have to be considered including cost of treatment and whether or not you feel able to nurse the dog through recovery. Some dogs do recover, especially if given both spinal surgery and good long term aftercare. In my experience, owners of recovered dogs, and also owners of permanently disabled dachshunds who cope well in wheels, are generally pleased that they didn’t opt for euthanasia at the start.

However, there’s unfortunately no easy treatment for dogs with no deep pain in their toes (grade 5). Recovery isn’t guaranteed at all, and many dogs are left incontinent and/or unable to walk without wheels or a sling. In addition, the recovery period is difficult for owners and can be quite difficult for some dogs. During the first few days, there’s also a risk of very unpleasant PMM occurring despite treatment (see above).  In addition to all of this, spinal surgery and hospital aftercare is out of the question for many owners because it is expensive. For all these reasons, early euthanasia may be considered the kindest solution for some of these dogs. For more thoughts on the topic of euthanasia, click here. If you need a little time to think things through while deciding, then have your vet start good care to keep your dog as comfortable as possible in the meantime, including painkillers and nursing care

Home care for grade 5 IVDD dogs (“no deep pain”)

Whether or not your dog has had spinal surgery, these notes are relevant during the home recovery period. Home care for these severely-affected dogs involves a combination of nursing care, providing a safe “recovery area” (large crate or pen) and further measures to help prevent your dog from dragging himself about or risking further injury. However, these dogs are not expected to improve if just left to languish in a cage. Whether or not your dog has had an operation, specific exercises are important in getting him stronger and in teaching him how to walk again. You’ll also need to help your dog with some basic activities if he can’t walk. He’ll need help with standing, plus sling-support whenever he’s taken out to the toilet. Nursing care for these dogs includes keeping them comfortable, cosy and clean (bedding may need frequent changes) and in some cases, bladder expression if your vet advises you to do this. 

Above: Bella was diagnosed with grade 5 (“no deep pain”) IVDD and went on to have spinal surgery. In the photo, she is being taken outdoors with support from a hindquarter sling. With good physiotherapy and dedicated home care, Bella was able to walk unaided within a few weeks of the operation and she then went on to make an excellent recovery. 

Home care: nursing for severely-affected dogs

Your dog will find it either difficult or impossible to get up or change position, so good nursing care is essential. Provide soft bedding and change it when needed to help keep him dry: A piece of covered orthopaedic foam with a layer of vet bed (fluffy washable matting) placed over the top is ideal. In the early stages, you may need to place an incontinence pad directly under your dog where he’s lying to help keep him clean and dry. 

If he’s unable to move about unaided, then you should “turn” your dog at least every four hours to help avoid pressure sores. To do this, don’t flip him over as this may twist his spine. Instead, bring him out of the cage or pen (this is a good time for a toilet break and/or some physiotherapy, plus you might need to give him a little clean-up), then replace him so that he’s lying the other way. So he could lie resting on his right side then on his left side and, if possible, resting supported on his front for part of the day too. Keep a frequent check on your dog’s skin for sores or other damage.

Your dog is likely to be incontinent to start with, so be prepared to wash and change his bedding frequently. He might also need cleaning at times. Don’t attempt to run him a bath. Sponge him off while he’s resting on an incontinence pad, non-slip shower mat or on short grass. Disposable gloves, old towels, kitchen roll, a bowl or spray-bottle of water, cotton wool padding and unscented baby wipes may all come in useful. Take care to dry him off very carefully, especially between any skin folds.

Many severely-affected dogs need their bladder expressed at home (squeezed out), especially in the early stages of IVDD. Ask your vet whether this applies to your dog and, if so, how often you should be doing this. There’s more information on bladder expression here.

Take your dog outdoors regularly for toilet breaks, even in the early stages when he seems quite helpless. Outdoor time is essential for helping dogs to relearn normal toilet habits, and it’s also extremely important for their general well-being. You’ll need to carry your dog outdoors to a suitable patch of ground, then use a hindquarter sling to support his rear end. There’s  information on sling-walking here.

Massage and range-of-movement is good for these dogs if done gently and safely. Ask your physiotherapist to teach you the necessary skills. 

Set up a “safe space” for your dog

Set up a a safe, comfortable recovery space for your dog. This could be a crate if you can get hold of one big enough for your dog. Or it could be an open-topped pen if your dog definitely won’t try to climb out.  Many dachshunds do well in an indoor pen. This will help your dog to avoid dragging himself about the house, otherwise dragging will soon become a habit and make it difficult for him to learn to walk properly again. It’s also sensible to get hold of a fixed-length lead and a chest harness. These will be very useful for your dog’s balance when he’s learning to walk, and the lead is important for his safety (it’s surprising how fast some dogs try to move, even when only their front legs are working). 

“The goal of the crate or pen is to improve safety, but not to immobilise the dog.”

The aim of the recovery space is to prevent your dog from doing anything risky. Whenever your dog is outside their crate or pen, they should be on a lead or in your arms to prevent any risky dashing about. There’s a small risk that exuberant activity might make your dog suddenly worse. Over-activity also prevents any inflammation of the affected area from settling down. Here’s a list of things to avoid:

  • Running
  • Jumping (e.g. on/off the sofa or bed, or in/out of the car)
  • Going up or down stairs or over steps (NB you should lift your dog over any doorstep or raised threshold, especially if he has short legs). 
  • Ball games
  • Being let outdoors unsupervised (it’s best to keep your dog on the lead for toilet breaks, even in the garden)
  • Rough play/chasing with other dogs or children
  • Rushing over slick surfaces (e.g. tiled or laminate flooring) Safety tip: Place non-slip runners or carry your dog over any slick flooring.

Trotting is generally also not a good idea until late in recovery.

A little gentle moving around is fine and, if your dog is able to stand and walk, then these are also safe activities. Your dog will tire easily, so the amount of walking he’s allowed to do will be restricted. Exercise-prescription varies from patient to patient, so your vet and/or physiotherapist will assess your dog and advise you.

Above: A comfortable pen that is suitable either for home recovery after surgery or for non-surgical treatment

It’s essential not to immobilise your dog completely. A little moving around will help him maintain his strength and ability to walk. Here’s a list of safe activities for your recovering dog:

  • Standing
  • Sitting
  • Getting up from rest, and moving around gently
  • Resting in any comfortable position 
  • A little gentle walking over non-slip flooring (e.g. carpet), short grass, concrete and other easy surfaces. You’ll need to support his rear end with a hindquarter sling. He should walk for no longer than 5 minutes at a time to start with. Some dogs should walk for less than this (e.g. only one minute at a time before being picked up for a rest). Ask your vet to advise you. Keep your dog on a lead whenever outdoors. If he’s likely to rush off, then he should also be carried or on a lead indoors, except when confined in his recovery crate or pen.
  • Relaxing with you on the sofa, but only if he is very safely restrained. Safety tip: Have him wear a harness, and keep your fingers tucked around the harness straps to be sure that he won’t leap off the sofa unexpectedly. 
  • Chewing on toys or filled Kongs (so long as he doesn’t shake them violently or throw and catch them)

For larger breeds, or for very calm dogs who definitely won’t try to jump onto the sofa, you might set up a room in your house to be a “recovery room” instead of using a crate or pen. If so, the room must have non-slip flooring, and all members of the family will need to take care whenever opening and closing the door so that the dog doesn’t slip out. If your vet has already advised “crate rest” or “room rest” for a certain number of weeks, then do your very best to follow their recommendation. Try the following links for more information:

Crate rest summary
Choosing a recovery crate
Where to put the recovery crate
Room rest summary
Choosing a recovery room

Keeping your dog comfortable during IVDD recovery

For good recovery, your dog needs to be as comfortable as possible in their recovery space. For a start, the crate or pen must be large enough for your dog to lie fully stretched out, and to sit, stand and turn around easily, and it should offer enough space for your dog to eat and drink as well as to lie down.

Above: Tiggy in her recovery pen. Toys and soft bedding are important, and take care to block off any draughts coming through the pen or crate. Some dachshunds like to hide in a fabric pouch.  If your dog has just had spinal surgery, check with your dog’s surgeon as to whether this is safe for your own dog. Photo courtesy of Michelle Randall.  

It is a good idea to introduce your dog’s recovery area gradually if at all possible. It is also important to set the recovery space up as a pleasant area before your dog even sees it.

Remember to include soft bedding, food, water and something good to chew on. You may find the following links useful:

Introducing your dog to the recovery crate or pen
Keeping your recovering dog calm and content
Crate rest: Bedding
Toys for recovering dogs

Outside the recovery crate or room

You’ll need to take special care to keep your recovering dog safe whenever he is outside the recovery crate or pen. A harness, fixed-length lead, and non-slip floor matting are all very useful. You’re likely to need a hindquarter sling if your dog cannot walk. Click here for advice on sling-walking your dog.

You will of course need to take your dog outside on the lead for regular “toilet breaks”. It’s important to follow your vet’s guidelines regarding how often to take your dog outdoors and on how long these outdoor sessions can be. In the absence of any advice, a good starting point is typically 3-5 toilet breaks per day, with each outdoor session being no longer than 5 minutes. Some IVDD-affected dogs need to be given more frequent outdoor chances to pee, e.g. up to 7 toilet break sessions per day (each up to 5 mins long, and carry your dog part of the way if required).

Watch your dog for signs of tiredness while you’re outside with him. Early in recovery, his legs may get tired long before the designated outdoor time is up. If your dog is getting increasingly weak and wobbly, then pick him up or put him in a dog pushchair to give him a break.

All walking should be slow. Even if your dog wants to use his front paws to rush ahead, use the lead to encourage him to move slowly. This will give his weak hind legs are chance to learn to step. It will also help avoid his front end getting worn out. 

 The following links offer more information on keeping your dog safe through the recovery period:

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

 

Above: It is essential to keep your recovering dog on the lead whenever outdoors.

The recovery routine

A regular routine is important during recovery. Recovering dogs cope better once they learn when to expect meal times, toilet breaks, and any quality time spent with the owner. It is also helpful to set aside quiet times during which your dog should expect no interaction from you (especially during the night, of course). For details on the daily routine during recovery, try the following links:

Crate rest daily routine
Room rest daily routine

Physiotherapy exercises

If your dog is not walking normally, then a tailored exercise programme is indicated from the start. Severely-affected dogs may be unable to move their hind legs at all to start with, and physiotherapy exercises are particularly important in getting these dogs moving correctly again. These dogs recover mainly through neural plasticity (the ability of the central nervous system to adapt to meet functional demands) Fouad & Tetzlaff 2012. Improvement will therefore not happen while the dog is lying in a cage or dragging himself about, but will be triggered by practice of coordinated movements and postures (e.g. getting up, standing, sitting and stepping). Exercises aim to achieve this improvement. It’s essential that exercises are performed safely and correctly, so ask your vet to refer your dog to a canine physiotherapist who is experienced in canine neurological cases. Tip: Ask your physiotherapist to start teaching you how to do the exercises with your dog, so that you can continue the good work between physio sessions. 

Timescale of recovery

Dogs who start off with “no deep pain” take time to recover.  We would hope to see at least a little improvement each fortnight, though full recovery takes months. A few of these dogs take their first steps as early two weeks after spinal surgery, but most “successful” dogs start walking at around 1-3 months after the operation. A few dogs take much longer to start walking, perhaps as long as 9 months after an operation.  Signs of improvement can be quite subtle, and could include: 

  • Return of deep pain sensation in the affected toes or tail (the surgeon or vet may monitor for this)
  • Reappearance of voluntary leg movement. This tends to start with a little movement from the top of the leg.
  • Becoming able to hold a “stand” position when supported.
  • Becoming able to stand for longer, and eventually with less support.
  • Becoming able to step a bit more normally with sling-support.
  • Managing to get up into a standing position unaided.
  • Managing to push off with a couple of steps from a standing position.

A good physiotherapist will watch out for these little signs of improvement, advise you and adjust the exercise programme accordingly.

If your dog is showing some of the small improvements listed above, then it’s generally worth giving him at least 3-6 months (and in some cases longer, perhaps at least 9 months) of trying to learn to walk before considering “giving up” and switching to wheels. 

Above: Dave went down with grade 5 (“no deep pain”) IVDD. He had spinal surgery, but took many months to learn to walk again. Progress came in fits and starts. Here he is on a good day at 5 months after the operation. 

Problems during recovery

Miserable dogs Some dogs need extra time to accept their new routine during recovery. If your dog won’t settle down in the crate, pen or recovery room, then try this link for advice. Also bear in mind that certain types of medication may cause individual dogs to act out of character. If you suspect that this may be happening, then discuss it with your vet. You might also find the following links useful:

Keeping your dog calm and content
Staying positive during your dog’s recovery.

Above: A dog pushchair can improve quality of life during the months of recovery as it enables both dog and owner to get out and about. Photo courtesy of J.Austin.

Dogs who don’t improve Treatment aims to get your dog more comfortable and eventually walking well. Unfortunately, not every dog manages to walk again. Improvements in walking ability tend to happen gradually (see above for “Timescale of recovery”). If your dog is not improving as expected then ask your vet for advice. Improvements to the physiotherapy regime can be very useful in many of these cases. 

If your dog is getting worse at any stage (walking less comfortably than before, or appears more painful), then go and see your vet at the next available appointment.

Above: Months after spinal surgery, Dave still had great difficulty standing and walking. 

Urinary incontinence Many of these “no deep pain” dogs are incontinent for at least the first few weeks. The bladder tends to become over-full and then to overflow. It’s not your dog’s fault, so don’t scold him for indoor “accidents”. Your vet may advise you to express your dog’s bladder, to add in some special medication for the bladder or, in more severe cases, your vet may need to admit your dog to pass a urinary catheter. Despite these measures, incontinence may still be a problem. It’s useful to continue taking your dog outdoors for attempts to pee (you’ll need to support him with a sling), and to persevere with physiotherapy exercises to help him learn to stand. If the incontinence seems to be getting worse, then book to see the vet and, if you can get one, bring a urine sample. Some of these dogs get a urine infection that makes the problem worse. 

To help cope with the incontinence problem, some owners buy belly bands (for male dogs) and/or dog nappies. These help to keep indoor surfaces clean but, at least in theory, might reduce the chance of your dog learning to pee normally again. If you do resort to using belly bands or nappies, then continue regular outdoor “toilet breaks“, and of course, remove the band or nappy for these.

Above: Dave showing off his very smart belly band. Photo courtesy of Justine Grieg.

Faecal incontinence It is of course very frustrating if your dog poos indoors. Many of these severely-affected dogs have poor bowel control. This sometimes improves once the dog can balance better in a standing position, though unfortunately some dogs do remain incontinent. It’s not your dog’s fault, so don’t scold him for indoor “accidents”. The surest way forward is just to continue taking him outdoors to try and poo regularly, and to support him in a standing position when he’s out there. In some cases, it can help to change the diet gradually to an easily-digestible complete dog food containing good-quality fibre. Ask for your vet’s advice on diet and medication.

Skin sores Pressure sores can happen if the dog is unable to get up and is not “turned” regularly. Skin can also get sore if not kept completely clean and dry, especially if the dog is incontinent. Nursing care is essential in preventing this, including bedding, turning and cleaning (see above, “nursing care”). Check your dog’s skin regularly for pink/red patches, swelling or fur loss. Clean and dry any suspicious areas straight away, and ask your vet for advice.

Sores can also appear on your dog’s legs or paws if he moves by dragging himself along. Again, these should be checked by the vet. For prevention and to allow the sores to heal, do your very best to prevent your dog from dragging himself around. Set him up in a pen with soft flooring and bedding. Whenever outside the pen, he should be either carried, or on a lead with his hindquarters supported by a sling so that his paws do not scrape along the ground.

If you are managing your dog as permanently-disabled, then you may need to protect his paws with non-slip dog socks and perhaps consider using a canine drag bag to protect other areas of skin when he’s indoors. Socks and other paw-coverings are best avoided for long term use if you expect your dog to walk again. Drag bags should definitely be avoided if you hope that your dog will walk again. They encourage the dog to drag himself and discourage walking. 

Other problems: If your dog goes off his food, starts vomiting, develops diarrhoea, starts drinking much more than before, or has increased difficulty peeing, then ask your vet for advice. 

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).

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.

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.

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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