If your IVDD-affected dog cannot walk but can still feel his toes, then he’ll be in the middle (blue) section of the clinical grading scale table. This gives useful information about his chances of recovery. Please scroll down for treatment options for these dogs, home care advice and some other useful information.
The “middle group” of dogs (grades 3-4)
Some of these dogs are not quite able to walk but can stand a little if held in a supported position. They might also move their hind legs in an attempt at walking. Others are worse-affected and cannot bear any weight or move their hind legs at all. None of these dogs have lost the ability to feel pain in their toes.
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.
Treatment options for grade 3-4 dogs
Spinal surgery plus aftercare: 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. The neurologist assess the dog and then, under a general anaesthetic, uses advanced imaging (MRI or in a few cases CT or myelography) to confirm which disc spaces are affected and on which side of the spine. Surgical techniques vary depending on these findings.
These days, most spinal surgery procedures involve the removal of disc material that is pressing on the spinal cord. An example of this is the “hemilaminectomy” procedure. To surgically decompress the spine, the surgeon removes a section of vertebral bone overlying the spinal cord and then very carefully removes herniated disc material so that it no longer presses on the spinal cord. In some cases, a “fenestration” procedure is also performed on the affected disc and/or adjacent discs. Fenestration aims to reduce the risk of the problem recurring, and involves removing the centre of the disc (the nucleus pulposus) via a little window cut out of its side.
Following surgery, about 90% of these dogs will eventually walk quite normally again. It usually takes these dogs about 1-3 weeks to start walking, though a few dogs take much longer than this. Dogs usually stay in the hospital for a few days, and are discharged once they are fairly comfortable and can be managed at home. You’ll need to set up a safe indoor recovery space (crate, pen or possibly a recovery room) ready for when your dog comes home. Your dog might not yet be able to walk and he might not have full bladder and bowel control on returning home, so you’ll need to continue with non-surgical treatment including sling-walking, supporting your dog in a standing position and, in some cases, bladder-expression, to help your dog through this phase. For further information on nursing these dogs at home, click here.
Above: Sling-walking a dog after a spinal operation
Non-surgical treatment. Non-surgical treatment can be a reasonable option for these dogs, though recovery is not guaranteed and the problem may recur. Without surgery, reported recovery rates vary widely from about 40%-80% Davies&Sharp 1983, Levine et al 2007, Hayashi et al 2007, Joaquim et al 2010. Dogs that do recover tend to start walking again within weeks and improve over the following months.
If embarking on non-surgical treatment then do so as a positive approach: good pain-relief, a comfortable recovery area, asupervised exercise therapy, nursing care and, if needed, help with bladder management are important from the start.
Initially, it may be worthwhile having your dog admitted to a veterinary hospital for intravenous fluids and oxygen (both of which may benefit the damaged spinal cord) and for top-quality pain-relief and nursing care. This may also give you a chance to set up a safe indoor recovery space (crate, pen or recovery room) ready for when your dog comes home. If your clinic does not offer in-patient care, or if you cannot afford this, then your vet may send your dog home straight away with pain-medication and you can make a start with home care.
You’ll need to learn some special skills for helping your dog if he cannot walk. These include sling-walking, supporting your dog in a standing position and, possibly, expressing his bladder if he cannot pee unaided. Do go back and see your vet regularly for advice and monitoring. A next-day check-up is a good idea to start with.
Physiotherapy is particularly important for IVDD-affected dogs who cannot walk. 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. Exercises aim to achieve this improvement, but must be performed correctly and safely. Physiotherapy referral is certainly recommended during the first week. 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.
Is treatment an emergency?
If your dog has just gone down with IVDD and is unable to walk, then he should be seen as soon as possible by your vet for assessment and treatment including painkillers. Ask for the next available appointment. Do ask to speak to a vet straight away if your dog seems to be getting worse and worse. A few cases deteriorate (see below) and may need urgent help.
Unless your dog is getting worse and worse, there is no need to rush into surgical referral for IVDD. Same-day surgery used to be recommended but studies now show that, for each grade of dog, delaying the operation does not affect the dog’s outcome Davis & Brown, Kazakos et al 2005, Ito et al 2005, Jeffery et al 2016. You should generally have a chance to consider all options and to check your financial position before going for surgery. Arguably, it may be sensible in some cases to start with non-surgical treatment and then progress to an operation if your dog is not improving. If surgery is delayed, then excellent pain-medication is important, and your dog should either be admitted to the clinic or have frequent repeat visits for monitoring.
Watch out for deteriorating dogs
A few dogs start with mild signs which then get worse as the spinal disc continues to herniate. The problem may get worse gradually or suddenly. Therefore it’s important to keep an eye on your dog and to be prepared for a change of treatment plan, especially in the early stages. Unless these dogs get really bad, then this won’t change the eventual outcome. However, there’s a big difference in outlook for grade 4 dogs (can’t walk, paralysed hind legs) and grade 5 dogs (can’t walk, paralysed hind legs and no deep pain sensation in toes). If your dog is in the “middle group” (grade 3-4) and you are considering an operation but hoping to avoid one, then have your vet reassess your dog frequently for the first few days.
If your dog is rapidly-deteriorating, then quick referral for surgery might be wise, ideally before he loses toe pain-sensation. It’s actually not helpful (and not a good idea) to repeatedly check toe deep pain sensation in this situation. Your vet may monitor the situation by rechecking your dog’s limb strength and standing ability in a supported position, by checking for voluntary leg movements and, if needed, by checking for superficial pain sensation in the skin between the toes.
Deterioration is generally nobody’s fault. It’s just that the disc has herniated over hours to days rather than all at once. As far as possible, prevent your dog from running and jumping during early recovery (see below for more guidance on this). We occasionally hear of dogs who start off mildly-affected, but then suddenly get much worse just after jumping off a sofa or chasing across a room.
Home care for IVDD dogs who cannot walk
Whether or not your dog has had an operation, good recovery requires a combination of medicine (including painkillers), nursing care, specific home care and exercise therapy.
You’ll need to set up a large crate or pen to help keep your dog safe (see below). It’s also sensible to get hold of a fixed-length lead and a chest harness. These precautions will help your dog to avoid risky activities. In particular, it’s important that your dog doesn’t drag himself about the house, otherwise dragging will soon become a habit and make it difficult for him to learn to walk properly again.
These dogs are however 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.
Set up a “safe space” for your dog
It’s important to set up 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 jump out. Many dachshunds do well in an indoor pen.
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 from settling down. Here’s a list of things to avoid:
- 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 may need to lift your dog over a shallow doorstep or raised threshold, especially if your dog is a short-legged breed)
- Ball games
- Being let outdoors unsupervised. Safety tip: 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 later 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:
- 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 will probably need to use a hindquarter sling to support his rear end. 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 1-2 minutes at a time). Ask your vet to advise you. Keep your dog on a lead whenever outdoors. If he’s likely to run, then he may also need to 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 (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” for your dog 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:
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:
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” (to pee and poo). 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 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 five minutes 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:
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:
Physiotherapy to help recovery
If your dog is not walking normally, then a tailored exercise programme is indicated from the start. This will help him recover by practising basic coordinated activities (e.g. getting up, standing, sitting and stepping). It’s essential that any exercises are performed safely and correctly. Ask your vet to refer your dog to a canine physiotherapist who is experienced in neurological cases.
Is my dog getting better?
If your dog has been unable to walk, then do not expect a sudden overnight recovery. Improvement is expected to be gradual. We would hope to see at least a little improvement each week, though full recovery can take months. Signs of improvement can be quite subtle:
- Reappearance of voluntary leg movement if this wasn’t there before. 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 and adjust the exercise programme accordingly.
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:
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. Dogs typically start to walk within 1-3 weeks following a spinal operation, though some dogs take longer than this. Without an operation, it may take your dog weeks to months to start walking, though there should at least be small signs of improvement each week (see above). If your dog is not improving as expected then ask your vet for advice. Physiotherapy can be very useful in many of these cases. In others, spinal surgery may be the best option. If your dog has already had an operation but is still not recovering, then discuss this with the surgeon.
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. A change to the treatment plan could be necessary.
If your dog is not getting worse but not really improving over time, then it’s worth discussing this with your vet. Failure to improve may mean that the non-surgical treatment programme needs adjusting, or may eventually mean that an operation becomes the preferred option.
Other problems: If your dog goes off his food, starts vomiting, develops diarrhoea, starts drinking much more than before, or has difficulty peeing, then ask your vet for advice.
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 Association, 241(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 Practice, 24(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 surgery, 31(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 practice, 43(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 neurology, 235(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 Association, 231(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 Association, 227(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 Association, 248(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 Association, 236(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 Diseases, 52(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 surgery, 36(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 Care, 17(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.
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.
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To book a physiotherapy session with The Rehab Vet (Herts, UK) or for other one-to-one support, please contact me here.</