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Surgery Considerations

The information on this page was reviewed for correct medical
information by Dr. Isaacs, DVM, ACVIM (Neurology)  April 2013

   Quick overview surgery vs. conservative treatment

When surgery is a consideration
If your dog can't walk OR with STRICT crate rest, neurological functions worsen and are lost (legs and bladder control)
STRICT crate rest is employed and after several attempts to go off of the anti-inflammatory, the pain returns
If 100% STRICT crate rest has been employed and pain medications have been adjusted (dose, frequency, and mix of pain relievers) yet the pain can’t be brought under control

if a dog is experiencing similar signs of neck or back pain, or mild neurological deficits for the 3rd or 4th time, meaning it may be the same disc is involved.






As damage to the spinal cord increases, there is a predictable stepwise deterioration of functions. When nerve healing begins, often it follows the reverse order.
1. Pain caused by the tearing disc & inflammation in the spinal cord
2. Wobbly walking, legs cross
3. Nails scuffing floor
4. Paws knuckle
5. Legs do not work (paralysis, dog is down)
6. Bladder control is lost
7. Tail wagging with joy is lost
8. Deep pain sensation, the last neuro function, a critical indicator for successful surgery.
 [Making Sense  of the Neuro Exam]

After a dog is paralyzed, the existence of deep pain sensation is an indicator that surgery could STILL be successful. That window of time is 12-24 hours from losing deep pain sensation (DPS). Even after that window of time, surgery is often successful. The spinal cord is very fragile, the more hours after the window, the less chance of a complete recovery.

Unfortunately, general vets do not see enough cases of IVDD daily, to become really proficient in giving the neuro exam and correctly interpreting what they see.  Therefore precious time can be lost in wrongly identifying deep pain sensation. Only take the word of a board certified neuro (ACVIM) or ortho (ACVS)  about DPS. 

No- or low-interest credit for veterinary costs can be obtained from Care Credit. You find out online if you qualify.

Surgery on the spinal cord takes a well-trained surgeon for this most delicate and tricky of surgeries. You can find board-certified neuro (ACVIM) and ortho (ACVS) surgical specialists at university vet teaching hospitals and in private hospitals. Find Veterinary surgeons (ACVS) and neuro surgeons (ACVIM) here: http://find.vetspecialists.com

Board Certified Dr. Wong, DVM, ACVIM (neurology) uses microscope-aided surgery to skillfully remove the offending disc material away from under the compressed (narrowed) area of the spinal cord in the video clip below:

Surgery compared with conservative treatment

Surgery immediately removes the offensive disc material and stops the pressure on the spinal cord. Immediate neuro improvement may or may not come during the 6 weeks of post-op rest… as nerves may take more than 6 weeks to heal… in fact there is no time limit for nerves to heal.  There may be temporary neuro setbacks caused by the swelling the surgical procedure itself causes. Surgical swelling likely will subside in two weeks  so that the true direction of nerve healing can better be seen.  Dr. Isaacs, DVM, ACVIM (Neurology) addresses Dodgerslist members' questions on surgery http://www.dodgerslist.com/literature/surgery.htm

The following has been compiled via observations surgeons and IVDD knowledgeable vets suggest for treatment.  Not all veterinarians will treat the same way. Follow the advise of your board certified surgeon when surgery is to be considered.

Surgery
  • Surgery is an invasive treatment with  trauma to the body and includes surgical-associated risks; no guarantees of return of neuro functions.
  • It immediately removes the offending disc material and the pressure on the spinal cord.
  • Surgery results can be very successful if performed early on a downed dog and by a board certified neruro or ortho surgeon
  • There is a window of 12-24 hours after paralysis plus loss of deep pain sensation that surgery could still be successful.  
  • The more hours that pass after 24 hours the less chance for full recovery.
  • Nerves are the slowest part of the body to heal. Nerves can take weeks, months or even a year+ to regrow and return function.
  • Because offending disc material has been removed PT can be started as soon as the surgeon directs during 6 weeks of post-op crate rest.
  • Acupuncture or laser light therapy helps to relieve pain and stimulate nerves to heal, it can be started at any time.
  • Costs vary widely across the country from $2500 to $8000 for a CT, MRI or myelogram, the surgery and the hospital stay of 2-5 days.
  • Reported costs of surgery

Conservative Treatment
  • Is not invasive, avoids surgical risks;  no guarantees of return of neuro functions.
  • Good prognosis with mild symptoms and even those with deep pain sensation still intact may be able recover nerve function.
  • Depends on an anti-inflammatory to reduce swelling in the spinal cord. Some dogs can get the swelling down in a couple of weeks others need a steroid for more like a month. Glucocorticoids are synthetic versions of the body's naturally occurring steroid, cortisol. Steroids are basically the most powerful anti-inflammatories when dealing with IVDD. Most often used when there has been loss of neuro functions (i.e. legs, bladder control)
  • NSAIDs (non-steroid anti-inflammatories) are also used most often when neuro functions are intact and there is pain only.
  • Depends on owners commitment to time of 8 weeks of little movement to allow the disc itself to heal and form good scar tissue, waiting til after crate rest for any active PT rehabilitation.
  • Nerves are the slowest part of the body to heal. Nerves can take weeks, months or even a year+ to regrow and return function.
  • Acupuncture or laser light therapy helps to relieve pain and stimulate nerves to heal, it can be started at any time.
  • Medications can be as low as $4 for each prescription with generic programs at Walmart, Target and local grocery store pharmacies.
  • There are other diseases that can mimic a disc problem, your vet will rule those out with appropriate tests.



Disclaimer:
This information is presented for educational purposes and as a resource for the Dachshund community. The coordinators are not veterinarians or health care professionals. Nothing herein should be interpreted as medical advice and all should contact their pet care professionals for advice. The coordinators are not responsible for the substance and content contained herein and do not advocate any particular product, item or position contained herein.


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