Conservative vs surgery -IVDD disc disease treatments

Imaging and diagnosing

• Surgery requires the exact location of the disc in order to plan the procedure. X-rays do not show the necessary detail of soft tissue (disc and spinal cord). Advanced imaging of a CT, MRI, or myelogram shows hard tissue of bone as well as the disc and spinal cord.
• Conservative treatment. Most often, a vet diagnoses a disc episode by considering four things: 
  
   1) The dog’s history of a previous disc episode.
   2) The way the dog acts at the vet visit.
   3) If the dog is a breed prone to IVDD.
  4) The hands-on neuro exam.
  
    If there is a high suspicion of another disease rather than IVDD, your vet will rule those out with an X-ray. For example: dog fell and may have fractured vertebrae, a tumor, bone infection, etc. X-rays do not show soft tissue such as disc or the spinal cord and therefore can not prove a disc episode. Under conservative treatment, all discs receive the same care of limited movement. Thus, no need to know which disc(s) is involved.

Guarantee and risk for the two IVDD disc disease treatments

• Surgery is an invasive treatment with trauma to the body and includes risks; there are no guarantees of a return of neuro functions.
• Conservative is not invasive, avoids surgical risks; there are no guarantees of a return of neuro functions.

Decompression of the spinal cord

• Surgery immediately removes the offending disc material and the pressure on the spinal cord.
• Conservative 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 (or a NSAID) for more like a month. Glucocorticoids are synthetic versions of the body’s naturally occurring steroid, cortisol.
  
  Steroids are the most powerful of anti-inflammatories when dealing with IVDD (e.g.generic: prednisone, dexamethasone, etc.) They are most often used when there has been loss of neuro functions (i.e. leg movement, bladder control).
  
  NSAIDs (non-steroid anti-inflammatories) are also used most often when neuro functions are intact and there is pain only(e.g. Rimadyl® (carprofen), Metacam® (meloxicam), etc.)
  
  ⚠️Steroids and NSAIDs are never given together nor close in time due to toxicity.

Time for the two IVDD disc disease treatments

• Surgery.  Neuro (ACVIM) or ortho (ACVS) surgeons find a window of not more than 12-24 hours from the loss of deep pain sensation (DPS) gives the best chance of spinal cord decompression which aids the body to self-heal nerves. The more hours that pass after 24 hours, it is thought the less chance for nerve function recovery after surgery. Because offending disc material has been removed, PT can be started as soon as the surgeon directs during 4-6 weeks of post-op crate rest. Trust only a board certified surgeon to determine a return of DPS. Identify easily a happy tail wag, which is the next expected neuro function to return.
• Conservative treatment depends on owner’s commitment to 8 weeks of little movement to allow the disc itself to heal and form good scar tissue. Wait until after the 8 weeks of crate rest for any active PT rehabilitation.

Nerve healing for the IVDD disc disease treatments

• Surgery. The spinal cord has a natural ability to heal itself. Nerve cells have long tendrils. Damage to the tendrils can grow back at approximately 1mm per day. The amount of nerve damage determines how much tendril regrowth  needs to happen to reach the area of the body not able to function. It is better to think in terms of many months (for some, more like a year) rather than days/weeks for nerve healing. If the spinal cord injury has been too severe, nerve function will not be able to come back.
• Conservative.  see above Surgery nerve healing

Costs for the two IVDD disc disease treatments

• Surgery costs vary widely across the country from $3000 to $8000+ for a CT, MRI, or myelogram, the surgery, and the hospital stay of 2-5 days.
• Conservative treatment includes the cost for a recovery suite (ex-pen, Pack ‘n Play, wire crate) used for 8 weeks to heal the disc. Prescription drugs are used for 7-30 days (an anti-inflammatory drug, 2-3 different pain meds, and an acid suppressor such as Pepcid AC® (famotidine).