Conservative vs. Surgery

▪️When conservative treatment of meds and rest

▪️When to consider surgery

▪️Featuring: How to Monitor for Neuro Functions

Two Treatments for IVDD

Be aware of the two IVDD disc disease treatments. Learn at what point conservative treatment of meds and rest OR a surgery could be considered.

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

JUMP to comparison of the two IVDD disc disease treatments

When surgery is a consideration

If your dog can’t walk OR with STRICT crate rest, neurological functions worsen and are lost (leg movement and bladder control).
STRICT crate rest is employed and after several attempts to go off of the anti-inflammatory, pain returns.
If 100% STRICT crate rest has been employed and pain medications have been adjusted (dose, frequency, and mix of pain relievers), but 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.

Monitoring Neuro Functions

As damage to the spinal cord increases, there is a predictable step-wise deterioration of functions during a current disc disease episode. When nerve healing begins, often the reverse order of healing takes place.

Pain caused by the tearing disc and inflammation in the spinal cord
Wobbly walking, legs crossing
Nails scuffing floor
Paws knuckle  under
Legs do not work (paralysis, dog is “down”)
Bladder control is lost: leaks on you, can no longer sniff and then release pee
Joyful tail wagging upon happy talk or seeing a treat is lost
Deep pain sensation (DPS), the last neuro function, is lost

IVDD disc disease treatments – Conservative or a Surgery?

After a dog is paralyzed, the existence of deep pain sensation (DPS) indicates that surgery could STILL be successful. That window of time is 12-24 hours from losing 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. It takes practice to become really proficient in giving a neuro exam and correctly interpreting what is observed. Therefore precious time can be lost in wrongly identifying DPS. Only take the word of a board certified neuro (ACVIM) or ortho (ACVS) about DPS.

If for any reason (health issue, financial, etc.) surgery is not an option, conservative medical treatment is the best option. Typically dogs recover to a pain-free, happy and good quality of life.

Financial

Obtain no- or low-interest credit for veterinary costs from Care Credit. Find out online if you qualify.

Finding a board certified surgeon

Surgery on the spinal cord (the most delicate and tricky of surgeries) takes a well-trained surgeon. Find board certified neuro (ACVIM) and ortho (ACVS) surgical specialists at university vet teaching hospitals and private hospitals.

Find an ACVIM board certified neuro surgeon:
https://vetspecialists.com
Find an ACVS board certified ortho veterinary surgeon:
https://online.acvs.org/acvsssa/rflssareferral.query_page?P_VENDOR_TY=VETS

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

Photo: Dr. Wong surgically removing disc material from where it should not be. The escaped disc material is compressing the spinal cord (see the narrowed section of the cord).

Owner education is vital to make the right decision for which IVDD disc disease treatments: Conservative or a surgery

X-rays used to rule out other diseases

“For general practitioners, it should be noted that survey radiographs are usually not indicated when intervertebral disk disease is suspected. Although radiographs may show mineralized disks, they are not reliable because they are unable to definitively diagnose which disk is causing the problem and are unable to show the extent of any spinal cord compression.”

O’Sullivan, VMD, Glass, MS, DVM, DACVIM (Neurology) and Silver, MS, DVM, DACVIM (Neurology). “Physitis & a Fracture in an English Bulldog” cliniciansbrief.com October 2017 p 68.

What calcifications on X-rays mean

Calcified Discs: What they are and what they mean. Laurie Miller, Surgical Vet Tech

Look at the two treatments for a disc episode

The following has been compiled via observations of what IVDD knowledgeable vets suggest for treatment during a current disc disease episode about a surgery vs. conservative treatment.

Not all veterinarians will treat the same way. Follow the advice of your board certified surgeon when surgery is to be considered.

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

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 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 (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 due to toxicity.

Time

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

Surgery. The spinal cord has a natural ability to heal itself. Nerve cells have long tendrils. It takes quite a long time for the nerve tendrils to grow back (approx. 1mm per day). The amount of nerve damage determines how much regrowth of the nerve tendrils 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

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. Member reported costs of surgery
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).