Emergency info for decisions conservative or surgery


A quick review of the two treatments for a disc episode

Conservative (medications + rest) — Surgery to remove disc material

Conservative or Surgery

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

When surgery is a consideration:

  • If your dog can’t walk OR with STRICT rest, neurological functions worsen and are lost (legs and bladder control)
  • If STRICT rest is employed and after several attempts to go off of the anti-inflammatory, the pain returns
  • If 100% STRICT rest had 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 the body begins to self heal nerves, 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 under
  5. Legs do not work (paralysis, dog is down)
  6. Bladder control is lost (leaks on you when lifted)
  7. Tail wagging with joy is lost when specifically doing some happy talk to your dog
  8. Deep pain sensation, the last neuro function, a critical indicator for nerves to be able to self heal after a surgery or with conservative treatment..
  9. If surgery is not an option (for whatever reason) then the best option is conservative therapy. Surgery can still be successful in the window of 12-24 hours after loss of deep pain sensation. Even after that window of time, there can still be a good outcome. Each hour that passes decreases that chance. Precious hours can be lost with a vet that gets DPS wrong. If surgery is an option for your family get to a neuro or ortho where ER hours are typical night and day.
General vets who may not see enough cases of IVDD daily, may not be 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.

Financial and  locating a surgeon

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

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 in many cases 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

Conservative treatment uses a steroid or a NSAID to resolve swollen tissue

around the spinal cord to relieve pressure on nerves. With time the hope is that the disc will recede or be re-absorbed enough to no longer aggravate nerves. Both the damaged disc and nerves is something the body does to self heal.  Discs take about 8 weeks to self heal. Nerve healing may range in weeks to close to a year out.
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Quick overview: conservative vs. surgery

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 recovery suite 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.

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 to 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 STRICT rest before any active PT rehabilitation is approached.
  • Nerves are the slowest part of the body to heal. Nerves can take weeks, months or even a year+ to regrow and return function or laser light therapy helps to relieve pain and stimulate nerves to heal, it can be started at any time.
  • Medications can be low in cost by using generics rather than brand names.  STRICT rest is free.
  • 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 dog IVDD 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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