Why your IVDD dog should not see the chiropractor
written for Dodgerslist by
Dr. Andrew Isaacs, DVM Diplomate ACVIM (Neurology
Dr. Jared Galle, DVM Diplomate ACVIM (Neurology)
Extreme caution should be exercised
when considering chiropractic and VOM therapy for a chondrodystrophic dog (Dachshund, Beagle, Basset Hound, Shih Tzu, Pekingese, Lhasa Apso, etc.) with clinical signs suggestive of intervertebral disk disease (IVDD).
This is especially true in those with neurologic deficits (knuckling over paws, weak, wobbly, paralysis) because it could aggravate an existing disk herniation. While this is a controversial topic, you should be educated about IVDD in chondrodystrophic breeds and the risks associated with chiropractic therapy.
There is a significant difference
between a chondrodystrophic dog with a herniated disk and a human with a “bad disk,” “slipped disk,” or “bulging disk.” Two important differences are dogs’ anatomies and that dogs do not understand “take it easy and rest for a couple of weeks.” A poor understanding of these differences often results in dogs being treated with human recommendations, which can lead to catastrophic results.
Several questions should be answered when determining if chiropractic therapy is an appropriate treatment for a chondrodystrophic dog with IVDD.
- Is the dog showing neurologic signs or deficits?
- How much disk material has herniated (ruptured)?
- Is the spinal cord compressed?
A thorough neurologic exam and advanced imaging of the spine (MRI/CT/myelogram) help answer these questions.
Patients suspected of having a herniated disk
that exhibit neurologic deficits should be examined by a specialist (neurologist or surgeon) before any chiropractic adjustment is done. Neurologic deficits indicate that the nerve fibers in the spinal cord are not working correctly. This commonly occurs with a herniated disk that compresses the spinal cord. The severity of the neurologic deficits does not indicate the amount of herniated disk material or the degree of spinal cord compression. Therefore, the risk with performing a chiropractic adjustment on these dogs is that it could cause more disk material to herniate and further compress the spinal cord. This could lead to a deterioration in neurologic function (i.e., weaker, paralyzed), necessitating emergency surgery.
Advanced imaging of the spine helps answer questions #2 and #3. Imaging confirms whether a disk has herniated, how much disk has herniated, and if the spinal cord is compressed. Chiropractic therapy may be safely recommended if a herniated disk can be eliminated as the cause for the clinical signs. Chiropractic therapy would not be recommended if the patient has a herniated disk and if the spinal cord is compressed.
An important point concerning chiropractic therapy
as a treatment for IVDD is that a lack of neurologic deficits does not exclude spinal cord compression. We have seen several chondrodystrophic breeds that present with back pain as the only sign and have significant spinal cord compression on an MRI. Therefore, we do not recommend chiropractic therapy in chondrodystrophic dogs that present with back pain alone for fear of causing more disk to herniate.
So how should chondrodystrophic dogs with suspected IVDD be treated?
Ideally, a neurologic examination and diagnostic work-up should be done if a herniated disk is suspected or if the patient has neurologic deficits. If the MRI or CAT Scan shows severe spinal cord compression, surgery to remove the herniated disk material is recommended. This facilitates a quicker and more complete recovery. If imaging does not show severe spinal cord compression, medical management (crate rest, medications) may be recommended. If advanced imaging and/or surgery is not feasible, medical management can be attempted. However, chiropractic therapy is NOT an advisable component of medical management for a chondrodystrophic dog with clinical signs suggestive of IVDD because of the risk of worsening an existing herniated disk.
Dr. DiVita and Dr. Wong discuss the effectiveness of chiropractic therapy for patients with IVDD or suspected IVDD in video clip below: