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Myelogram vs. MRI vs. Xrays
Neuro Corner Answers
Dr. Andrew Isaacs
DVM Diplomate ACVIM (Neurology)
Dogwood Veterinary Referral Center
Primary interests include intervertebral disc disease, seizure management, luxations/fractures of the spine, and surgery for brain tumors
Question
ELLEN ASKS:
When is a myelogram warranted versus an MRI versus regular xray?
ANSWER
Regular X-rays (radiographs) are good for evaluating bony abnormalities (fractures, infection of the bone, tumors of the bone). A healthy intervertebral disk and spinal cord are not visible on a radiograph because they are soft tissue and not bone.
Sometimes an unhealthy disk (degenerative) will become mineralized and this can be seen on the radiograph.
A myelogram is a radiograph, but a contrast agent has been injected around the spinal cord. The contrast agent is a liquid that shows up on the radiograph and highlights around the spinal cord. If something is putting pressure on and compressing the spinal cord the myelogram helps one visualize this.
An MRI uses technology completely different than radiographs and myelograms. It is better at imaging soft tissue than bone. It also allows for a better evaluation of the spine because it provides images in three planes while a myelogram only provides images in two planes.
In general, radiographs are a good screening tool, but not reliable enough to diagnose a herniated intervertebral disk and decide if surgery is warranted.
A myelogram is a good and typically less expensive way of diagnosing a herniated intervertebral disk and deciding if surgery is warranted. It does carry with it some risk (contrast is injected around the spinal cord) and it is not as good as an MRI in evaluating diseases other than herniated intervertebral disks that can cause problems with the spinal cord.
An MRI is the gold standard for imaging the spine. Because of the excellent soft tissue detail and the a ability to get images in all three planes.
Andrew
Multiple surgeries
Neuro Corner Answers
Dr. Andrew Isaacs
DVM Diplomate ACVIM (Neurology)
Dogwood Veterinary Referral Center
Primary interests include intervertebral disc disease, seizure management, luxations/fractures of the spine, and surgery for brain tumors
Question
LISA ASKS:
I recently became associated with Dodgerslist and am thankful for the support and community it provides dachshund owners like myself. My little guy, Bailey, is just about to turn nine.
He has undergone two IVDD surgeries; one about four years ago and the other about a year and a half ago. He recovered from both very well.
Recently, he has shown signs of beginning herniation again unfortunately. I’d like to note here that we keep Bailey from any steps or jumping at all! I know that sounds defensive but I love my dog greatly and I would never put him in an environment to exasperate his disease. Nonetheless, he is currently undergoing another episode. He is currently taking a tapering dose of prednisolone along with gabapentin and tramadol. We are about five days into the medication and he appears to be doing much better and seems to not be in any pain. We are not allowing him to move other than potty breaks so it seems the medical management may be working.
My questionis IF he doesn’t recover through the medical management or even encounters a future episode after this, is a third surgery an option… is it cruel? It seems like a lot to put him through but I will do everything to treat my buddy and am not asking from a financial perspective but more from a realistic perspective.
Thank you for any advice you may have and thank you so much for taking my question.
ANSWER
A third surgery is not cruel. Ultimately, you as Bailey’s advocate are the best to make the decision about his quality of life, but by no means would a third surgery be cruel. I would try to see how well he does with the conservative medical management, but if he does not respond or declines the next step would be to purse imaging to see what you are dealing with.
Andrew
Fenestration, why only adjacent discs?
Neuro Corner Answers
Dr. Andrew Isaacs
DVM Diplomate ACVIM (Neurology)
Dogwood Veterinary Referral Center
Primary interests include intervertebral disc disease, seizure management, luxations/fractures of the spine, and surgery for brain tumors
Question
REBECCA ASKS:
What is the reason behind only the immediate discs either side of an extrusion being fenestrated?
ANSWER
Rebecca,
Good question – fenestration of the disks on either side of the herniated disk is more a general rule rather than a hard and fast one.
There are multiple variables at play in deciding if fenestration is warranted and which disks to fenestrate (length of surgery, location of surgery, health of intervertebral disks, surgeon’s comfort with fenestration, surgeon’s opinion about benefits of fenestration, etc).
Fenestration requires exposing the disk to be fenestrated. When performing decompressive surgery the adjacent disks are already exposed in the surgical site and require relatively little additional dissection to fenestrate. To fenestrate disks, other than the adjacent ones, the surgery site would need to be enlarged (adding more time and tissue trauma). However, if a mineralized/degenerative disk is noted two disk spaces away fenestration is sometimes performed.
Andrew
Conservative treatment first?
Neuro Corner Answers
Dr. Andrew Isaacs
DVM Diplomate ACVIM (Neurology)
Dogwood Veterinary Referral Center
Primary interests include intervertebral disc disease, seizure management, luxations/fractures of the spine, and surgery for brain tumors
Question
LAUREN WRITES:
My dog Alexis is 8 years old and has had 3 surgeries for IVDD so far. The first was in her back when she was about 5, then at about 6 she had her first one in her neck, and a second on the neck recently in the spring when she was 8. Our neurologists tells me this is very rare for them to need 3 however she still shows signs of it possibly being needed again in the future. We have days where I have to give pain medicine because she is obviously in pain from her IVDD. She has also been having painful nerve episodes where she hold her front leg out to the side, cries in pain, and wont move for about a min then it goes away. I guess I want to make sure that I’m doing the right thing by continuing to do so many surgeries and wondering how many times this will happen? Are these nerve pain episodes a sign that another disk is beginning to herniate? She has done well and fully recovered from each surgery and we take all the precautions to keep her from jumping and being too active for her back to handle.
ANSWER
I’m so sorry to hear about Alexis. Unfortunately, even with taking the precautions you have, we occasionally see dogs that herniate more than one disk in their lifespan to the point of requiring multiple surgeries.
It’s similar to people getting struck by lightening. It’s unusual to get struck once, but then you hear about people that have been struck multiple times. Also, if you do not take precautions there is a greater chance of getting struck multiple times.
Ultimately, it comes down to trying to do what you can to give him a good quality of life. If he has responded well in the past there is no reason to not consider surgery this time.
I would want to exhaust medical management first, which it sounds like you are. To help decide if surgery would be helpful advanced imaging (MRI or CT/Myelogram) would warrant consideration if he is not responding to medical management. Then, with additional information, you can make an informed decision with his best interest in mind.
[Editor’s NOTE: Tips and ideas to provide good crate rest recovery during medical management (conservative treatment) or after a surgery: https://dodgerslist.com/strict-rest-recovery-process/ ]
MRI: potential surgery vs conservative
Neuro Corner Answers
Dr. Andrew Isaacs
DVM Diplomate ACVIM (Neurology)
Dogwood Veterinary Referral Center
Primary interests include intervertebral disc disease, seizure management, luxations/fractures of the spine, and surgery for brain tumors
Question
ANDREA ASKS:
Due to cost we must treat our dachshund’s back problem conservatively. My husband is wondering if an MRI can show whether conservative treatment is enough, or conversely if surgery is the only option?
ANSWER
An MRI lets us know the degree of compression that is present. If there is severe compression the chance that medical management will work is less than if the compression is mild. So, a broad general response is yes, the MRI lets us know more about the cause and potential response to medical versus surgical management. That being said, I have seen some Dachshunds respond to medical management when ideally surgery was warranted due to severe compression.
Possible for an MRI to miss a disc problem
Neuro Corner Answers
Dr. Andrew Isaacs
DVM Diplomate ACVIM (Neurology)
Dogwood Veterinary Referral Center
Primary interests include intervertebral disc disease, seizure management, luxations/fractures of the spine, and surgery for brain tumors
Question
LINDA ASKS:
Has there ever been a time when an MRI didn’t show a herniated disk yet when you did the surgery you found one?
ANSWER
An MRI is a good diagnostic tool. However, just like any diagnostic test it is not able to provide us with a diagnosis 100% of the time. Image quality with MRI is subject to motion artifact and the size of the dog. Therefore, to obtain a good image the dog ideally should not be moving and be the size of a human. However, the fact that a dog is a dog and not human in conjunction with the fact that we want the dog alive (breathing and blood circulating) leads to artifact that sometimes makes interpretation of the image difficult. In circumstances where the MRI does not provide us with a diagnosis we will use a myelogram. If we see a compressed spinal cord we will then perform surgery.
Expected time for nerve healing
Neuro Corner Answers
Dr. Andrew Isaacs
DVM Diplomate ACVIM (Neurology)
Dogwood Veterinary Referral Center
Primary interests include intervertebral disc disease, seizure management, luxations/fractures of the spine, and surgery for brain tumors
Question
CIARA WORRIES ABOUT THE FUTURE AFTER A SURGERY:
My dog is currently in recovery, he had deep pain sensation before surgery as far as I was aware.
The vet said they are happy with him and the surgery but he hasn’t regained motion in his legs yet but it has only been 29 hours.
I am obviously very worried and I’m hoping to see signs of improvement. If he does walk again can I still take him on walks when he is better? And is he more likely to re learn that he needs to pee than to walk? I just want him to be ok and pain free and if that means wheels that is ok too. It’s not ideal but which comes first, bladder control or walking?
Thank you for taking the time to read this I just need some answers I hope I have provided enough information. ~Ciara
ANSWER
Ciara, hope all is going well with your dog. I know it is hard, but the time that sets the tone for his recovery is the first 2 to 4 weeks after surgery. Not that there is not continued improvement after 2-4 weeks, but I would not want you to get discouraged until at least 2-4 weeks have gone by without any signs of improvement – the spinal cord takes time to heal.
You definitely can take him on walks when your vet lifts the post-operative restrictions. The key is to make sure your dog is on a leash with harness to help prevent higher impact movements on the walk.
Typically, we will see dogs start to voluntarily urinate when they start to get movement in their legs. It does not have to be enough movement to walk though. So, urination usually precedes walking.
Please let me know if you have any other questions.
Andrew Isaacs, DVM
Diplomate ACVIM (Neurology)
Leg spasms-kicking
Neuro Corner Answers
Dr. Andrew Isaacs
DVM Diplomate ACVIM (Neurology)
Dogwood Veterinary Referral Center
Primary interests include intervertebral disc disease, seizure management, luxations/fractures of the spine, and surgery for brain tumors
Question
DAWN ASKS:
My 10 year old Doxie is an IVDD survivor. She had surgery 5 years ago and made a full recovery . Lately she has been having some leg spasms. Left hind leg. Spasm is the best way I can describe it. The back leg kicks back and out several times. I’ve noticed this a few times in the past where it happened and the it was over. However tonight it has been happening frequently. Could this be related to IVDD? She does not appear to have any other symptoms or be in any discomfort . I have an apt with her neurologist next week. And I think I will call the place she did rehab therapy after surgery. I would love some input of this is normal or should be of concern. Thank you
ANSWER
Dawn, this is a good question. It is not unusual for us to see some dogs develop chronic upper motor neuron (UMN) reflexes post IVDD episodes. Depending on the degree of the injury the reflexes in the legs can get up regulated leading to exaggerated/hyper reflexes. This may be the case with your girl, but it definitely would be worth having the neurologist examine her just to make sure there is nothing new going on. It can be difficult, but if you are able to get video of the episodes it can help in determining the cause.
Please let me know if you have any other questions.
Take care,
Andrew
Laser Disc Ablation (LDA)
Neuro Corner Answers
Dr. Andrew Isaacs
DVM Diplomate ACVIM (Neurology)
Dogwood Veterinary Referral Center
Primary interests include intervertebral disc disease, seizure management, luxations/fractures of the spine, and surgery for brain tumors
Question
JUDY ASKS:
I would appreciate any info you can give me on LDA. I’m considering it for my 4 yr. old doxie Ruby who has had a flare-up every six months since she turned 3. I live in the Dallas area which is one of two places in the US where the procedure is performed. Her last episode was in July 2011 – she’s had 8 weeks of crate rest & meds each time with complete recovery but she’s a very active dog.
ANSWER
Prior to having LDA performed I would advise advanced imaging (MRI, CT, Myleogram) of the spine. This would provide a definitive diagnosis and knowledge that you are addressing the true cause of the clinical signs. LDA will not address herniated disk material within the spinal canal compressing the spinal cord. It is a prophylactic procedure. With the prior history of flair-ups there is the potential disk material has already herniated. Therefore, decompressive surgery may be warranted and fenestration can be performed intraoperatively killing two birds with one stone.
Laser Light Therapy Contraindication
Neuro Corner Answers
Dr. Andrew Isaacs
DVM Diplomate ACVIM (Neurology)
Dogwood Veterinary Referral Center
Primary interests include intervertebral disc disease, seizure management, luxations/fractures of the spine, and surgery for brain tumors
Question
LINDA WOULD LIKE TO KNOW:
Are there are any situations that laser light therapy would not be recommended for pain and nerve stimulation during a disc episode?
ANSWER
Linda, laser therapy is contraindicated for use with tumors.
So, this is why it would be ideal to perform diagnostics (and rule out a tumor) prior to using laser therapy.
Granted, in some cases where finances are limited and the index of suspicion is great enough for a disk herniation laser can be used, but the owner should be made aware of the potential deleterious effects if it is not a disk.
[Editor’s note: It is known laser light energy promotes a reaction which increases cellular metabolism. Activity of tumor cells could also increase with laser light therapy.]
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