Emergency info: conservative or surgery decision

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Quick review for disc episode treatments

Conservative treatment (non-surgical) uses an anti-inflammatory medication + pain meds to provide comfort + rest for disc healing

As the inflammation around the spinal cord resolves, pressure on the cord is relieved. 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 from weeks to close to a year out.

Surgery immediately removes the offensive disc material

The surgery relieves the pressure on the spinal cord. Immediate neuro improvement may or may not come during the 4-6 weeks of post-op rest. This is because nerves in many cases take more than 6 weeks to heal. In fact there is no time limit for nerves to heal. There often can be a temporary neuro setback caused by the swelling the procedure itself causes. Surgical swelling likely will subside in two weeks so that the true direction of nerve healing can better be seen.

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.

Monitoring Neuro Damage

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:

Pain caused by the tearing disc & inflammation in the spinal cord
Wobbly walking, legs cross
Nails scuffing floor
Paws knuckle under
Legs do not work (paralysis, dog is down)
Bladder control is lost (leaks on you when lifted)
Tail wagging with joy is lost when specifically doing some happy talk to your dog
Deep pain sensation (DPS), the last neuro function, a critical indicator for nerves to be able to self heal after a surgery or with conservative treatment..
If surgery is not an option (for whatever reason such as dog’s health or family finances) 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 (DPS). 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.

Consider the two treatments: pros and cons

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.

Compare the two IVDD disc disease treatments for a disc episode

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

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 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 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 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 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. 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 for the two IVDD disc disease treatments

Surgery costs vary widely across the country from $4000 to $12000+ 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).