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Formation of spinal cord scar tissue
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
GUADALUPE ASKS:
A dog who had NO previous herniation (not even a yelp of back pain), suddenly displayed IVDD like symptoms (pain, neuro deficit, etc). After examining the dog and a myelogram, the surgeon determined there were two bulging discs with some scar tissue material pressing on the spinal cord as the body had previously tried to heal itself.
ANSWER
Can scar tissue be formed so fast for it to be a consequence of a current herniation?
Not likely (but I never say never). However, more likely it was from another episode. The myelogram showed two sites of spinal cord compression. One was the acute disk that caused the recent decline in neuro status and the other site of compression was chronic from a previous disk herniation.
It is not unusual for us to occasionally see when imaging the spine (MRI/CT/myelogram) a disk that looks chronic in addition to the acute disk (especially in Dachshunds).
If scar tissue is a result of a previous herniation, can scar tissue be formed with a herniation so “mild” it produces practically no symptoms?
Yes
What does it take for a dog’s body to start forming scar tissue on the spinal cord?
Tissue (disk material) being where it normally should not be (spinal canal) causes inflammation and subsequent scar tissue (adhesions).
Nerve Root Signature Pain
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 WANTS TO KNOW MORE:
How many do you see with the rear legs affected by nerve root signature pain vs. the front legs?
ANSWER
“Root signature” is a term used to describe outward signs an owner or veterinarian would see secondary to irritation of the nerve roots. “Nerve roots” is a term referring to the anatomical origin of the nerves as they arise off of the spinal cord. Basically, you can think of the nerve roots as the beginning of the nerve that comes off of the spinal cord and travels down the leg. There are nerve roots in both the neck and the lower back that go to the thoracic and pelvic limbs respectively. If the nerve roots are irritated it will cause the dog to hold up the leg as if painful and can mimic a lameness.
We do see root signature in both the pelvic and thoracic limbs, but it is more common in the thoracic limbs (front legs). The reason is due to the fact that it is more likely to have a disk rupture in the cervical spine versus the lower lumbar spine.
The majority of the time lameness is due to an orthopedic disease and not a neurological disease. However, if an orthopedic cause cannot be identified, “root signature” should be considered.
There are several things that can irritate the nerve roots and cause “root signature,” but the top two are herniated/protruded intervertebral disks and tumors. If “root signature” is suspected in your dog, the two ways to proceed are either conservatively with rest and medications or to have advanced imaging performed to identify the exact cause. This decision depends on multiple variables including history and exam findings (severity of pain and concurrent neurological deficits) and is best discussed with your veterinarian.
How disc material is surgically removed
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
Questions
SUE ASKS:
If they remove the disc, what do they do in the space where the disc was? Do they put in some kind of artificial “place holder”?
SHARON WANTS TO KNOW:
Why don’t they remove all of the disc material so that it cannot rupture again in the future?
ANSWERS
Sue, when a disk herniates only a small percentage of the intervertebral disk is involved. The remainder of the disk material is still present and functioning as it should. I think the confusion comes from hearing “we will remove the disk material”. The disk material that is removed is only the herniated component that is compressing the spinal cord.
Sharon, the disk material that has not ruptured is where it should be and is serving the function to help provide cushion between the vertebrae. Therefore, we do not want to remove material that is helping serve a needed function. Also, after recovery from the surgery (4-6 weeks) the chance of the same disk herniating is very low (because the disk is no longer under pressure – similar to a balloon that has air let out of it being less likely to pop compared to one that is fully inflated).
Random episodes of pain
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
VICKIE ASKS:
After surgery for IVDD my dog will occasionally have random episodes of pain every three to six months. He jumps up, cries out in severe pain, turns around and looks at his rear end. It takes about a day for it to go away. Is this typical, why is it occurring, and what can be done about it?
ANSWER
Painful episodes are one of the more frustrating presentations we deal with. Unfortunately, there are so many potential causes of pain that it can be a difficult hunt to go on.
It would be important to have a good exam performed by your veterinarian to try and localize the source of the pain (neurological, orthopedic, abdominal, soft tissue, etc.). Depending on their exam findings it may be warranted to perform additional diagnostic (radiographs, ultrasound, blood work, etc.).
Potential causes related to IVDD surgery include residual compression of the spinal cord and/or nerve roots, and paraesthesia secondary to abnormal healing of the nerve tissue.
Residual compression
Sometimes it is difficult and risky to remove all fragments of disk material with surgery. Therefore, when your dog assumes certain positions there is the potential that the residual fragments irritate the spinal cord and/or nerve roots.
Paraesthesia (Neuropathic pain)
The other potential cause for the episodes is abnormal neuropathic pain— paraesthesia.
Paraesthesia is a sensation of tingling, pricking, or numbness of the skin with no apparent long-term physical effect. The manifestation of paresthesia may be transient or chronic. In cases of severe spinal cord injury I have seen dogs go on to develop paraesthesia. The fact that your dog had absent deep pain sensation prior to surgery is consistent with a severe spinal cord injury. Therefore, in the healing process there is the potential for signals to get “crossed” and result in paraesthesia.
If the painful episodes are not increasing in severity or frequency, associated with neurological deficits, and your veterinarian is not able to identify any other causes a drug to discuss a trial course of is gabapentin (Neurontin). If the gabapentin helps some, but not adequately, another drug to consider in the same category (but more expensive) is pregabalin (Lyrica).
Seroma a swelling around the incision
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
ROSIE’s MOM WRITES:
Has anyone here had experience with seromas over incision site following surgery? My Rosie developed one 5 weeks after surgery. She seems ok otherwise. The vet drained it and gave antibiotics but it refilled almost immediately. Has seemed to have gone down a bit already, and I read the body eventually reabsorbs it. I am just worried there is an issue with the healing or this indicates she has reinjured herself?
ANSWER
When performing spinal surgery the superficial layers of tissue are disrupted to expose the deeper structures (vertebrae/spinal cord).
After the procedure is complete the tissue layers are closed with absorbable suture. However, these layers are never apposed exactly as prior to surgery and there is the potential for serum (the fluid component of blood) to fill in the voids and create a seroma. Also, as activity is reintroduced movement can cause irritation and promote the formation of a seroma.
A seroma will appear as a swelling around the incision and feel like fluid is trapped under the skin. A seroma is not an infection. The fluid is trapped in the superficial tissue far away from the spinal cord. Therefore, it is highly unlikely to cause any significant problems.
Seromas typically resolve on their own over 1-2 weeks if the pet is kept quiet. However, it is best to have your veterinarian examine your pet to make sure nothing more concerning is occurring. Your veterinarian may advise warm compresses to help increase circulation and absorption of the fluid.
In cases not responding to conservative management, it may be necessary to drain the seroma. Rarely, if draining is not working, surgery is required to address the seroma.
The take home is if you appreciate any abnormalities with the surgical site to notify your vet. If your vet finds a seroma it is not anything to get overly concerned about and is, with the majority of cases, just a speed bump on the road to recovery.
Popping sound in the back
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
JENNIFER WRITES:
Why does my boy’s back pop sometimes? I mentioned it to my vet and then he noticed it too when he was examining him. He said he thinks it’s related to his t11 and t12 issue but acted puzzled. I notice it sometimes happens when i lift him.
ANSWER
Popping can sometimes be appreciated when articular facets are degenerative.
The articular facets are part of a vertebra that form a joint with the adjacent vertebra. The facets have cartilaginous surfaces and joint fluid enclosed by a joint capsule. It is similar to fingers or knees that will crack or pop when moved. It is unlikely the popping is directly related to the disk itself, but rather the articular facets.
Penis comes out of sheath treatments
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
TARA ASKS:
My 6 year old paralyzed doxie has started getting these huge erections where it comes out of the sheath. The few times it has happened before, I have been able to put him in a cool tub of water & it would go down. Then I used KY to get it back in. Is there a long term solution for this problem? It is getting harder to handle this as it is getting more often. Thank you! Tara.
ANSWER
Hi there,
This can be a reflex that gets upregulated with time. There are medications I would want to try first before trying any type of penile surgery.
I would want to try medical management with a benzodiazepine (like Valium) first.
Myelomalacia not anyones fault
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
RENAE ASKS:
I just lost my best friend, Chewy, a long hair brindle standard, to Myelomalacia 2 months ago. The vet wouldn’t really give me the time to explain how it may have happened or if I did something wrong, or can do something to prevent it from happening again. I have 2 other doxies, is there anything you can tell me about how to prevent something lie this happening again? Thank you so much!
ANSWER
Renae, I’m so sorry to hear about the loss of Chewy. Probably the greatest factors leading to myelomalacia is the intensity and speed of the concussive injury that occurs when the disk ruptures. Unfortunately, there is no way to modify how the disks rupture other than lifestyle changes that decrease the higher impact activities (jumping on/off sofas/beds, and up/down stairs).
Also, unfortunately there is no way to make a dachshund not a dachshund and the inherent personality that goes along with them.
So, to summarize-— do not feel bad, there is nothing that you did or did not do to cause the myelomalacia. With your other dogs the most important thing is to minimize/discourage high impact activities within reason. Take care, Andrew
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
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