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Canine Intervertebral Disc Disease

Canine intervertebral disc disease (IVDD) is a common problem seen mostly in chondrodystrophoid breeds, such as the Dachshund, Pekingese, Shih-tzu, and Lhasa-apso.  Other commonly affected breeds include the American Cocker Spaniel, Boston terrier, Poodle, Basset Hound, and Miniature Schnauzer.  The Dachshund has by far the highest breed incidence, with a risk for IVDD that is 10-12 times higher than that of any other breed.  Approximately 85% of dogs with IVDD are between three and eight years old.

The spine is comprised of several vertebrae, which make up the bony column that supports and protects the spinal cord.  An intervertebral disc separates each vertebrae, and functions to cushion the spine and increase flexibility.  Intervertebral disc disease has two forms, disc protrusion and disc extrusion (other common terms include prolapsed, slipped, herniated or ruptured discs).  Diseased intervertebral discs occur in the previously mentioned breeds due to biochemical changes at a young age.  In fact, approximately 80% of Dachshunds have at least one diseased, or mineralized, intervertebral disc by two years of age.

Rupture of an intervertebral disc can result in a variety of signs and progression, which range from pain only to complete paralysis.  These signs may progress very rapidly (minutes) or may have a chronic (days to weeks) onset. IVDD can lead to lifelong, severe neurological deficits and paralysis.  Therefore, do not delay seeking veterinary care and treatment when signs of back/neck pain, difficulty walking, stumbling, weakness or paralysis are noted.   

In general, IVDD can be separated into two anatomic regions, cervical or thoracolumbar.  Cervical IVDD occurs in approximately 15% of IVDD cases.  The most commonly affected regions in small breed dogs are the C2-3 and C3-4 intervertebral discs.  These dogs show signs of neck pain, unwillingness to look up or move their head, reluctance to go on walks, unprovoked crying, quivering or tremors of the neck and shoulder muscles.  They may become weak or paralyzed in all four limbs.  Some dogs with cervical IVDD will only show signs of a “pinched” nerve.  These dogs may hold one of their front legs off the ground or limp.

Thoracolumbar IVDD most commonly occurs at or near the junction of the ribs and lower back.  This type of IVDD accounts for 85% of all IVDD cases, and can be a very devastating disease leading to severe neurological dysfunction.  Dogs suffering from IVDD typically have signs of back pain (arched back), and have incoordination or weakness of the hind limbs.  Advanced cases may be unable to walk, and may have complete paralysis of the hind limbs.  As a result, these dogs are also unable to urinate or defecate voluntarily.  If your dog cannot walk, or has not urinated in over eight hours, you should contact your veterinarian immediately.   

Treatment of IVDD is usually determined by the severity of pain and neurological deficits.  Two options exist for treatment, conservative and surgical management.  Conservative management consists of anti-inflammatory doses of steroids, muscle relaxants, and strict rest.  Pain medications may also be required to keep your dog comfortable.  It is important to avoid non-steroidal anti-inflammatory drugs (aspirin, Rimadyl, Deramaxx) and drugs that inhibit clotting (aspirin, Adequan, heparin) if future surgical intervention is contemplated.

Surgical management is indicated in dogs that have severe or persistent pain, moderate or severe neurological deficits (weakness or paralysis), or progressive neurological signs.  Prior to surgical management, several diagnostic procedures must be performed to locate the site of the ruptured disc.  These diagnostics include blood work, x-rays, and a myelogram (contrast study) or an MRI.  Surgery typically consists of a procedure to “decompress” the spinal cord.  This procedure relieves the compression placed on the spinal cord by the ruptured disc. Bruising and swelling of the spinal cord can and, in most cases, will heal over time.  This healing can take between six and nine weeks, depending on the severity of the neurological signs.

Surgery and anesthesia does unfortunately have risks and potential complications.  As with neurosurgery in people, the spinal cord is very delicate.  Specially designed equipment and special training has led to complication rates that are low, but the risks of infection, surgery and anesthesia can never be completely eliminated.  Utilizing the newest and safest anesthetic agents and monitoring equipment minimizes anesthetic risks, and a dedicated anesthetist continuously monitors each case.

Overall prognosis of return to function depends on the severity of the neurological deficits prior to surgery.  Dogs that have sensation in their feet (deep pain) will have an 85-90% chance for successful recovery when taken to surgery within 24 hours of the onset of signs.  Dogs that have an absence of deep pain perception have a worse prognosis, and this prognosis is also time related.  Dogs that have a loss of deep pain perception for <12 hours have approximately a 50% chance for recovery.  This is compared to a 25% chance for recovery if deep pain perception is lost for 12-36 hours.  Dogs with a loss of deep pain perception for >36 hours have approximately a 5% chance of recovery.  Recurrence of IVDD is very uncommon, and is most commonly seen in Dachshunds.  Approximately 3-5% of dogs will require surgery due to a ruptured disc at a second site.  We recommend lifestyle changes, such as weight loss and eliminating unnecessary jumping, to help reduce the risk of subsequent surgery.

In summary, canine IVDD can be a devastating disease.  Nevertheless, treatment options exist for every case, and successful outcomes can often be achieved.  Time is of the essence in many cases, therefore it is important to seek veterinary care immediately if you suspect your dog has ruptured an intervertebral disc or is showing signs of back or neck pain.

Dogs that have had surgery for IVDD usually will require in-home assistance for 4 to 6 weeks.  Assistance may include walking the dog outside with a sling, providing physical therapy, exercise, and monitoring urinations.   
       

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