Dogs

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Intervertebral Disc Disease

Intervertebral disc disease (IVDD) or “a slipped disc” is one of the most common spinal cord conditions in the dog. Between the bones of the spine (vertebrae) are discs (intervertebral discs) composed of a fibrous capsule and a gel-like centre.

These discs act as cushions and shock absorbers.

IVDD is a general term describing where the disc protrudes into the spine from it’s normal position into the spinal canal, compressing the spinal cord.

Three types of IVDD occur in the dog

-       Type I arises with hardened or calcified disc gel squirting out of a burst capsule to compress the cord

-       Type II arises with degeneration of the entire disc causing it to bulge into the canal to compress the cord

-       Type III is a non-compressive herniation where a small amount of disc material shoots out at high velocity to hit and damage the cord.

Clinical Signs

Type I is mainly seen in 3-6 year old dogs with short legs and long backs, such as the dachshund, shih tzu, beagle and cocker spaniel. Onset of signs is typically sudden

Type II is mainly seen in older, larger breeds of dog such as German shepherds and Labradors. Onset of clinical signs is often slow and progressive over weeks to months.

Type III have sudden onset of signs.

Neurological signs depend on the site of disc herniation and degree of cord injury

Signs often occur in progressive stages

-       Mild compression or injury may cause only pain

-       More severe compression or injury causes an unsteady gait and weakness (paresis)

-       As the spinal cord injury worsens, the dog may lose the ability to move his legs (paralysis) and may be unable to urinate voluntarily

-       With the most severe injuries, dogs are unable to feel any pain to their toes. This is called loss of deep pain sensation and is important in determining prognosis

Some dogs may progress through these stages rapidly but the degree of cord compression does not always correlate with the severity of the signs

Compression of the neck causes signs in all four legs, whilst compression in the chest or back region (more common) causes signs in the back legs only.

Diagnosis

A thorough clinical and neurological evaluation is vital

X-rays may be used to rule out other possible causes such as vertebral fractures, but will not normally show up herniated disc material. They can appear normal in even a dog with severe IVDD and cannot aid in planning surgery

Myelography involves injecting a contrast fluid into the spine to aid in locating a compression but is not 100% accurate

Magnetic resonance imaging (MRI) is by far the best method to both diagnose IVDD and locate the site of injury prior to any planned surgery

Treatment

Treatment options consist of conservative and surgical therapies

The degree and duration of neurological signs are important in deciding the best course of action

Conservative treatment can be tried in dogs that have mild pain or inco-ordination that can walk but unsteadily (ataxia). Dogs with type III compressions are also treated conservatively as there is no compression of the spinal cord to relieve

Conservative therapy consists of

-       Exercise restriction with strict confinement and limited leash walking for toilet purposes only for 4-6 weeks

-       Anti-inflammatory drugs

-       Pain-killers

Surgical treatment is usually chosen for dogs with more severe, or worsening, neurological problems. It is also considered in dogs with pain that will not resolve.

Surgery involves removing a portion of bone to allow access to the cord at the site of compression. The offending disc material is gently removed, thereby relieving spinal cord compression

Good nursing care is required after surgery to allow proper recovery

Follow up and prognosis

Recovery time depends on severity and duration of clinical signs.

Most dogs with only mild or moderate pain will recover without surgery, but prognosis for more severely affected dogs treated with conservative therapy is poor.

Typically dogs treated with surgery recover after 1-2 weeks, but severely affected dogs may require months to regain leg and bladder function.

Some severely affected dogs never walk again, and may have persistent urinary incontinence.

Maximal improvement occurs by 3 months after the initial onset and further improvement after this time is unlikely

Deep pain sensation (DPS)is an important prognostic tool for determining whether surgery will help, and prognosis is very poor in dogs that are paralysed and have no DPS. If treated surgically within 24 hours of onset, dogs with no DPS have a 50% chance of regaining the ability to walk, but chance of success lessens with further delay.

Some dogs can have recurrence of IVDD, with other discs developing the disease along the spine.