Clinical presentation and outcome of dogs treated medically or surgically for thoracolumbar intervertebral disc protrusion

Abstract

To date, few studies have investigated the clinical characteristics of thoracolumbar intervertebral disc protrusion (IVDP). The aim of this retrospective study was to evaluate the presentation and outcome of dogs receiving medical or surgical treatment for thoracolumbar IVDP. Eighty-four dogs were included, with a median age of 9.4 years. German shepherd dogs and Staffordshire bull terriers were the most common breeds. Significantly more surgically treated dogs (n=53) had neurological deficits and were non-ambulatory, compared with medically treated (n=31). Outcome data were available for 27 of 31 medically managed dogs; 11 initially improved, 7 remained stable and 9 deteriorated. Of 18 dogs that initially improved or stabilised, 10 (55.6 per cent) demonstrated recurrence of clinical signs within 12 months of diagnosis. Outcome data were available for 45 of 50 surgically treated dogs that survived to hospital discharge; 34 improved, 9 remained stable and 2 deteriorated following surgery. Of 43 dogs that improved or stabilised with surgical treatment, 11 (25.6 per cent) demonstrated recurrence of clinical signs within 12 months of surgery. Overall, significantly more surgically treated dogs (71.1 per cent) had a successful outcome, consisting of sustained clinical improvement of more than 12 months duration, compared with medically treated dogs (29.6 per cent).

Comparison of medical and surgical treatment for acute cervical compressive hydrated nucleus pulposus extrusion in dogs

“…Although successful outcomes have been reported after both medical and surgical management of cervical compressive HNPE, it is currently unclear which type of treatment is associated with more favourable outcomes 5 11 13 . Previous studies have suggested that medical management in dogs with spinal disease is usually reserved for dogs with less severe clinical signs and less severe spinal cord compression 8 19–21 . More severe spinal cord compression observed on MRI has indeed been considered the most important indicator to elect surgery over medical treatment in dogs with cervical compressive HNPE 8 .…”

Classification of Intervertebral Disc Disease

“…Clinical signs tend to reflect the chronic, slowly progressive nature of the IVD degeneration, typically with milder neurological deficits than those seen with acute spinal cord injury secondary to IVD extrusions ( 63 ). The characteristic clinical picture is therefore that of a slowly progressive, often non-painful myelopathy in an older, usually non-chondrodystrophic dog ( 63 , 64 ). Pain can be present depending on the presence of nerve root compression but is less common than in the more acute IVD extrusion.…”

Minimally invasive microsurgical decompression of an intervertebral disc protrusion in a dog

“…Diagnosis is made with advanced imaging . Conservative management (anti‐inflammatory drugs, rest combined with rehabilitation) is more appropriate in dogs with mild deficits and with less severe spinal cord compression, with a success rate of 29% and mean survival time of 330 days . Surgical management is indicated in dogs with more severe deficits and progressive signs, with a success rate of 71% and mean survival time of 630 days .…”

“…Conservative management (anti‐inflammatory drugs, rest combined with rehabilitation) is more appropriate in dogs with mild deficits and with less severe spinal cord compression, with a success rate of 29% and mean survival time of 330 days . Surgical management is indicated in dogs with more severe deficits and progressive signs, with a success rate of 71% and mean survival time of 630 days . Various surgical techniques have been described (hemilaminectomy with anulectomy, minihemilaminectomy with partial lateral corpectomy, dorsal laminectomy, partial lateral corpectomy, hemilaminectomy with vertebral stabilization, hemilaminectomy with partial discectomy), with associated immediate postoperative clinical deterioration reported particularly in approaches to the lamina and pedicle.…”

“…Surgical management is indicated in dogs with more severe deficits and progressive signs, with a success rate of 71% and mean survival time of 630 days . Various surgical techniques have been described (hemilaminectomy with anulectomy, minihemilaminectomy with partial lateral corpectomy, dorsal laminectomy, partial lateral corpectomy, hemilaminectomy with vertebral stabilization, hemilaminectomy with partial discectomy), with associated immediate postoperative clinical deterioration reported particularly in approaches to the lamina and pedicle. Approaches that focus on a more ventral access (partial lateral corpectomy) appear to be safer …”