ACVIMconsensus statement on diagnosis and management of acute canine thoracolumbar intervertebral disc extrusion

Abstract

Background Thoracolumbar intervertebral disc extrusion (TL‐IVDE) is the most common cause of acute paraparesis and paraplegia in dogs; however, guidelines on management of the condition are lacking. Objectives To summarize the current literature as it relates to diagnosis and management of acute TL‐IVDE in dogs, and to formulate clinically relevant evidence‐based recommendations. Animals None. Methods A panel of 8 experts was convened to assess and summarize evidence from the peer‐reviewed literature in order to develop consensus clinical recommendations. Level of evidence available to support each recommendation was assessed and reported. Results The majority of available literature described observational studies. Most recommendations made by the panel were supported by a low or moderate level of evidence, and several areas of high need for further study were identified. These include better understanding of the ideal timing for surgical decompression, expected surgical vs medical outcomes for more mildly affected dogs, impact of durotomy on locomotor outcome and development of progressive myelomalacia, and refining of postoperative care, and genetic and preventative care studies. Conclusions and Clinical Importance Future efforts should build on current recommendations by conducting prospective studies and randomized controlled trials, where possible, to address identified gaps in knowledge and to develop cost effectiveness and number needed to treat studies supporting various aspects of diagnosis and treatment of TL‐IVDE.

Clinical Occurrences in the Neurorehabilitation of Dogs with Severe Spinal Cord Injury

“…All of these are compatible with our population of plegic dogs, with a total of 74% (361/488) paraplegic, and 26% (127/488) tetraplegic dogs, reflecting a sample that can benefit from FNR. This is also in agreement with different authors, who refer to the suggestion that intensive neurorehabilitation protocols are not necessary for all patients with incomplete spinal cord injuries, supported by moderate-level evidence [ 28 ].…”

Approach to Small Animal Neurorehabilitation by Locomotor Training: An Update

“…Post-operative rehabilitation may be safely used in the first 24 h after surgery, provided it does not worsen spinal hyperesthesia or decrease the neurological status [ 19 , 56 , 57 ]. Also, moderate-level evidence research has supported the implementation of LT within the first three days after surgery, in contrast with activity restriction (e.g., cage rest) that was supported by low-level evidence, demonstrating that this restriction does not mean annulment of LT and rehabilitation exercises [ 56 ] ( Table 2 ).…”

“…In chronic or acute SCI patients, LT performed on the UWTM should be initiated as early as possible. Different protocols are described in Table 4 , considering each disease, post-operative or conservative management option and disease progression stage [ 19 , 56 ]. All guidelines are dependent on the cardiovascular and motor ability of each patient, and training should not be performed without monitorization of vital parameters (mucous membranes; capillary refill time, heart rate, respiratory rate; blood pressure, electrocardiogram, muscle fasciculations, spinal hyperesthesia and neurological grade), especially in intensive exercise with increasing time, speed, and slope ( Figure 3 ).…”

Is decompression in acute thoracolumbar intervertebral disc herniation overvalued?

“…Nevertheless, summary recovery rates for dogs treated by decompressive surgery or by fenestration alone are indistinguishable ( 23 ) and, importantly, there have been no clinical trials comparing decompression with non-surgical treatment or fenestration. Despite this lack of evidence a dogma has developed that decompressive surgery is superior and perhaps even necessary for recovery ( 25 ). Therefore, at present, the consensus of opinion is that dogs that are unable to walk following acute onset thoracolumbar disc herniation are candidates for decompressive surgery—overwhelmingly using the 70-year-old technique described by Greene ( 7 ), often with little modification from the original description.…”

“…The general acceptance that surgical decompression is necessary for recovery, especially in dogs that lose deep pain sensation, makes constructing clinical trials of alternative approaches highly problematic. Indeed, in the current opinion environment ( 25 ), it would be difficult for any specialist neurologist NOT to recommend decompressive surgery for a non-ambulatory dog with a herniated thoracolumbar disc. So, in view of this ethical background, how can this potentially fallacious dogma be challenged?…”