Epidural Steroids for Disc Herniation in Dogs?
Epidural steroid administration has been a common therapeutic option for humans with low back pain secondary to intervertebral disc herniation (IVDH) but is rarely employed for veterinary patients. This option was recently evaluated in a double blind evaluation in 41 dogs.
Methods
The dogs were randomly assigned to either the control group (given epidural saline) or treatment group (1 mg/kg epidural methylprednisolone sodium succinate: MPSS). All dogs underwent surgical intervention (decompression) and the saline or MPSS was applied in the epidural space at surgical closure. Post operative care was similar between both groups.
Results
The dogs that received MPSS walked at a median of 3 days (range 1-8 days) and control dogs walked in a median of 7 days (range 1-17 days). This was a significant (P=0.01) difference between groups. Bodyweight did not affect recovery, however age did influence recovery. Younger dogs walked faster than older dogs, but both groups contained similar age ranges nullifying this finding as a cause for the significant difference.
One dog in the treatment group became non-ambulatory after regaining the ability to walk. This dog developed discospondylitis secondary to Staphylococcus aureus and dygalactidae which was ssumed to be seconcary to MPSS application, however an N=1 makes this association challenging to make. The dog was treated with antibiotics and subsequently regained ambulation.
Key Points
Although this isn’t the first report of intrathecal MPSS use in dogs, it contained the biggest case count. The significant difference in ambulation leads me to wonder about using this as another treatment option for dogs unable to undergo surgical intervention. Given the sufficient safety data from this and prior studies, it appears safe to administer with a less than 10% chance of serious adverse effects (discospondylitis). If you have a patient that is non-ambulatory but cannot go forward with surgery, and we have a high index of suspicion for IVDH, let’s talk about intrathecal MPSS. If you are a general surgeon performing spinal surgeries, or a neurosurgeon, I’d love to know if you give epidural MPSS or if you’re inclined to do so after reading this report. In case you’d like to read the full study you can find it here: DOI: 10.1002/vetr.4962
Thanks for reading! Have a wonderful week!