Last week, we discussed a paper from that outlined the clinical presentation of cats with IVDH. This week, I would like to take it a step further and review an article comparing surgical to medical treatment outcomes in cats with IVDH. Enjoy!
Materials and Methods
This was a retrospective study including 92 cats with compressive TL disc herniations from two UK hospitals. Surgical decompression was not standardized. Each surgeon chose the surgical approach best fitting the cat/disease. Conservative management was also not standardized. Treatment options were not discussed in this paper, leaving the reader to wonder if steroids were utilized for either group?
Results
The most affected sites were T13-L1 and L7-S1. Feline lumbosacral disease remains clinically relevant. The majority of cats had a disc extrusion (61%) compared to 29% of cats with a protrusion. A small but important minority of cats had an acute-on-chronic type (10%) which I found surprising. Most cats showed spinal pain (71%) and also had progressive neurologic dysfunction (68%).
Surgery vs. Conservative Management
At 6 weeks:
Surgical success: 62%
Conservative success: 54%
Younger and heavier cats showed more improvement
92% of conservatively managed cats had persistent neurologic deficits
86% of surgically treated cats had persistent neurologic deficits
At 6 months:
Surgical success: 74%
Conservative success: 65%
No statistically significant difference was identified between treatment groups at either time point. However, the surgical group had significantly higher overall severity compared to the conservatively managed group.
Only a small percentage of the group became neurologically normal. Rather, success was defined as able to walk (or walk better if ambulatory at the onset of treatment), urinary and fecal continent and not dependent of pain management. This might be the most important part of the paper and, as a result, we should stress this to owners when discussing treatment.
Key Points
Conservative management may be a legitimate option in selected feline compressive IVDH cases, with outcomes approaching those of surgical management in this retrospective population.
At the same time, the data should not be interpreted as evidence that surgery lacks benefit in severe or progressive disease.
Residual deficits are common post operative and with conservative treatment
Cats with a more affected neurologic exam were more often referred for surgery, which may have skewed the results in favor of conservative care.
Thanks for reading! Have a great week!
Reference: Amey J, et al. DOI: 10.1111/jvim.16950