What do we know about the natural progression of thoracolumbar intervertebral disc extrusion (TL-IVDE) in dogs? We have been taught when a dog stops having voluntary movement of their pelvic limbs (paraplegia) they need surgery to recover the ability to walk, right? What about those that have lost deep pain? What if we didn’t do surgery – what happens to those dogs? A study was published in JVIM this year that looked at the natural progression of medically managed TL-IVDE in non-ambulatory dogs and evaluated not only the recovery rate, but also what the discs “did” on sequential MRI 3 months after starting medical management.
Results
Sixty-seven dogs met the inclusion criteria – 51 with deep pain, 21 without deep pain, 5 with signs of myelomalacia at presentation.
Treatment consisted of NSAIDs (steroids were discontinued and replaced with NSAIDs if started), pain management and physiotherapy.
· Recovery
· Dogs with deep pain: 96% regained walking and voluntary urination (49/51)
o Median time to recovery 11 days (7-21 days IQR).
· Dogs without deep pain: 63% regained walking and voluntary urination (10/21).
All dogs (regardless of ambulatory status on recheck) did not have signs of back pain on evaluation 3 months after enrollment in the study.
The change in compression on MRI was interesting. In some patients, the compression almost completely resolved, and for others there was less than a 5% change. This wasn’t correlated with clinical signs but looking at the figures it does not appear to have a direct relationship.
Key point:
If you have a patient presenting with acute, non-ambulatory paraparesis or plegia, surgery is a very reasonable first step. However, it isn’t the only option! Don’t euthanize unless myelomalacia is present!! Consider conservative treatment because we may end up with an ambulatory patient after 3 months! Just because an owner cannot afford an MRI or surgery, doesn’t mean we should do a neurology consult, either. 😊
Thanks for reading! I hope you’re having a good week and look forward to working with you soon.