Management of Intervertebral Disc Disease in Dogs: An In-depth Exploration

Written by Dr. Gaemia Tracy

Intervertebral Disc Disease (IVDD) poses a significant challenge for our canine companions, characterized by the herniation of disc material into the vertebral canal, leading to compression and injury of the spinal cord. This presentation delves into the intricacies of IVDD, encompassing its mechanisms, clinical signs, diagnosis, treatment methods, and preventive measures.

Understanding IVDD Mechanisms:

To comprehend IVDD, we begin with the anatomy of the intervertebral disc—a structure comprising an incompressible nucleus pulposus surrounded by the annulus fibrosus. Certain risk factors contribute to disc herniation, including degeneration, specific breeds (such as Dachshunds, Beagles), and excessive activity. The injury mechanism involves contusion, triggering various cascades like calcium entry, enzyme activation, oxidative damage, inflammation, and glial cell activation.

Clinical Signs of IVDD:

Clinical signs vary based on the affected spinal cord region. For instance, cervical spine involvement may manifest as tetraparesis and neck pain, while thoracolumbar spine issues lead to pelvic limb complications and urinary/fecal incontinence. Tail disc herniations, affecting the caudal spine, exhibit signs like low tail carriage and severe tail pain.

Diagnosis of IVDD:

Diagnosing IVDD involves a thorough examination, including a general physical and neurologic assessment. Radiographs offer initial insights, while advanced diagnostics like CT scans and MRI scans provide detailed views. Differential diagnoses include inflammatory spinal cord disease, spinal neoplasia, vertebral anomalies, and fibrocartilaginous embolism.

Treatment Methods:

Medical management is recommended for less severe cases (Modified Frankel Score Level 1-2), involving strict activity restriction, anti-inflammatory medications, and pain relief. Surgical treatment becomes imperative for higher severity cases (Modified Frankel Score Level 3-5), employing procedures like hemilaminectomy or ventral slot decompression based on the affected region.

Prognosis and Preventive Measures:

Prognosis varies between medical and surgical interventions. Medical management shows a 50-70% recovery rate with a 50% recurrence for Modified Frankel Score 1-4, while surgical treatment boasts a 90-95% recovery rate with a 25% recurrence. Preventive measures include lifestyle changes, avoiding activities that stress the spine, and, notably, the innovative Percutaneous Laser Disc Ablation (PLDA) procedure.

Percutaneous Laser Disc Ablation (PLDA):

PLDA is a minimally invasive prophylactic laser procedure designed to reduce the risk of disc herniation, especially in chondrodystrophic breeds with a history of IVDD. Administered through spinal needles, the procedure utilizes a laser to vaporize the nucleus pulposus, decreasing intradiscal pressure and minimizing the risk of disc herniation.

Aftercare and PLDA History:

After PLDA, patients undergo controlled leash walks and crate rest. Pain control involves medications like gabapentin and carprofen. PLDA's success is evidenced by its history, developed in 1993 and boasting a 97% success rate in the original study. Recent research demonstrates a 3.6% recurrence rate, emphasizing its efficacy.

Conclusion:

Navigating the complexities of IVDD demands a comprehensive approach—from understanding mechanisms to exploring treatment options and embracing preventive measures. This holistic understanding ensures the best possible care for our four-legged companions facing the challenges of Intervertebral Disc Disease.