SUMMARY: IVDD surgery is often thought of as a last resort for dogs diagnosed with intervertebral disc disease. So when is IVDD surgery the best option? And why? In Part III of Dr. Julie Buzby’s series on IVDD in dogs, she resumes the story of Tango, a 4-year-old miniature Dachshund who had been diagnosed with his first episode of IVDD. (For Parts I and II, please read: IVDD in Dogs: Why It Happens and IVDD: Can a Dog Recover Without Surgery? ) After an unsuccessful attempt managing IVDD at home with medications and strict rest, Tango is back at Dr. Buzby’s office.
Unfortunately, two days later, I saw Tango back on my appointment schedule. The notes read “not walking after falling off bed.” I groaned inwardly and headed to the lobby. There sat Tango with his mom. She was holding him tightly and crying. I gestured for her to follow me into an exam room, where she placed Tango gently on the table. He waddled like a seal—his chest elevated and his hind end awkwardly dragging behind. He clearly wasn’t moving his back legs.
Since I’d already performed a thorough physical and neurologic exam on Tango at his first visit (explained in Part 1 of this series), I skipped right to the heart of the matter. Did he still have what veterinarian’s call “deep pain”?
What is deep pain perception and why is it relevant to IVDD surgery?
The spinal cord is like a superhighway of nerve fibers. Imagine strands of rope, yarn, and thread bundled together and running from your brain, through each of your vertebrae, to your lower back. That’s the spinal cord.
Certain fibers carry the impulses associated with conscious proprioception (sense of body position). Others carry the signals for motor function (the ability to walk). The smallest fibers carry the impulses for deep pain.
These deep pain fibers are the last to be impacted by a compressive force (i.e. a disc herniation) precisely because they are the smallest fibers. The fibers vary by diameter, and this is why there is a predictable progression in what reflexes/responses an IVDD dog loses neurologically. Conscious proprioception, carried on big fibers—the “ropes”—is lost first, followed by loss of motor function—the “yarn.” The last sensation to go is the perception of deep pain, carried by the “thread.”
Distinguishing between Grade 4 & 5 IVDD
Treatment plan and prognosis (expected outcome) are both based upon symptoms, which correlate to the fibers that have been impacted. IVDD dogs are graded on a scale of 1-5. Grade 5 dogs represent the most critical cases. They are paralyzed and have lost deep pain perception. Grade 4 IVDD dogs are also paralyzed but retain deep pain sensation.
Studies have shown that with surgery for grade 1-4 cases more than 90% of dogs recover successfully. (For an explanation of IVDD grades, please read IVDD in Dogs: Why It Happens.) However, with grade 5 IVDD, success drops to only 50-60% if the surgery occurs within 24 hours of symptoms. If surgery is performed after that initial 24-hour window, the success rate drops dramatically.
Having already lost motor function, Tango was a grade 4 or 5, but I needed to test his deep pain perception to know which one.
I took a hemostat out of the drawer and pinched one of his back toes, hoping desperately he could still feel them. His mom watched anxiously.
Tango let out a yelp when I tested both hind paws. His mom and I both breathed a sigh of relief as I rubbed Tango’s head to ask for forgiveness. I then gently felt his abdomen. His bladder was enormous——another sign of grade 4 or 5 IVDD.
I looked up and began explaining my thoughts to Tango’s owner. “He’s now gone from grade 2 to grade 4,” I explained, “but he can still feel his feet. It’s time for referral to a neurologist for IVDD surgery.”
Why IVDD surgery is recommended
IVDD surgery is the recommendation for dogs who have lost motor function as a result of intervertebral disc disease. In fact, surgery is the gold standard treatment for any dog who has more than just pain symptoms (grade 1 IVDD). The prognosis with surgery for these dogs is significantly better than without surgery.
But I also appreciate that not every client can afford IVDD surgery. There is no judgment from veterinarians when clients cannot spend thousands of dollars for their dog to go to a referral hospital for back surgery. And in those cases, we do the best we can with medical management and home care.
How much does IVDD surgery cost?
IVDD surgery cost varies based on common sense factors like how long the dog remains hospitalized and how extensive/complicated the surgery is, but geographic location is one of the major factors affecting cost. The price tag for IVDD surgery varies from $3000 to $8000 based on the city, state, or geographic area of the United States where the surgery is performed.
During Tango’s very first puppy visit, when he was just nine weeks old, I had discussed intervertebral disc disease with his mom. That may sound depressing, but we had talked about many other health and wellness issues like diet, teeth brushing, nail care, and since he was a high-risk breed, I felt compelled to also go over the basics of IVDD. I suggested that she consider pet insurance for Tango.
Tango’s mom had not purchased pet insurance, but instead set up what she dubbed “The Tango Fund.” Every month she had been putting money aside in case Tango ever needed IVDD surgery. Sadly, that day had come, but her foresight made the decision to say “yes” to my recommendation much easier.
Prepping for IVDD surgery
I made a phone call to our local neurologist to set up the consult. Within 30 minutes of walking into my exam room, Tango was on his way to the specialty hospital for advanced diagnostics.
Before surgery, the location of the herniated disc(s) needs to be determined. This can be done with several modalities including a CT scan, an MRI, or a myelogram. MRI is the best way to look at soft tissue in the spine, but it is not always available. CT is a good method, as well, but also not always at hand. A myelogram is a contrast study using radiographs. A dye is injected into the cerebrospinal fluid (CSF) around the spinal cord and then sequential X-rays are taken. This will show where a disc (or discs) is bulging and help the surgeon plan his approach. Any of these three techniques may be used depending on the capabilities of the local neurosurgeon.
Types of IVDD surgery
Thus far, we have been referring to “IVDD surgery” as a general concept, but there are several types of IVDD surgeries, all with lovely, long, Latin-based names:
- Dorsal Laminectomy
- Ventral Slot
The most common surgery for a herniated thoracolumbar disc is the hemilaminectomy. In this procedure, the articular facets (the joint surfaces between vertebrae) are removed and bulging disc material is cleared away from the spinal cord. If a disc in the neck has slipped, then the ventral slot procedure may be performed. These are advanced surgeries that are always performed by a neurosurgeon. They require specialized equipment and excellent technique for a good outcome. (For more detailed information on IVDD surgeries, please read Disc Disease by the Veterinary Medical Teaching Hospital (VMTH) at UC Davis.)
Tango had an MRI which identified a disc bulging between his 11th and 12th thoracic vertebrae. He went to surgery, and a hemilaminectomy was performed. The surgeon was concerned about the disc in front of and behind the herniated T11-12 disc, so he “fenestrated” those as a preventative measure. In this procedure, a small window is cut into the “jelly donut” (described in Part I of our series), called the annulus fibrosus, and the “jelly”, called the nucleus pulposus, is removed. This, in theory, prevents spinal cord damage from future herniation of these discs.
What to expect after IVDD surgery
After surgery, Tango spent three days in the hospital recovering. He had a urinary catheter in place so his bladder would stay empty because he couldn’t yet urinate on his own or walk.
This is a common scenario after surgery. Several days to weeks are needed for swelling in the spinal cord to decrease. If everything goes as planned, movement will gradually come back to the legs during that time. The same is true for bladder control. In some cases, it can take one to three weeks for this to happen, and a dog might even go home with a urinary catheter in place. Typically, dogs stay in the hospital for three to 10 days and go home once they can urinate on their own.
Convalescent care includes four to six weeks of restricted activity (crate rest), administering pain medications, and sometimes gentle physical therapy. Physical therapy for pets is one of the fastest-growing aspects of veterinary medicine and many veterinary surgeons will routinely prescribe physical therapy as part of their post-op plan for their patients because rehab can provide dramatic benefits. Additionally, rehab practitioners can teach owners to do simple techniques, such as massage and passive range of motion, as part of a home therapy program.
Alternative treatments that I’ve found to be very helpful include acupuncture and laser therapy. Supplements may also be added to conventional medications for possible anti-inflammatory benefits. My personal favorite is the combination of deer velvet and green-lipped mussel. I’ve had such good results with New Zealand Deer Velvet in my IVDD patients and in senior dogs that we now offer it through our website.
In fact, I recently received this note from a dog owner who tried New Zealand Deer Velvet for her Dachshund:
I have 2 short-haired Dachshunds: one is 11 years old and one is 5 years old. In late October, the younger one tweaked his back from jumping off the couch and was in a lot of pain for several weeks. He slowly got better after strict crate rest, Neurontin, and a muscle relaxant. Absolutely no long walks/exercise during this time. In early December, I went outside to look at the Christmas lights, and Oscar launched from the couch again. I forgot to put him in the crate and he reinjured himself. The cycle of multiple vet visits, strict crate rest, Neurontin, and a muscle relaxant began again. Oscar was getting very sad and tired of being in pain.
Then, it was recommended that I call Dr. Julie Buzby. Her advice was life-changing for Oscar. I tried the New Zealand Deer Velvet while he was recuperating with his daily crate rest. THE RESULTS WERE ABSOLUTELY INCREDIBLE. After 3 days of being on the Deer Velvet, Oscar’s sadness changed to happiness and he began to regain his normal activity level. He is now completely pain-free. No prescription medicines for his strained back (partially herniated disk) and he has resumed his 30-minute walks a day. My husband and I will continue the New Zealand Deer Velvet as a daily regimen for Oscar. He does have disk disease (as many Dachshunds do), so we are very grateful for this product to keep him pain-free and active for many years to come!” ~Jennifer Chastain
How quickly will a dog recover following IVDD surgery?
The speed of recovery and the success of the surgery are dependent on the extent of injury to the dog’s spinal cord, the length of time between injury and surgery, and post-operative care. As you might imagine, the more severely the dog was affected by IVDD on our grading scale and the longer the time between injury and surgical decompression, the worse the prognosis (expected outcome). Thankfully, most dogs do very well with surgery and recover normal function quickly, but severely affected dogs may be left with varying degrees of permanent damage.
Strict rest is incredibly important after surgery, as too much activity can lead to pain, trauma, and reinjury. This time, Tango’s owner was prepared. She had his gabapentin, trazodone (discussed in Part II), and a comfy crate ready with his favorite snuggly toys. Also, she had purchased low-fat dog food, consulted with me about how many calories he needed per day to lose weight, and had decided no more bacon scraps.
Two weeks after his surgery, Tango was walking well again. He was able to control his bladder, and his mom had started him on his weight loss regimen. Tango’s story has a happy ending.
Will IVDD strike again?
The good news is that most dogs who undergo IVDD surgery will not experience additional disc herniations. However, some will. (Dachshunds have been proven to have a higher risk of recurrence than other breeds.) As explained in Part I in this blog post series on IVDD, the main reason Type I IVDD occurs in dogs is because of genetic factors which affect chondrodystrophic breeds. But I’m a huge believer in being proactive and positively impacting what we can.
Making home and lifestyle modifications
IVDD survivors may benefit from modification of their lifestyles and I recommend the following to my clients:
- adding ramps or stairs for porches, beds, and other furniture to reduce the dog’s jumping
- maintaining the dog at a healthy weight
- engaging in low-impact, controlled activity/exercise only
- changing from a collar to a harness for dogs with cervical IVDD (IVDD in the neck)
- wearing Dr. Buzby’s ToeGrips® dog nail grips to prevent slips and falls while increasing stability, especially for dogs who struggle with slipping on hard surface floors.
Finally, if your dog is being treated for IVDD, whether managed medically or surgically, the key is REST, REST, REST, AND MORE REST. I can’t emphasize enough the importance of crate training your canine companion from puppyhood. It is invaluable in case strict crate rest is ever prescribed for any medical condition.
Most importantly, perhaps, is being aware and observant; at the first sign of back pain and weakness, seek veterinary care. And if your dog does have IVDD, remember—there are many treatment options! Maintaining close communication with your veterinarian is important.
In the final chapter of our series on IVDD in dogs, I’ll discuss IVDD in large breed dogs—Type II IVDD. Don’t miss out! Please sign up for Dr. Buzby’s Barkworthy, my weekly dog health email, so you’re sure to receive “the rest of the story” delivered to your inbox. Plus, when you sign up now, you’ll receive my free e-book, Seven Ways to Love Your Senior Dog.