INTERVERTABRAL DISC DISEASE (IVDD)
The anatomy of a disc
The spine is made up of a chain of bones called vertebrae that keep the spinal cord protected. There is intervertebral discs between each of these boney vertabra.
The disc provides cushioning between the vertebral bodies of the vertebrae. It is made up of the outer fibrous annulus fibrosis, and a soft nucleus pulposus which has a jelly like consistency. The vertebra are joined above and below with continuous ligaments. The ligament above the discs (dorsal ligament) is quite sensitive, comprised of many nerves.
What happens to the spine structures in IVDD
Due to aging or disease the disc loses its normal sponginess. It become tougher and less flexible. The area of the spine where the diseased disc sits also becomes less flexible. In some situation discs that are severely affected can get squashed between vertebra and push upwards towards the upper spinal ligament (disc herniation). This causes pressure on the dorsal ligament and on the spinal cord. It is this pressure and inflammation of both the ligament and spinal cord that causes pain and loss of function
Clinical signs of IVDD
There is a mild to severe area of pain over the back or neck adjacent to the affected disc. Mild cases of disc herniation may only cause pain whereas severe cases can cause neurological deficits and loss of function. .
The loss of function will follow a pattern
1. Loss of proprioception - the ability of the brain to perceive where their paws and correct when necessary. Pets who have lost proprioception will scuff their feet and lose balance.
2. Loss of motor funtion - this is the ability to walk and also control urination and defaecation.
3. Loss of recognition of superficial pain.
4. Loss of recognition of deep pain
Diagnosis and tests performed
The Neurologic Exam
A physical exam and assessment of the reflexes may help determine the location of the problem.
This may not be sensitive to all cases of disc disease but can help rule out other spinal diseases that can look similar to disc disease eg infection, cancer.
These are more sensitive than xray and can help get a better picture of what is going on. These include myelogram, CT or MRI.
Conservative treatment (medication and those outlined below) is generally successful in pet that are still able to walk. In my experience pets that have deep pain also generally have good results with conservative management
A multimodal approach offers the best chance of recovery in these pets with intervertabral disc disease.
Studies suggest surgery may be the preferred option if there is no deep pain present (the pet is not showing any awareness that you are pinching their toe and the pet is in the early stages of disease (48 hours since injury). Surgical success in pets that have been down for more than 48 hours with no deep pain is generally low.
A large majority of pets with intervertabral disc disease can be managed well with conservative treatment
Conservative treatments offered by Balance Vet Rehab that may be beneficial for these pets include:
The underwater treadmill is usually very helpful in recovery of patients with IVDD either post surgically or in patients receiving conservative therapy
Manual therapy is often helpful with pain relief and recovery in IVDD pets.
Study: Osteopathic Manual Treatment and Ultrasound Therapy for Chronic Low Back Pain: A Randomized Controlled Trial John C. Licciardone)
Pain control is always an issue in pets with IVDD. Acupuncture is a very helpful tool for helping reduce pain in these guys.
Study: Meta-Analysis: Acupuncture for Low Back Pain Eric Manheimer et al)
Electroacupuncture can help reduce pain in IVDD pets and likely helps speed up recovery time.
Clinical Effect of Additional Electroacupuncture on Thoracolumbar Intervertebral Disc Herniation in 80 Paraplegic Dogs Hyun-Jung Han et al
Evaluation of electroacupuncture treatment for thoracolumbar intervertebral disk disease in dogs. Hayashi AM et al
Laser therapy can be quite helpful in reducing pain and speeding up recovery after disc damage.
It helps achieve this by
Increasing metabolism in nerve cells.
Preventing degeneration of neurons
Increasing myelinization of nerves. (helps regrow the outer sheath of nerves.
(Low‐level laser therapy reduces time to ambulation in dogs after hemilaminectomy: a preliminary study W.E. Draper et al)
A home exercise programs can help an IVDD pet throughout recovery including reducing inflammation and regaining strength after prolonged periods of inactivity.
(The Efficacy of Systematic Active Conservative Treatment for Patients With Severe Sciatica: A Single-Blind, Randomized, Clinical, Controlled Trial Albert, Hanne B et al)
Shockwave (COMING SOON)
If there is facet pain of the vertabrae secondary to intervertabral disc disease shockwave therapy is likely to be of benefit.
Mechano-transduction effect of shockwaves in the treatment of lumbar facet joint pain: Comparative effectiveness evaluation of shockwave therapy, steroid injections and radiofrequency medial branch neurotomy Tomas Nedelka et al
This therapy has been shown to help in pets recovering from spinal surgery and may also be beneficial in IVDD cases that are managed conservatively.
The Effect of Electromagnetic Fields on Post-Operative Pain and Locomotor Recovery in Dogs with Acute, Severe Thoracolumbar Intervertebral Disc Extrusion: A Randomized Placebo-Controlled, Prospective Clinical Trial Natalia Zidan et al