Acute thoracolumbar disc extrusion: Chances of success for conservative treatment

Inspired by Erin Y. Akin, DVM, DACVIM (Neurology), Locum Neurologist, Woodstock, Georgia

---

What is a thoracolumbar disc extrusion?

A dog's spine consists of many individual vertebrae separated by intervertebral discs. These discs act as shock absorbers and allow for movement. In thoracolumbar disc extrusion, the inner, gel-like material of an intervertebral disc protrudes through the outer membrane and presses on the spinal cord. This can lead to pain, paralysis, and, in severe cases, loss of the ability to walk.

This condition is common in certain dog breeds, such as dachshunds, which have a genetic predisposition for intervertebral disc problems. Symptoms can appear suddenly and range from back pain to complete paralysis of the hind legs.

(C) https://www.mdpi.com/2075-1729/15/1/68

---

How is a thoracolumbar disc extrusion diagnosed?

The diagnosis begins with a thorough clinical examination by the veterinarian. This includes checking gait, reflexes, and pain perception. Important diagnostic steps are:

1. Neurological examination: This involves testing affected body regions to narrow down the location of the spinal cord damage.
2. X-ray images: These can provide clues about changes in the spine, but they do not show the intervertebral discs themselves.
3. MRI (magnetic resonance imaging): The best method for accurately diagnosing disc extrusions. This allows you to see if and how severely the spinal cord is compressed by the extruded disc material.
4. CT (computer tomography): An alternative to MRI, especially when surgery is planned.
5. Myelography: A special X-ray technique in which a contrast agent is injected into the spinal canal to visualize constrictions. Today, however, it is mostly replaced by MRI or CT scans.

A rapid diagnosis is important because the prognosis depends heavily on how early treatment is initiated.

---

Study results on conservative treatment

Kahn S, Jeffery ND, Freeman P. Recovery of ambulation in small, nonbrachycephalic dogs after conservative management of acute thoracolumbar disk extrusion. J Vet Intern Med. 2024;38(5):2603-2611. doi:10.1111/jvim.17149

Acute thoracolumbar myelopathy due to intervertebral disc extrusion (IDE) is a common cause of neurological deficits in dogs. This condition causes a mixture of blunt (contusive) and compressive injury to the spinal cord, which can lead to back pain, paraparesis, paraplegia, loss of deep pain perception (DPP), urinary incontinence, and other neurological symptoms.^1,2

Treatment consists of either conservative therapy or surgical decompression of the spinal cord (usually by hemilaminectomy).3 Surgery is often considered more promising for non-ambulatory dogs, regardless of whether DPP is present.3 However, a systematic analysis showed that up to 86% of non-ambulatory dogs with DPP could regain ambulatory ability without surgery.4

Study design: Acute thoracolumbar disc extrusion

This prospective study examined 72 non-ambulatory dogs with acute thoracolumbar IDE regarding their recovery potential under conservative therapy over 12 weeks.

• All dogs weighed under 15 kg and were not brachycephalic, with dachshunds being the most common breed.
• 67 dogs received a confirmed diagnosis via MRI.
• Conservative treatment included pain medication, restriction of movement (stall rest), physiotherapy measures by the owners, and bladder management.
• Activity was gradually increased, and pain medication was slowly reduced.

Results

• Dogs with preserved DPP (n = 51): 96 % patients regained the ability to walk, on average after 11 days.
• Dogs without DPP (n = 21): 48 % patients regained the ability to walk, on average after 25 days.
• MRI after 12 weeks (n = 63): A reduction in spinal cord compression was observed, but not directly correlated with the recovery of the ability to walk.
• Complications: A higher incidence of ascending and descending myelomalacia than in previous studies, possibly due to the inclusion criteria.

Conclusions

• This study provides evidence that small, non-ambulatory dogs with thoracolumbar IDE can regain their ability to walk within 12 weeks without surgical intervention.
• In a previous study, dogs underwent surgery after four weeks of conservative therapy if no improvement occurred. This study suggests that some of these dogs would have regained the ability to walk with extended conservative therapy.
• A treatment duration of at least 12 weeks should be considered., especially in dogs with preserved DPP, as the chances of recovery are high.
• Conservative therapy includes pain management, muscle relaxation, rehabilitation, restriction of movement (box rest), care (e.g. bladder management) and other supportive measures.
• Close collaboration between the primary veterinarian, neurologist, and pet owner is crucial. Care can be provided through phone calls, emails, in-person examinations, or video consultations.

Practical implications

The results of this study underscore that conservative treatment can be a promising alternative to surgery for many dogs with thoracolumbar disc extrusion. Recovery without surgical intervention is particularly possible in small dogs with preserved deep pain sensation.

The decision between conservative therapy and surgery should be made on a case-by-case basis. Factors such as the severity of the symptoms, the level of pain, the dog's mobility, and the owner's ability to provide intensive home care are crucial.

Recommendations for pet owners

If your dog is suffering from disc extrusion, the following measures can help support the healing process:

• Strict restriction of movementAdhere to the veterinarian's instructions regarding crate rest. Even if it's difficult, the dog must only move in a very controlled manner during the acute phase.
• Administration of medicationStrictly adhere to the prescribed pain and inflammation medication to promote spinal cord regeneration.
• Bladder and bowel managementIf your dog has trouble urinating independently, consult your veterinarian. Veterinarian Show him how to empty his bladder. Make sure he can defecate regularly.
• Physiotherapy and supportive measuresDepending on the recovery process, targeted exercises, gentle massages or even hydrotherapy can help to maintain muscles and improve mobility.
• Patience and loving careRecovery can take several weeks to months. Maintain regular contact with your veterinarian and carefully monitor your dog's condition.

Physiotherapeutic approaches to rehabilitation

Physiotherapy plays a crucial role in the rehabilitation of dogs with thoracolumbar disc extrusion. It helps improve mobility, prevent muscle atrophy, and support the healing of the nervous system. The following physiotherapy interventions may be part of the treatment plan:

1. Passive movement exercises: Controlled limb movements stimulate muscles without the dog having to actively walk. This helps prevent joint stiffness and promotes blood circulation.
2. Hydrotherapy: Exercise in water, especially on an underwater treadmill, allows for joint-friendly training. The water resistance strengthens the muscles, while the buoyancy reduces the strain on the spine.
3. Massages and manual therapy: These techniques help to release tension, promote blood circulation, and alleviate pain. They are particularly valuable in the early rehabilitation phase.
4. Electrical stimulation (TENS/EMS): Electrical impulses can help activate weakened muscles and reduce pain. This is particularly helpful for patients with limited or lost muscle control.
5. Balance training: Exercises with wobble boards or balance cushions improve coordination and stability and help the dog regain its mobility skills.
6. Targeted muscle strengthening: Once the dog makes progress, targeted strength exercises can help strengthen the muscles around the spine and better distribute the load.

Physiotherapy should always be individually tailored to the dog's condition and carried out under veterinary supervision. Regular progress checks help to optimize the training and provide the best possible support for the dog.

Non-conservative treatment: Surgical options

In some cases, conservative therapy is insufficient, particularly if the dog shows no signs of improvement despite intensive medical care or if severe neurological deficits are present. Surgery may be the best or only option in such situations to stop the progression of the disease and preserve spinal cord function as much as possible.

1. Indications for surgery

Surgical intervention is recommended if:

• The dog is completely paralyzed and no longer has deep pain perception (DPP).
• Despite conservative therapy, no improvement occurs or the symptoms worsen.
• Recurring episodes of disc problems occur.
• Severe compression of the spinal cord was detected in the MRI or CT scan.

2. Surgical procedures

The most common surgical procedure for treating a thoracolumbar disc extrusion is the Hemilaminectomy. In this procedure, part of the affected vertebra is removed to relieve the compressed spinal cord and remove the extruded disc material.

Other procedures may include:

• Dorsal laminectomy: Used when greater decompression is required.
• Fenestration: A preventative procedure in which disc material is removed from adjacent vertebrae to prevent further incidents.

3. Recovery phase and prognosis

Postoperative recovery can take several weeks to months, depending on the severity of the damage. Strict restriction of movement is usually recommended immediately after surgery. Subsequent physiotherapy is essential to rebuild muscle strength and coordination. The prognosis depends on several factors:

• Dogs with recovered DPP have a very good chance of a full recovery.
• In dogs without DPP before surgery, the success rate is lower, however, some dogs can walk again through intensive rehabilitation.
• The risk of a postoperative complication, such as myelomalacia (progressive tissue death in the spinal cord), exists but is rare.

While the Conservative therapy is a promising option. An option for many dogs is a surgical intervention in severe cases Often unavoidable. An early decision to operate can improve the prognosis, especially in animals with severe spinal cord compression. The choice of the best treatment method should always be made in close consultation with an experienced veterinarian. Veterinarian or neurologists to ensure the best possible quality of life for the dog.

Frequently Asked Questions (FAQ) about Acute Thoracolumbar Disc Extrusion

Summary Acute thoracolumbar disc extrusion

Acute thoracolumbar disc extrusion is a serious but treatable condition. Dogs with acute thoracolumbar disc extrusion can be treated either conservatively or surgically, depending on the severity. Conservative therapy for acute thoracolumbar disc extrusion includes strict exercise restriction, pain management, and supportive care. In many cases, acute thoracolumbar disc extrusion can resolve without surgery, especially if deep pain sensation is preserved. Dogs with acute thoracolumbar disc extrusion that do not improve with conservative therapy may be treated surgically, for example, with a hemilaminectomy. The prognosis for acute thoracolumbar disc extrusion depends heavily on the timing of diagnosis and the chosen treatment.

Early treatment of acute thoracolumbar disc extrusion significantly improves the chances of recovery. Pet owners should consult a veterinarian immediately if they suspect their pet has an acute thoracolumbar disc extrusion. Acute thoracolumbar disc extrusion can cause various neurological symptoms, including paralysis and pain. Therefore, a comprehensive diagnosis is essential. Acute thoracolumbar disc extrusion is particularly common in small dog breeds, especially dachshunds. The prognosis for acute thoracolumbar disc extrusion is better the earlier appropriate treatment is initiated. An individually tailored treatment plan is crucial for recovery after an acute thoracolumbar disc extrusion.

Through consistent physiotherapy, dogs with acute thoracolumbar disc extrusion can often regain their ability to walk. Acute thoracolumbar disc extrusion requires close cooperation between veterinarians, neurologists, and pet owners. With patience and care, acute thoracolumbar disc extrusion can be successfully treated. Recurrent acute thoracolumbar disc extrusion can be avoided through preventative measures such as weight management and joint-friendly exercise. Acute thoracolumbar disc extrusion should always be taken seriously to prevent long-term damage.

Owners should watch for signs of acute thoracolumbar disc extrusion in their dogs and react promptly. If acute thoracolumbar disc extrusion is diagnosed, consistent therapy should be initiated. Dogs with acute thoracolumbar disc extrusion require intensive care and attention. A targeted rehabilitation program can significantly improve recovery after acute thoracolumbar disc extrusion. Despite the challenges associated with acute thoracolumbar disc extrusion, many dogs have a good prognosis. Veterinarians recommend that dogs with acute thoracolumbar disc extrusion undergo regular checkups to monitor their recovery.

Acute thoracolumbar disc extrusion is a condition that requires considerable knowledge and commitment from pet owners. With careful management, the quality of life of a dog with acute thoracolumbar disc extrusion can be significantly improved. Overall, acute thoracolumbar disc extrusion is a well-researched and treatable condition that can be successfully managed with the right therapy.

Further information: https://www.mdpi.com/2075-1729/15/1/68

---