Acute thoracolumbal intervertebral disc extrusion: chances of success of conservative treatment

Inspired by Erin Y. Akin, DVM, Dacvim (neurology), Locum neurologist, Woodstock, Georgia

What is a thoracolumbal intervertebral disc extrusion?

The spine of a dog consists of many individual vertebrae, which are separated by intervertebral discs. These intervertebral discs act like shock absorbers and enable mobility. With a thoracolumbal intervertebral disc extrusion, the inner, gel -like material of a intervertebral disc leaves through the outer shell and presses onto the spinal cord. This can lead to pain, paralysis and in severe cases to loss of walking ability.

This disease often occurs in certain dog breeds such as dachshunds, which have a genetic predisposition to intervertebral disc problems. Symptoms can suddenly occur 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 thoracolumbal intervertebral disc extrusion diagnosed?

The diagnosis begins with a thorough clinical examination by the veterinarian. The gait, reflexes and pain sensation are checked. Important diagnostic steps are:

1. Neurological examination: Affected body regions are tested in order to narrow down the location of spinal cord damage.
2. X -rays: These can provide information about changes in the spine, but they do not show the intervertebral discs themselves.
3. MRI (magnetic resonance imaging): The best way to diagnose intervertebral disc extrusions. This allows you to see whether and how strongly the spinal cord is compressed by the leaked intervertebral disc material.
4. CT (computer tomography): An alternative to MRI, especially if surgery is planned.
5. Myelography: A special X -ray technology in which a contrast medium is injected into the vertebral canal in order to make narrow points visible. Today, however, it is mostly replaced by MRI or CT.

A quick diagnosis is important because the forecast 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. 2024; 38 (5): 2603-2611. DOI: 10.1111/JVIM.17149

Acute thoracolumbale myelopathy through intervertebral discus extrusion (IDE) is a common cause of neurological failures in dogs. This disease causes a mixture of duller (accounting) and compressing violation of the spinal cord, which can lead to back pain, paraparesis, paraplegia, the loss of depth pain perception (DPP), urinary incontinence and other neurological symptoms. 1,2

The treatment consists either conservative therapy or surgical decompression of the spinal cord (mostly through hemilaminectomy) .3 An operation is often viewed as a promising dog, regardless of whether DPP is present. 3 However, a systematic analysis showed that that Up to 86 % of the non-running dogs with DPP can be able to walk again without surgical intervention. 4

Study design acute thoracolumbal intervertebral disc extrusion

This prospective study examined 72 non-running dogs with acute Thorakolumbal IDE with regard to their recovery potential under conservative therapy over 12 weeks.

• All dogs weighed below 15 kg and were not brachyzephal, with dackeln as the most common breed.
• 67 dogs received a diagnosis confirmation via MRI.
• Conservative treatment included pain medication, movement restriction (pit rest), physiotherapeutic measures by owners and bladder management.
• The activity was gradually increased and pain medication was slowly reduced.

Results

• Dogs with a DPP obtained (n = 51): 96 % achieved the walking ability in the median after 11 days.
• Dogs without DPP (n = 21): 48 % were capable of walking again, in the median after 25 days.
• MRI after 12 weeks (n = 63): A reduction in spinal cord compression was recognizable, but was not directly correlated with the recovery of walking ability.
• Complications: a higher incidence of ascending and descending myeloma alazy than in previous studies, possibly due to the inclusion criteria.

Conclusions

• This study provides indications that small, non-running dogs with Thorakolumbal IDE can regain their walking capacity within 12 weeks without surgery.
• In an earlier study, dogs were operated on after four weeks of conservative therapy if no improvement occurred. This study suggests that some of these dogs with an extended conservative therapy have nevertheless regained the ability to walk.
• A treatment period of at least 12 weeks should be considered , especially in dogs with a preserved DPP, since the chances of recovery are high.
• Conservative therapy includes pain management, muscle relaxation, rehabilitation, movement restriction (box rest), care (e.g. bladder management) and other support measures.
• A close cooperation between the veterinarian, neurologist and pet owners is crucial. The care can be made through telephone calls, emails, personal examinations or video consultation.

Meaning for practice

The results of this study underline that conservative treatment in many dogs with thoracolumbal intervertebral disc extrusion can be a promising alternative to surgery. A recovery without surgical intervention is possible, especially in small dogs with a recovered depth of pain.

The decision between conservative therapy and an operation should be made individually. Factors such as the severity of the symptoms, pain pollution, the dog's mobility and the possibilities of the owners to provide intensive domestic care are crucial.

Recommendations for pet owners

If your dog is affected by an intervertebral disc extrusion, the following measures can help support the healing process:

• Strict movement restriction : stick to the veterinarian's box rest. Even if it is difficult, the dog can only move very controlled during the acute phase.
• Medicinal administration : stick strictly to the prescribed pain and inflammatory medication to promote the regeneration of the spinal cord.
• Bladder and intestinal management : If your dog has problems urinating independently, let your veterinarian show you how you can empty the bladder. Make sure that he can take drops regularly.
• Physiotherapy and supporting measures : Depending on the recording process, targeted exercises, gentle massages or even hydrotherapy can help maintain the muscles and improve mobility.
• Patience and loving care : recovery can take a few weeks to months. Keep regular contact with your veterinarian and observe how the condition of your dog develops.

Physiotherapeutic approaches to rehabilitation

Physiotherapy plays a crucial role in rehabilitation of dogs with thoracolumbal intervertebral disc extrusion. It helps to improve mobility, prevent muscle reduction and to support the healing of the nervous system. The following physiotherapy measures can be part of the treatment plan:

1. Passive movement exercises: Muscles are stimulated by controlled movements of the limbs without the dog having to walk actively. This helps to avoid joint stiffening and to promote blood circulation.
2. Hydrotherapy: Movement in the water, especially on the underwater treadmill, enables joint -friendly training. The water resistance strengthens the muscles during the buoyancy reduces the strain on the spine.
3. Massages and manual therapy: These techniques help to solve tension, promote blood circulation and relieve pain. They are particularly valuable in the early rehabilitation phase.
4. Electrostimulation (TENS/EMS): Electrical impulses can help to activate weakened muscles and reduce pain. This is particularly helpful in patients with limited or lost muscle control.
5. Balance training: Exercises with wobble boards or balances improve coordination and stability and support the dog in recovering its movement skills.
6. Targeted muscle strengthening: As soon as the dog makes progress, targeted strength exercises can help to strengthen the muscles around the spine and to better distribute the stress.

Physiotherapy should always be individually tailored to the condition of the dog and carried out under veterinary guidance. Regular progress controls help to optimally adapt the training and support the dog as best as possible.

Non-conservative treatment: operational options

In some cases, conservative therapy is not sufficient, especially if the dog does not show any signs of improvement despite intensive medical care or if there are severe neurological deficits. Operation can be the best or only option in such situations to stop the progression of the disease and to maintain the function of the spinal cord as much as possible.

1. Indications for an operation

Surgical intervention is recommended if:

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

2. Surgical procedure

The most common surgical procedure for the treatment of thoracolumbal intervertebral disc extrusion is hemilaminectomy . Part of the affected vertebra is removed to relieve the compressed spinal cord and remove the leaked intervertebral disc material.

Further procedures can be:

• Dorsal laminectomy: is used when larger decompression is required.
• Fenestration: A preventive intervention in which the intervertebral disc material is removed in neighboring vertebrae to prevent further incidents.

3. Recovery phase and forecast

The postoperative recovery can take several weeks to months depending on the severity of the damage. A strict movement restriction is usually recommended immediately after the operation. A subsequent physiotherapy is essential to rebuild muscle strength and coordination. The forecast depends on several factors:

• Dogs with a DPP obtained have a very good chance of full recovery.
• In dogs without DPP before the operation, the success rate is lower, but some dogs can run again through intensive rehabilitation.
• However, there is rare the risk of a postoperative complication, such as a myeloma alazy (progressive tissue death in the spinal cord).

While conservative therapy is a promising option for many dogs, surgical intervention in severe cases often essential. An early decision to surgery can improve the forecast, especially in animals with strong spinal cord compression. The choice of the best treatment method should always be made in close consultation with an experienced veterinarian or neurologist to ensure the best possible quality of life for the dog.

Frequently asked questions (FAQ) to acute thoracolumbal intervertebral disc extrusion

Summary acute thoracolumbal intervertebral disc extrusion

The acute thoracolumbal intervertebral disc extrusion is a serious but treatable disease. Dogs with acute thoracolumbal intervertebral disc extrusion can be treated either conservatively or surgically depending on the severity. The conservative therapy of acute thoracolumbal intervertebral disc extrusion includes strict movement restrictions, pain management and supportive care. In many cases, the acute thoracolumbal intervertebral disc extrusion can heal without surgery, especially if the deep pain perception is preserved. Dogs with acute thoracolumbal intervertebral disc extrusion, which despite conservative therapy do not improve, can be treated with surgery such as hemilaminectomy. The forecast of acute thoracolumbal intervertebral disc extrusion depends heavily on the time of diagnosis and the selected therapy.

Early treatment of acute thoracolumbal intervertebral disc extrusion improves the chances of recovery significantly. Animal owners should immediately visit a veterinarian if they are suspected of acute thoracolumbal intervertebral disc extrusion. The acute thoracolumbal intervertebral disc extrusion can cause various neurological symptoms, including paralysis and pain. Therefore, comprehensive diagnostics is essential. The acute thoracolumbal intervertebral disc extrusion occurs particularly often in small dog breeds, especially in the case of dackeln. The earlier a suitable treatment is the forecast of acute thoracolumbal intervertebral disc extrusion. An individually adapted therapy plan is crucial for recovery after acute thoracolumbal intervertebral disc extrusion.

Consistent physiotherapy can often regain dogs with acute thoracolumbal intervertebral disc extrusion. The acute thoracolumbal intervertebral disc extrusion requires close cooperation between the veterinarian, neurologist and veterinary owners. The acute thoracolumbal intervertebral disc extrusion can be successfully treated with patience and care. A repeated acute thoracolumbal intervertebral disc extrusion can be avoided by preventive measures such as weight management and joint -friendly movement. The acute thoracolumbal intervertebral disc extrusion should always be taken seriously to prevent long -term damage.

In your dog, owners should pay attention to signs of acute thoracolumbal intervertebral disc extrusion and react early. If an acute thoracolumbal intervertebral disc extrusion has been diagnosed, consistent therapy should be initiated. Dogs with acute thoracolumbal intervertebral disc extrusion require intensive care and attention. A targeted rehabilitation program can significantly improve recovery after acute thoracolumbal intervertebral disc extrusion. Despite the challenges that an acute thoracolumbal intervertebral disc extrusion entails, many dogs have a good forecast. Veterinarians recommend that dogs with acute thoracolumbal intervertebral disc extrusion are regularly examined to monitor the healing process.

The acute thoracolumbal intervertebral disc extrusion is an illness that requires a lot of knowledge and commitment on the part of the pet owners. Through careful support, the quality of life of a dog with acute thoracolumbal intervertebral disc extrusion can be significantly improved. Overall, the acute thoracolumbal intervertebral disc extrusion is a well -researched and treatable disease, which can be successfully managed with the correct therapy.

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