By Keith Loria
The tried and true ways to treat intervertebral disc disease in dogs—both medically and surgically—are what most veterinarians choose today. Medical treatment typically consists of pain drugs and bed or crate rest, while the surgical side involves the removal of disc material from around the spinal cord to reduce clinical signs.
The most common surgical treatments include a dorsolateral hemilaminectomy and cervical ventral cervical slot, but neither is 100 percent effective.
Sarah Moore, DVM, Dipl. ACVIM, noted that for particular canine patients, the best choice is based on the severity of clinical signs such as pain, weakness and difficulty walking.
While little progress has been made in finding new treatments, that hasn’t stopped some innovative ideas from coming to fruition.
One of the most interesting new bits of information concerns the use of steroids for dogs suffering from IVDD-related paralysis. Steroids have been used for awhile, but more evidence is needed that they really make a difference.
“Steroids have been a controversial topic for a long time in terms of their usefulness to treat spinal cord injury caused by an assortment of different causes,” said Dr. Moore, an associate professor of neurology and neurosurgery at Ohio State University’s College of Veterinary Medicine. “A study published recently looked at the use of steroids in dogs with [spinal cord injury] caused by IVDD and found that it did not improve the outcome for the dogs in the study.”
Changes have been slow, perhaps because standard of care treatments work well for many patients.
However, Moore said, a smaller subset of patients with severe spinal cord injury experience a less favorable prognosis. Only about 50 percent recover the ability to walk, even after aggressive surgery.
“For the dogs with this most severe form of injury, there have been a few recent clinical trials looking at certain types of cell-based therapies and other neuroprotective treatments to improve outcome,” she said. “And some of these studies have even shown some success.”
Signs of Advancement
Nicholas Jeffery, BVSc, Ph.D., MSc, Dipl. ECVS, conducted a trial with veterinary scientist Robin Franklin while at Cambridge University. They tested cell stem treatments on spinal cord injuries in dogs suffering from severe disc disease.
“One of the main things we looked for was how urgently dogs with extremely severe disc ruptures and severe spinal cord injuries needed to be treated,” said Dr. Jeffery, the Ramsey Chair in Veterinary Research at Iowa State University.
He explained that cells were collected from inside the back of a dog’s nose—the cells are capable of supporting the growth of new nerve fibers—and were injected into the spine.
“The good news is that about 60 percent of the dogs were able to walk again and got better,” Jeffery said. “What’s interesting is that the data was telling us there was no particular rush to get the dogs treated.
“That can be regarded as good news,” he said, “because you don’t have to tell the owners that ‘Unless you get a dog there within 12 hours, it’s not going to walk again.’ They should be treated quickly, but there’s no evidence that it’s urgent.”
Another trend in IVDD treatment is using more acupuncture and chiropractic approaches—either alone or in conjunction with an integrated approach that may include pain medication, steroids and surgery.
For example, in some patients, acupuncture and osteopathic therapy form the basis of the treatment, but additional choices may include prednisone, pain management, anti-anxiety medication and nutritional supplements. Rehabilitation methods are employed during post-recovery care.
Elizabeth Perone, VMD, CCRT, CCMT, a staff veterinarian with Petplan pet insurance, noted that the veterinary industry has made great strides over the past 10 to 15 years in physical rehabilitation of dogs.
“In my experience, pets who undergo surgical correction of intervertebral disc disease can have improved outcomes with a guided rehabilitation program during their postoperative period,” she said. “Previously, in those pets where surgical correction may not be an option, veterinarians would prescribe pain medications and strict crate rest.
“However, we are now seeing the benefit to adding rehabilitation therapies and gentle guided exercises as well as other rehabilitation modalities, such as laser, acupuncture and massage, into conservative medical management.”
These give clients additional options when surgery may not be the right choice.
“Some effective therapies include hydrotherapy and guided therapeutic exercises, which can help pets regain proprioception, increase strength and retrain normal gait dynamics,” Dr. Perone said. “Additionally, acupuncture and laser therapy can be utilized to help decrease inflammation, stimulate nerves and decrease pain.”
Richmond, Va., veterinarian Joel Ehrenzweig, DVM, published a paper a few years ago on the first USDA-approved biological treatment for osteoarthritis pain and inflammation, including disc disease and degeneration. His paper showed that lymphocyte T-Cell immunomodulator (LTCI) exhibited safety and efficacy in the management of pain in dogs with inflammation in the spine.
“The anti-inflammatory benefit of LTCI in dogs with no side effects is groundbreaking and is going to be a game changer, as it can be used in older dogs,” he said. “Being able to treat intervertebral disc disease with a safer line of products is pretty dramatic.”
Iowa State’s Jeffery is running a trial with the drug chondroitinase, which is injected into the spinal cord of dogs who have not recovered from disc herniation after the spinal cord was badly injured.
“We’re seeing if we can get them to improve by giving them the drug many months after the initial injury,” he said. “It’s been used in labs, working with rats, for more than a decade, but this is the first time it is being used in dog clinical patients.”
Intervertebral disc disease is the 12th most common condition in Petplan insurance claims. Perone revealed that in 2015, pet owners spent an average of $2,014 on veterinary treatment of the disease, a 13 percent increase from 2014.
“Veterinarians are always looking for new and improved treatments and therapeutic options that are affordable and cost-effective for pet owners,” she said.
“As intervertebral disc disease is a relatively common issue, it is certainly an area that all hope to increase and enhance patient outcomes.”
Originally published in the May 2017 issue of Veterinary Practice News. Did you enjoy this article? Then subscribe today!