Spinal Disease – When is Surgery Necessary?

Presenter: Peter Gilbert BVSc (Hons) MVetSc, Diplomate of the American College of Veterinary Surgeons and Associate Professor for 4 years. Now back in Australia with Veterinary Specialist Services in Brisbane, Peter has written book chapters, published multiple papers and spoken in the USA, Canada and Europe. He has a keen interest in minimally invasive surgery (arthroscopy, laparoscopy and thoracoscopy), wound management, orthopaedics, joint and tendon disor-ders, surgical oncology and neurosurgery.

Being presented with a paraplegic Dachshund and having to make a decision whether this case should be rushed to a referral surgeon or just requires time to recover is always a scenario which causes me anxiety. Either way, if I make the wrong decision, I could potentially have condemned a dog to death due to its irreversible paralysis or have needlessly spent my client’s hard earned money by sending them to a specialist when it wasn’t necessary.‏

I realise it’s not always this black and white, and Peter Gilbert confirmed this belief in last week’s webinar covering practical tips on diagnosing and managing spinal disease. Peter stated that the spinal cord is very durable and adaptable and is consequently unpredictable, sometimes not reacting the way one might expect, which explains why decision making on diagnosis and treatment is not always straight forward.

Peter offered a number of tips on how best to diagnose and advise clients when presented with a neurological case despite the sometimes unpredictable nature of these conditions. He explained initially that it is important to establish if the presented case is indeed neurological. Any clinical presentation which include seizures and/or cranial nerve deficits and/or conscious proprioception will definitely have a neurological component, however he explained that it is important to remember when testing conscious proprioception using the knuckling technique, that some dogs with cruciate disease will find it just too painful to lift their legs.

Intervertebral disc disease is one of the more common problems encountered in practice especially in the aforementioned Dachshund and is often the situation where decisions need to be made about whether surgical intervention is necessary. Under these circumstances Peter finds it useful to use the neurologically grading scheme for intervertebral disc disease which grades from one to five, one being where only pain is present and five being where there is paraplegia/paralysis with no deep pain. Grade 4 is allocated to dogs which are also displaying paraplegia/paralysis but do have the presence of deep pain (urinary retention must always be considered as a potential problem in grade 4 and grade 5 cases). These grades can be used as a guideline for decision making when considering either medical management or surgical intervention.

Conservative therapy involves confining a patient and providing analgesia and offers a 90% recovery rate in dogs graded 1-3. However this recovery rate drops to 50% in grade 4 patients and only 7 % in grade 5 cases.

Peter believes surgical intervention becomes an option in any dogs graded 2 and higher or for recurrent grade 1 cases. Surgery is also warranted in cases which deteriorate rapidly or for animals with unrelenting pain. There is a more than 90% recovery rate within 3-6 weeks in patients where deep pain in present. If deep pain is not present there is a 56% recovery rate for those which lost deep pain less than 12 hours prior to surgery, 25% for those between 12 and 36 hours and less than 5% for those after 48 hours.

The information delivered to you within this blog is just a 10th of the practical tips available from this practice-relevant webinar. I have concentrated on an area I feel particularly anxious about and actually it’s nice to know I have been making sensible decisions. However the addition of statistics to help guide owners in the direction appropriate to them and their pet is invaluable. If you want to find out more about general diagnosis and management of a variety of spinal conditions including discospondylitis, neoplasia and fibrocartilagenous embolism then log into ‘The Webinar Vet’ and I can assure you it will be an hour of your time very well spent.

The Stethoscope (MRCVS)