Degenerative Disk Disease, Canine - contd.
Dogs with symptoms of disk disease should be seen by a veterinarian without delay. It is important to keep them quiet and still. Confinement in a cage or crate until examination is recommended. The dog should not be encouraged to walk or jump, as this may make the situation dramatically worse by causing more disk material to herniate. The sudden onset of weakness or paralysis calls for emergency treatment. The goal of treatment is to reduce spinal cord swelling, inflammation, and compression as quickly as possible, so that normal spinal function will return. Disk herniation may be managed either medically or surgically, depending on the findings of a neurological examination and the overall condition of the dog.
Medical treatment consists of strict cage rest for three to four weeks. Medication to reduce pain and inflammation may be used with care when the patient is under direct veterinary supervision. Eliminating an animal�s pain entirely encourages it to become overactive, and this will increase spinal cord injury. Medical management is indicated for initial episodes of pain, pain combined with mild lack of coordination, dogs with other medical conditions that preclude surgery, and dogs that have lost the ability to feel deep-tissue pain for more that 48 hours. Many dogs that have maintained the ability to feel deep-tissue pain will improve with medical treatment alone. In these cases, however, recurrence is likely, and some residual neurological deficits may remain.
Surgery should be considered when there have been repeated episodes of mild signs, when a dog that is being treated medically deteriorates, when there is progressive neurological dysfunction, or when there is moderate to severe weakness or paralysis. Surgical techniques may involve fenestration, decompression, or both.
Fenestration is a surgical technique in which the disk space is opened and the nucleus pulposus is removed without entering the spinal canal. Fenestration alone may be beneficial in cases in which there have been repeated episodes of pain without any other signs, or when there is a second episode of pain and mild weakness.
Surgical decompression is a technique in which a portion of the vertebra at the disk rupture site is removed, thus reducing the compression of the spinal cord and allowing removal of the ruptured disk from the spinal canal. Decompression is indicated when there is moderate to severe weakness or paralysis. Dogs that are paralyzed and have no deep-tissue pain sensation should ideally undergo decompressive surgery within two hours. If a dog has lost deep-tissue pain sense for greater than 48 hours, the likelihood that surgery will be beneficial is extremely small and surgery is not recommended.
Methods of decompression include ventral slot, in which the spinal cord is approached through the bone from the bottom. This is generally done only with cervical disk disease. Hemilaminectomy, in which the spinal cord is approached from the right or left side, is usually performed with thoracolumbar disk disease. Dorsal laminectomy, in which the spinal cord is approached from the top, is performed in some cases of cervical, thoracolumbar, and lumbar disk disease.
Adequate nursing care both for post-operative patients and for weak or paralyzed dogs that are being managed medically is critical to their overall recovery. The dogs should be kept clean and dry, and provided with a well-padded surface to prevent the development of bedsores. Urinary bladder function must be carefully monitored and maintained to prevent over-distension and secondary bacterial infection. Most patients are hospitalized until they regain control of bowel and bladder. Strict exercise restriction for three to four weeks is critical. Physical therapy is important for post-operative patients, in order to maintain muscle tone and flexibility.
