Clean Run - June 2011 - 54

job of identifying Type I disc ruptures. However, soft tissue detail is not as clear, which can make judging soft tissue swelling and Type II disc ruptures challenging. If necessary, CT can be combined with myelography. Magnetic Resonance Imaging (MRI) MRI provides the best soft-tissue detail of any imaging modality and thus is considered the gold standard for assessing the spinal cord by most surgeons and neurologists. As with CT, the entire spinal column is visualized in cross section. MRI has the advantage of allowing internal assessment of the spinal cord, which may help determine prognosis. It also demonstrates early and subtle degenerative changes within the intervertebral disc. The quality of the MRI can vary significantly depending on the type of machine (open vs. closed, size of magnet) and software used to obtain the images. It is also the most expensive type of advanced imaging.

MRI) is performed before surgery to correctly identify the location of the compression. Surgery involves making a window in the vertebral bone above (dorsal laminectomy), below (ventral slot), or along the side (hemilaminectomy) of the vertebral canal to gain access to the spinal cord. The disc material is then removed from around the cord or nerve root and the remaining disc material that is still present between the vertebra is removed (termed fenestration). Rehabilitation Therapy Veterinary rehabilitation plays an integral role in the care of an IVDD patient, whether medical or surgical management is recommended. The combination of manual techniques, laser therapy, acupuncture, appropriate home exercise plans, and hydrotherapy have all been shown to aid the recovery process. Recent research demonstrates that laser treatments not only alleviate pain, but are also capable of healing tissues at the cellular level. Hydrotherapy has the added benefit of allowing the patient the ability to bear weight and encouraging ambulation. Many pets find it mentally rewarding as well, which cannot be overlooked in the overall healing process. Finding a therapist to tailor a treatment plan for your pet both at home and in the clinic setting will prove invaluable.

Prognosis
Nonsurgical Management Little is known about IVDD prognosis with conservative therapy. Studies have reported varying success rate with medical management alone. Success with conservative therapy will also depend on anatomic location and type of disc rupture, severity of clinical signs, breed, and duration of injury. The reported recurrence rate is as high as 40%. Surgical Management The most important prognostic variable is the presence or absence of deep nociception (the recognition of pain by the dog’s brain when the toes are squeezed, noted by facial reaction, vocalization or an attempt to bite). Deep nociception fibers run deeply within the spinal cord; if these deep fibers are damaged then the compression is very severe and those dogs have a worse prognosis. The prognosis for the return to ambulation in a dog with surgical decompression and intact deep nociception ranges from 72% to 100%. In our practice, we have greater than a 95% surgical success rate at restoring function in patients that present with deep pain sensation intact. If deep nociception is lost, the chance of recovery to ambulation falls to 25% to 78%. The postsurgical recurrence rate (disc rupture at a different site) is 10% to 20%. D

Treatment
Nonsurgical Management In performance patients, this is typically only recommended in dogs with short-term discomfort and no or only mild neurological weakness. If the dog is unable to bear his own weight, surgery is usually recommended. The paramount of conservative management of IVDD is strict exercise restriction for four to six weeks to allow the spinal cord to heal and analgesic (opioids and/or anti-inflammatory) therapy. Rehabilitation therapy, chiropractic adjustment, and/or acupuncture may also be of significant benefit and the use of such treatment is supported in the veterinary literature. If the neurological status worsens, then surgery may become warranted. Surgical Management Surgery involves an approach to the spinal canal and removal of the compressive lesion. Advanced imaging (myelogram, CT, or

Dr.Peter Lotsikas is a Diplomate of the American College ofVeterinary Surgeons.He holds a DVM degree from theVirginia-Maryland Regional College ofVeterinary Medicine.He also completed a general small animal internship at Kansas State University,followed by a surgical internship at DallasVeterinary Surgical Center.Dr.Lotsikas received his formal surgical residency training at Iowa State University.He now practices at the Veterinary Orthopedic & Sports Medicine Group (VOSM) in Annapolis Junction,Maryland (www.VOSM.com). Dr. Chris Leasure received a DVM degree from the Virginia-Maryland Regional College of Veterinary Medicine. He completed a general small animal internship at VCAVeterinary Referral Associates, followed by a surgical internship at the University of Florida. Dr. Leasure received his formal surgical residency training at the Animal Medical Center in New York City. He now practices at Veterinary Orthopedic & Sports Medicine Group (VOSM) in Annapolis Junction, Maryland (www.VOSM.com). Dr. Faith Lotsikas earned her veterinary degree from the Virginia-Maryland Regional College of Veterinary Medicine. She has always had a strong interest in whole pet wellness. For that reason, she also became a certified canine rehabilitation therapist. Dr. Faith now offers rehabilitation services as a mobile veterinarian in the Washington D.C. area, and at Gunny’s Rainbow in Bethesda. She also enjoys being an amateur veterinary medical illustrator. 54 Clean Run | June 11

http://www.VOSM.com http://www.VOSM.com

Clean Run - June 2011

Table of Contents for the Digital Edition of Clean Run - June 2011