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Intervertebral disks are located between the vertebrae (bones of the spine). Each disk has two parts, a fibrous outer layer and the jelly-like interior. When disk herniation occurs, the interior either protrudes (bulges) or extrudes (ruptures) into the vertebral canal, where the spinal cord resides. The onset of herniations can be either acute or chronic. When the spinal cord is compressed by this disk material, the dog or cat experiences signs ranging from mild back or neck pain to paralysis of limbs, loss of sensation, and loss of bladder and bowel control. Sometimes a disc herniation can be seen on radiographs (see below) but it may take more specialized studies of the spine (MRI or CT scan or a myelogram) to see the exact site where the disc herniated; this is especially true if surgery is part of the treatment plan because the surgeon must be sure of the exact rupture site.
Intervertebral disk disease sometimes occurs in cats, but it is not as common as it is in dogs, especially in the long, low chondrodystrophic breeds (e.g., dachshund, basset hound, beagle, Cocker spaniel, Shih Tzu, Lhasa apso, Pekingese, and corgi). In these breeds, there is a genetic predisposition for degeneration of the inside of the disk due to the animal’s conformation, which predisposes the disk to herniation. These chondrodystrophic dogs tend to get the bulging extrusions. Larger breeds of dogs are more typically affected with protrusions.
Although most disk herniations are caused by degeneration of the disk, they can also be caused by physical trauma (an accident, such as being hit by a car).
Disk herniation can occur anywhere along the spine but is commonly seen in the mid back area, the lower back area, and the neck area. Disk herniation in the mid back to lower back area may cause paralysis of the hind limbs and inability to properly urinate or defecate. Disk herniation in the neck often causes neck pain or limping on one front limb; however, it can also cause paralysis of all four limbs.
In affected dogs of chondrodystrophic (long, low-slung) breeds, disk degeneration occurs within the first few months of life, but the actual herniation doesn’t occur until the dog is typically over 3 years of age. The herniation may have a very sudden in onset, i.e. suddenly extruding into the spinal canal where the spinal cord runs. In non-chondrodystrophic breeds, the disk degeneration starts later in life and the herniation may occur more slowly over time (slowly protruding or bulging disc).
A neurological examination allows the severity of clinical signs to be graded as follows:
Grade 5: normal
Grade 4: ambulatory, but mildly paraparetic (weak/wobbly)
Grade 3: markedly paraparetic (weak/wobbly), but is able to get up on his/her own
Grade 2: severely paraparetic (weak/wobbly); good voluntary motion still present in hind limbs, but cannot get up without assistance
Grade 1: slight voluntary limb motion present
Grade 0: paraplegic (no voluntary motion present). This grade is further subdivided as to whether or not the patient can feel any deep pain sensation in the affected limbs.
A tentative diagnosis is based on age and breed of patient, clinical signs, and spinal radiographs. Remember, though, that disc herniations are not always as visible as the one demonstrated in the above radiograph; some are impossible to see without more specialized imaging. Therefore, a definitive diagnosis usually requires myelography, MRI, or CT scans of the spine. Myelography is a type of imaging involving the injection of a contrast agent (a liquid that x-rays don’t go through) into the spinal canal to pinpoint the compressed area of spinal cord. CT or MRI scans are also another way to see more clearly if a disk is the cause of the problems. These tests require general anesthesia, at which time the attending veterinarian may also remove some spinal fluid and have it analyzed for signs of other diseases that can mimic a disk herniation.
Mild cases that are not paralyzed are often managed medically. Confinement to a crate with minimal physical activity (no jumping, no running, no going up/down stairs, no playing, etc.) is necessary for several weeks. Pain medication may be prescribed by your veterinarian during the confinement.
Surgical intervention may be recommended if medical management isn’t working, if the pain can’t be controlled, or if the patient is paralyzed. Surgery is often the quickest way to get function to return. However, the success of the surgery depends on the amount of damage that the spinal cord has incurred and how long of a time period the disk has been compressing the spinal cord. The neurological examination will help to determine the degree of damage as well as estimating the prognosis for return of function. In general, more than 90% of the dogs who have the ability to sense pain in their hind limbs will walk again after surgery; this decreases to 60% or less if the patient has lost the ability to sense deep pain sensation in their limbs. Surgery to treat disk herniation requires the expertise of a veterinarian with training in disk surgery, which is usually a surgical specialist, a neurologist, or a neurosurgeon.
With either medical or surgical treatment, the pet owner will need to provide nursing care for the pet during the recovery phase. This may mean keeping the pet confined to a small space while it is recovering, keeping it calm and quiet, carrying it outdoors frequently for eliminations, assisting with urination and defecation, flexing and extending joints to keep them flexible, etc. Consult with your veterinarian as to how you can assist your pet during recovery. More intensive physical therapy may be needed in some cases. Full recovery usually takes several weeks and, in some cases, even several months.
The prognosis depends on how severe the clinical signs are, how long the problem has been present, which treatment is selected, and how the patient responds to treatment. Most animals respond well if veterinary advice is followed, but some patients end up with permanent paralysis and fecal/urinary incontinence despite proper treatment and management.
These are a list of the things that we may recommend for back pain or back injury with your pet.
GENERAL RECOMMENDATIONS FOR ARTHRITIS:
Medical management of osteoarthritis (OA) requires a short- and long-term plan because the symptoms arthritis can often be managed but arthritis cannot be cured. Careful communication with your veterinarian is important so a plan that works for both you and your pet is developed. Some of the factors that influence the plan include patient age and breed, cause of arthritis and the duration and severity of the symptoms. The treatment plan generally incorporates weight loss if needed, use of a nonsteroidal anti-inflammatory drug (NSAID), use of an omega-3 fatty acid supplementation in the form of a prescription diet (e.g. Purina J/M or Hills J/D), controlled activity (e.g. leash walks, swimming, cavalettis) and pain medication (e.g. Amantadine) if needed. Adequan, and FDA-approved disease-modifying osteoarthritis drug, is used in some situations to reduce cartilage loss in a joint. Even if your pet had surgery, often these are incorporated into the long-term treatment plan to limit symptoms of arthritis that might develop in the future.
There are many alternative therapies (not approved or regulated by the FDA) that can be considered for the treatment of OA. While these options are plentiful, the scientific support for their use is generally limited. Examples include Wellactin omega-3 fatty acid supplements, cetyl myristoleate, glucosamine and/or chondroitin products, Duralactin, Niacinamide, cold laser therapy, prolotherapy injections, biologics (e.g. platelet rich plasma, protein products, stem cell injections) and acupuncture.
Feel free to discuss recommendations with one of our surgeons (480) 674-3200.
Resources:
Sanderson RO, Beata C, Flipo RM, Genevois JP, Macias C, Tacke S, Vezzoni A, Innes JF. Systematic review of the management of canine osteoarthritis. Vet Rec. 2009 Apr 4;164(14):418-24.
Smith GK, Paster ER, Powers MY, Lawler DF, Biery DN, Shofer FS, McKelvie PJ, Kealy RD. Lifelong diet restriction and radiographic evidence of osteoarthritis of the hip joint in dogs. J Am Vet Med Assoc. 2006 Sep 1;229(5):690-3.
Marshall WG, Hazewinkel HA, Mullen D, De Meyer G, Baert K, Carmichael S. The effect of weight loss on lameness in obese dogs with osteoarthritis. Vet Res Commun. 2010 Mar;34(3):241-53. doi: 10.1007/s11259-010-9348-7. Epub 2010 Mar 17.
Roush JK, Cross AR, Renberg WC, Dodd CE, Sixby KA, Fritsch DA, Allen TA, Jewell DE, Richardson DC, Leventhal PS, Hahn KA. Evaluation of the effects of dietary supplementation with fish oil omega-3 fatty acids on weight bearing in dogs with osteoarthritis. J Am Vet Med Assoc. 2010 Jan 1;236(1):67-73.
Lascelles BD, Gaynor JS, Smith ES, Roe SC, Marcellin-Little DJ, Davidson G, Boland E, Carr J. Amantadine in a multimodal analgesic regimen for alleviation of refractory osteoarthritis pain in dogs. J Vet Intern Med. 2008 Jan-Feb;22(1):53-9.
Upchurch DA, Renberg WC, Roush JK, Milliken GA, Weiss ML. Effects of administration of adipose-derived stromal vascular fraction and platelet-rich plasma to dogs with osteoarthritis of the hip joints. Am J Vet Res. 2016 Sep;77(9):940-51.
The long bones of dogs and cats are almost identical to the bones of the legs and arms of people, and just like people, dogs and cats can break these bones due to trauma. A bone can break in many ways; this is called a fracture. Fractures are classified into several categories: Incomplete, Complete, Transverse, Oblique and Comminuted. The type of fracture will determine the length and cost of surgery and/or treatment. With surgical intervention, fractures have a more successful chance of healing as the instability is eliminated and this allows for the bone to adequately heal.
Surgery does dramatically improve the chances of the fracture healing, and by using plating, pin, and/or wire techniques, most fractures can be stabilized surgically. This depends on a case by case basis however. If there are financial constraints and surgery is not a viable option, external coaptation (splinting / bandaging) can be attempted. However, it must be reiterated that bone healing may not fare as well with external coaptation as it would with surgical repair. Some cases may require limb amputation depending on severity and financial constraints. Below is a range of options for treatment, comparing a surgical fracture repair with and without complications, external coaptation, and/or to limb amputation.
Price includes initial exam and x-rays, anesthesia, uncomplicated fracture repair, pain injections, antibiotics, overnight hospitalization, IV fluids, bloodwork, plate & screws for repair, post-operative pain medications, follow up exams and follow up x-rays. Estimated cost = $3,000 – $5,000
Price includes initial exam and x-rays anesthesia, complicated fracture repair, pain injections, antibiotics, overnight hospitalization, IV fluids, bloodwork, plate & screws for repair, post-operative pain medications, follow up exams and follow up x-rays. Estimated cost = $5,000 – $7,000
Price includes initial exam and x-rays, anesthesia, amputation procedure, pain injections, IV fluids, bloodwork, post-operative pain medications, antibiotics and overnight hospitalization. Estimated cost = $4,000 – $5,000
Includes initial exam and x-rays, pain medications, sedatives (if necessary), follow up splint and bandage changes, follow up exams and follow up x-rays.
External Splint & Bandage (small animal): $1,500 – $1,800
External Splint & Bandage (medium animal): $1,700-$2,000
External Splint & Bandage (large animal): $1,800 – $2,200
**These cost ranges are based on an average healing time of 6-8 weeks. Some cases may require longer treatment and may exceed the above estimated ranges.
Depending on your pet’s individual situation, surgery might not be a first or realistic option. Here are some medical alternatives that may be right for you and your pet:
Cetyl-M: Cetyl myristoleate is a supplement recommended for the treatment of osteoarthritis and joint disease in dogs. It helps to relieve pain, increase range of motion and improve mobility. This product is highly recommended for the first month after a ligament injury to see if it will heal on its own. If still limping after a month generally surgery is necessary. Cost is $35-90 dollars.
PRP: Platelet rich plasma uses a growth factors derived from your pet’s blood to enhance the body’s natural healing process. This is achieved by delivering a high concentration of growth and healing factors at an injured site. PRP is especially recommended if you cannot afford surgery, if your pet has a partial tear, or they already have arthritis in the joint. Cost is $500-800 dollars depending on the number of injections.
Prolozone: This joint injection pairs ozone therapy and prolotherapy to initiate a healing cascade. This cascade then works by strengthening tendons and ligaments which reduces inflammation and relieves arthritic pain. Many times, this therapy is combined with PRP. If performed with PRP there is no additional cost, but if performed alone, estimated cost is $200-$300 depending on number of injections.
Braces: A custom brace made specifically for your pet that works to alleviate pain and lameness, offer support and maintain quality of life. These braces are generally ineffective for healing the joint, but may stabilize it enough to improve quality of life. May be recommended for old patient where surgery is ineffective. Cost is $500-900 dollars.
In cases of chronic joint disease, your veterinarian will work with you to come up with a comprehensive plan to best manage your pet’s joint pain. This may include: a weight loss program, physical therapy exercises, swimming, a prescription joint diet, fish oil and other joint supplements, and pain medications. Cost varies depending on the required medications.
Stem Cell Therapy: Stem cell therapy is sometimes recommended for management of healing and chronic pain with joint disease. Cost is $1,800 -2,500 dollars.
Anti-inflammatories/NSAIDS: Though anti-inflammatory medications do play a part in managing pain, they are contraindicated in acute injuries as they may inhibit joint healing long term. Ask us about other pain medication options for your pet.
Here are some surgical options to discuss with your veterinarian to see which might be the best option for you and your pet. Regardless of the surgical technique, approximately 60% of dogs will require surgery on the opposite (good) knee in the future:
Bilateral Extracapsular Stabilization Technique (BEST Technique): This technique uses suture to stabilize both sides of the knee joint. For larger dogs, multiple pieces of suture are used to aid in recovery. It aids in stabilization of the cruciate ligaments, collateral ligaments, and generally has a 95% return to normal function. This technique allows scar tissue to form over the suture stabilizing the joint long term. This technique will fail if your dog is too active and breaks the suture or if they are poor at forming scar tissue.
Lateral Suture, Extra-Capsular Repair: This technique uses suture to stabilize the knee joint. It aids in stabilization of the cruciate ligaments, and generally has a 95% return to normal function in small dogs. This technique allows scar tissue to form over the suture stabilizing the joint long term. This technique will fail if your dog is too active and breaks the suture or if they are poor at forming scar tissue.
Tightrope Implant: These extra-articular (outside the joint) procedures utilize suture material placed under the skin but just outside the knee joint to mimic the stability of an intact cruciate ligament. The Tightrope is a suture technique that involves tunnels to be drilled through the thigh and shin bones for more accurate anatomic placement of the suture/toggle implant. This procedure has less likely hood of the suture breaking than the BEST or the Lateral Suture. This technique has a slightly higher post-operative infection rate, and does not stabilize collateral ligament damage. Return to normal function is also 95%.
Tibial Plateau Leveling Osteotomy (TPLO Technique): This procedure involves making a circular cut into the top of the shin bone and rotating the contact surface of this bone until it is level at about 90 degrees to the patellar tendon. At this angle and orientation, the knee is relatively stable independent of the cruciate ligament. A plate and screws are used to stabilize the cut in the bone. Once the bone is healed, the bone plate and screws are no longer needed, but are seldom removed unless infection occurs. Return to normal function is approximately 95%. Complications can include fracture of the bone plate, bone infection, and non-union. Cost is approximately $5,500-7,000.
Tibial Tuberosity Advancement (TTA Technique): This procedure involves making a linear cut along the front of the shin bone and advancing it forward until the patellar tendon is oriented about 90 degrees to the top of the shin bone (tibial plateau). At this orientation, the knee is relatively stable independent of the cruciate ligament. Similar to the TPLO, the cut in the bone is stabilized with a bridging plate and screws. Though the bone plate and screws are not needed once the bone is healed, they are seldom removed unless infection occurs. Return to normal function is approximately 95%. Complications can include fracture of the bone plate, bone infection, and non-union.