- Tiffany Downing, RVT
Intervertebral Disc Disease (IVDD)
CROC commonly treats IVDD patients in an attempt to restore as much normal bodily function as possible. Patients can present at a variety of stages in their disease progression, from experiencing slight back pain to complete paralysis. While no one can guarantee that your pet will regain 100% normal function, there’s plenty to be done to give them the very best chance of doing so. We’ll go over IVDD in depth so that you know exactly what to expect with your dog’s rehab journey from here on out.
What is Intervertebral Disc Disease?
While the spinal cord is mostly encased within the vertebrae, it is exposed in the Intervertebral Spaces and sits just above the Intervertebral Discs. This is why the spine is so flexible in so many different directions. Between each vertebra of the spinal column, there is a disc of semi-squishy material that helps absorb the impact of an animal’s daily life. The Intervertebral Disc is composed of a jelly-like inner material with a more rigid outer layer. With IVDD, this rigid outer layer of the disc starts to weaken and break down prematurely. Eventually, the outer layer breaks down enough that the disc ruptures and the jelly-like material herniates outside the rigid outer layer up, towards the Spinal Cord. This herniated material puts pressure on the spinal cord, restricting blood flow and damaging nerves.
In the best-case scenario, this results in mild to moderate neck or back pain and the dog can heal with strict cage rest and pain medications. In the worst-case scenario, this pressure causes pain AND blocks neurological signals traveling back and forth between the brain and the lower body, often causing partial or complete paralysis of the hind legs. Complete or partial loss of bladder and bowel control usually comes along with the paralysis/paraparesis. For the remainder of this handout, we’ll be addressing the worst-case scenario since most of it still applies to best-care scenario as well.
We describe the spinal cord as an unforgiving tissue, meaning that it does not tolerate or bounce back from injury very well and frequently requires quick (often expensive) diagnostics, treatments, or surgeries to have any chance of recovery. Failure to relieve significant pressure from the spinal cord in a timely manner will almost always result in permanent paralysis or paresis. Some patients with less severe disc herniation can recover to some degree without surgery, but there is no way to predict if your dog will recover without surgery. We do know that surgery increases chances that your dog will recover, but there are no promises there either.
Who is at Risk for IVDD?
Chondrodystrophic breeds (dogs with long bodies and short legs) like Dachshunds, Corgis, Shih Tzu, Basset Hounds, Cocker Spaniels, Pekingese, and mixtures of those breeds are at highest risk for developing IVDD. Anecdotally, CROC sees a significantly higher number of Dachshunds and French Bulldogs presenting with IVDD than any other breeds. Breed predisposition combined with body condition and lifestyle will determine risk factor for an individual dog.
Diagnosing Intervertebral Disc Disease
Many dog owners are not aware of IVDD until their dog suddenly can’t move their back legs. It is a common misconception that the paralysis is from an acute injury like a fall, rough play, or jumping down from furniture. In reality, the Intervertebral Disc had been degenerating for some time and then finally ruptured due to the extra stress on the disc from whatever activity the dog was engaged in.
For the best chance at recovery, your dog should be seen by a Board-Certified Veterinary Neurologist as soon as possible. While radiographs (X-Rays) are helpful to rule out any fractures, identify narrowing disc spaces, and sometimes detect calcifications of the discs, these things frequently fail to correlate with the true location of the herniated disc. Therefore, radiographs are not sufficient to diagnose IVDD or Disc Herniation and Spinal Cord Impingement. Myelography, injecting a contrast agent and then performing radiographs, can provide more information but comes with significant risks that often outweigh the reward. Myelography and Computed Tomography (CT) have historically been used together to diagnose IVDD but have fallen by the wayside since they are not as effective as MRI. Magnetic Resonance Imaging (MRI) is the Gold Standard for diagnosing IVDD as it allows for detailed imaging of all soft tissue structures. While IVDD can go undetected with Myelography or CT, MRI has a diagnostic accuracy of 98-100%.
IVDD is staged according to its severity and while the earlier stages can recover without surgery, later stages have much lower rates of success. Surgical correction by a Board-Certified Veterinary Neurologist is considered Gold Standard treatment for IVDD, the goal being to relieve the pressure from the spinal cord as quickly as possible. There are several surgical options from which to choose from, but your Veterinary Neurologist should advise you as to the best option for your dog.
This can be where things get challenging for pet parents. At this point, you’ve gone through the stress and expense of rushing your suddenly paralyzed pet to a specialist for an expensive MRI, but you’re not done yet. Unfortunately, surgery can’t be postponed. The sooner your dog gets surgery, and therefore gets that pressure relieved from their spinal cord, the better their chances of being able to walk again. Yet another aspect that can be difficult to swallow – even with timely surgery, there is no way to guarantee that your pet will regain the ability to walk or how long it will take.
After surgery, your pet will likely need to be under strict cage rest for the first part of recovery and may be on multiple pain medications. Many IVDD patients are urine and fecal incontinent, meaning they will need to wear diapers to control the resultant mess. Some patients need to have their bladder manually expressed as they no longer have the ability to empty it themselves and it will continue to fill. If that’s the case with your pet, your Veterinary Neurology team should teach you how to safely do this at home. A regular schedule for bladder expressions is important to avoid infections or damage to the kidneys.
As soon as your veterinarian deems it safe, starting Physical Rehabilitation Therapy as soon as possible will significantly increase your dog’s chances of walking. It’s important to note that your dog’s recovery will require a significant commitment of your time and energy. CROC will guide you through all the steps, stages, and details of this recovery but it will be up to you to follow through with the Prescribed Homecare between Rehab Sessions. Recovery from paralysis and spinal surgery requires patience and consistent participation for at least 6 months minimum.
What Does Rehab for IVDD Look Like?
The maximum healing of neurological tissue takes place over approximately 6 months. This means that we have 6 months from surgery to Rehab your pet to their maximum physical ability. Some pets will regain independent mobility before then, but it’s important to stick with the 6-month plan, as many pets quickly lose ground if they stop Rehab too early in the recovery process. Success of Rehab does depend on your pet’s condition at the time they start Rehab. Pet’s that don’t have any movement or feeling in their back legs will be at a greater disadvantage than those that are just weak and uncoordinated.
IVDD patients begin their Rehab journey with target exercises intended to kickstart neurological activity. The nerves must be firing to be able to tell the muscles what to do. CROC often uses Electrostimulation Therapy (E-Stim) to help with this process. E-Stim uses low doses of electricity to stimulate nervous function but it doesn’t hurt. It can feel strange, like a tickle or in the best case, a big muscle twitch! Please note that E-Stim therapy requires us to shave small patches of your pet’s fur to allow electrical conduction through the tissues.
We’ll also start simulating the body’s normal movement to help your pet “remember” what that feels like and to work on maintaining good Range of Motion in all the limbs. Once we start to see any sort of muscle contractions in the hind legs, we’ll step up our exercises to
get that muscle moving as much as possible, while also stimulating more nerves and muscles to join in. We’ll practice weight bearing, essentially re-teaching your pet how to stand on their own. Many exercises for IVDD patients are focused on improving proprioception or knowing where your body is in space. Because of the damage to the spinal cord, IVDD patients often can’t feel their environment and have no sensations to tell them where their legs and feet are. This is important because if we can get your dog to the point of consciously controlled leg movement, they have to know where to move their legs in order to stand and eventually walk.
This initial stage of rehab is frequently the hardest for pet parents. It can be discouraging to be a few weeks into Rehab without seeing obvious improvement. Meanwhile, us Rehabbers are getting super excited over the tiniest little muscle twitch or spontaneous kick or even a few seconds of weight bearing. We’re excited about these seemingly insignificant improvements because they are big indicators for what your pet will eventually be capable of, so hang in there!
Hydrotherapy can be an exciting phase of their recovery. The buoyancy of the water allows for more movement with less effort, so we often see legs moving in the underwater treadmill before we see it on land. The underwater treadmill also allows them to feel the ground beneath them, so that continues to stimulate nervous function. Because they are walking in the water, instead of swimming in it, exercise in the Underwater Treadmill is low-impact, high resistance with slower, more controlled movements.
Through their recovery process, CROC continues to challenge your pet with a variety of exercises while also treating any pain that your pet experiences. Thermotherapy and Therapeutic Massage help to relieve tense muscles and increase blood flow. Therapeutic Laser Therapy not only helps increase circulation to the tissues, but it also encourages healing at a cellular level. Veterinary Medical Acupuncture stimulates the nervous system while also releasing endorphins which helps with pain relief.
Safety for IVDD Patients
Changing Habits: Remember that IVDD is a chronic disease; it never goes away. And while your dog may have had surgical correction, that doesn’t mean that they won’t rupture another disc in another part of their spine. At home, some simple changes can make all the difference to protect your dog’s spine. Many IVDD dogs regularly sprint across their home, launching themselves on and off furniture with delight. Unfortunately, that’s also one of the number one ways they herniate a disc! Jumping on and off furniture or running down the stairs, even jumping out of the car is extremely risky for IVDD patients, so we strongly encourage you to stop your pup from engaging in those activities. Rough play with housemates or any sort of acrobatic activities puts them in great danger, so great care must be taken in multi-pet households.
Swimming: Sadly, swimming is NEVER appropriate for IVDD patients. There is a video viewable at this link, https://www.caninerehaboc.com/post/swimming, that provides a visual for this, but we’ll explain here too. When dogs swim, they generally paddle fiercely with their front legs while keeping their back legs tucked up alongside their body. This type of movement means they are over-working their already strained front legs and barely working the back legs that actually need the exercise. Swimming also puts immense strain and twisting movements on the spine which is probably one of the worst things for a patient that just had a spinal injury/surgery.
Chiropractic: We know this is a soft spot and that many people enjoy chiropractic for themselves. Human Chiropractic has been practiced since the late 19th Century but is still in contention regarding its efficacy today. In Veterinary Medicine, Chiropractic is a very controversial and divisive topic. We do not want to shame anyone for previous choices made with the intention of helping their pet. We do feel compelled as thoroughly educated Veterinary Medical Professionals to share our perspective. At CROC, we have treated multiple patients that were receiving chiropractic care and were in significant pain when they came to us, which resolved when chiropractic sessions stopped while proper Physical Rehabilitation Therapy continued.
A good percentage of CROC patients arrive here after being referred by their veterinarian. Because of this, we have developed very close relationships with the local Neurological and Orthopedic Veterinary Specialists. CROC does not offer Chiropractic services because not a single one of these Board-Certified Specialists will support or recommend Chiropractic therapy for IVDD patients. Even when consulting with Boarded Neurologists outside of Orange County, we have yet to find one that would approve of their spinal patients undergoing Chiropractic treatments. At this time, there are no Peer-Reviewed studies to substantiate claims that Chiropractic is an appropriate (or even safe) treatment for Veterinary patients. In addition, the American Veterinary Medical Association, America’s leader in advancing the science and practice of veterinary medicine to improve animal and human health, has not published any policies supporting Chiropractic.
Reviewing Chiropractic on a basic level - Chiropractic treatment involves applying jarring and intense force on the body, which is also one of the worst things for a patient that has spinal instability or just had spinal surgery. Your dog’s spine is particularly fragile and the force of Chiropractic can push your dog even closer to rupturing another disc. If your dog is experiencing enough pain that you are exploring other treatments like Chiropractic, please check in with us or your regular veterinarian first. There are certainly better and safer options for pain relief available.
The End Goal
Ultimately, our goal is to try to get your pet as independently mobile as possible. We hope that your pet can regain the ability to walk or even run and regain control of their bowels and bladder. This isn’t possible for every patient and the ones that do… well, sometimes they learn how to do it in a different way than pet parents might have expected. Not all patients can regain conscious movement of their legs but instead learn something called a “spinal walk”. Spinal Walking is when a dog still doesn’t have sensation or proprioception in their back legs, but they develop a reflexive walk. Since the signals aren’t getting through the spinal cord to the brain (and vice versa), they are instead relying on more basic reflex signals to get their legs moving enough for them to be able to walk. This reflexive walk isn’t always pretty but it is functional. If we’re given the choice between paralysis and a goofy looking walk, we’ll take goofy any day of the week.
What If They Still Can’t Walk?
At CROC, we always want to give IVDD patients the full 6 months of treatment before throwing in the towel. If we’ve reached the 6-month mark and still haven’t seen significant improvement, that’s when we start looking at a Rear-Wheeled Cart, sometimes referred to as a Doggie Wheelchair. It’s important not to jump into using a cart too soon as once your dog starts getting around without using their back legs, that pretty much seals the deal that they never will. For more information regarding Rear Wheel Carts and what the process for getting one looks like, be sure to check out our in-depth article about carts at https://www.caninerehaboc.com/post/the-wheel-deal.
Tools To Make Your Lives Easier
While your pet is re-learning to walk, they will frequently drag their hind legs, so it is key to protect their paws from the scuffing and abrasions that will happen. Lots of dog booties are readily available for purchase, but our favorite is a rubber variety called Pawz. We like these best because they protect the paw while still allowing your pet to feel the textures of the ground and providing extra grip.
With any dog booties, care should be given to appropriately size your pet’s paws and to only leave them on when your dog is on a surface that is harmful to their skin to rub on. Booties left on for too long can cause skin infections, reduced circulation, or worst case – be chewed off and eaten!
Home modifications like adding rugs and ramps are quick and easy ways to help your dog get around the house more easily. Rugs and yoga mats make it easier for your dog to grip the floor, reducing their risk of falling. The softer surfaces also make abrasion wounds on their paws less likely, although rug burn is certainly a possibility for some dogs. Ramps can make obstacles like stairs less challenging, although care should still be taken to monitor your pet while using these.
A good harness is a must! Your dog will depend on you for assistance, so your choice of harness makes all the difference in comfort for both you and your dog. Our favorite harness for IVDD dogs is called the Help ‘Em Up Harness. It was created to help owners better assist their dogs without hurting their own backs in the process. It comes in two pieces, one to go around the chest and one to go under and around the pelvis. In the early stages, your pet will need the back half, but as their coordination and strength improves, the back half of the harness will become less necessary. It is comfortable enough that your pet can wear it for extended periods, and it is more ergonomic for you and your dog than just lifting them or using a sling. If you are interested in purchasing this harness for your dog, be sure to speak to us as sizing and fitting your dog can be trickier than it might appear. Please note that this harness still needs to be removed each day and kept clean to prevent any abrasions or skin infections. You can learn more about this harness at https://www.caninerehaboc.com/post/help-em-up.
If your dog doesn’t have complete control of their bladder and bowels, diapers and belly bands become good options to help keep your dog and your home clean. Some dogs lose urinary control before fecal, so in those cases, belly bands are a nice alternative for male dogs over a full diaper. Just as with humans, good hygiene when using diapers and belly bands is a must! Dogs left in dirty diapers for too long are at risk for urinary tract infections and skin infections. It’s also important to note that dogs instinctively want to avoid their waste, so being stuck in it is not great for their mental health. Disposable and washable options are readily available for purchase online or at major pet stores.
Just like us, dogs certainly benefit from a quality bed. Orthopedic Memory Foam beds are ideal. Your dog’s bed should be at least 1 & 1⁄2 times as long as your dog and at least 1-2 inches of thickness for every 40 pounds of body weight. Encourage your dog to change position regularly, such as switching which side of their body they lay on. Laying in one position for extended periods of time can lead to significant stiffness and possibly pain once they go to get up.
Is There Anything Else?
One of the best things you can do for your IVDD dog is keep them lean! We generally recommend a Body Condition Score (BCS) of about 4 out of 9. The less weight there is for them to haul around, the easier it will be to start lifting and moving their own body. Many IVDD dogs are also old enough to have developed arthritis, so all the more reason to reduce any extra work on their joints. For more information on the BCS and Weight Management, read our online article https://www.caninerehaboc.com/post/body-condition.
Some dogs will need medication to control their pain. CROC works closely with you to make sure your dog is on the right pain control regimen. Joint supplements are also helpful to support their joints as the front of their body takes on the extra load, compensating for the weaker back end. A supplement for muscle growth/maintenance called Myos Canine Muscle Formula may be helpful for the IVDD dog and is available online. CROC strongly discourages the use of marijuana products for IVDD patients. While emerging research shows some promise for marijuana products in veterinary medicine, there is much more to be done and IVDD patients are already weak and have limited coordination, making them poor candidates for this treatment.
Quality of Life
We touch on this subject for your sake as well as your dog’s. Compassion fatigue is a prevalent concern for clients caring for IVDD dogs. The hope is that as your dog progresses through rehab, the amount of effort you will need to put into their care will decrease. For dogs whose paralysis is more advanced or who don’t have control of their bowels and bladder, the strain on you to keep them clean and safe, as well as the physical strain of carrying them around, is enough to wear down even the most dedicated owners. We bring this up because we want you to know that we are available to you as you navigate your pet’s condition. We frequently support our clients through the big decisions and help them to find the plan that works best for them while keeping quality of life as high as reasonably possible for all involved.