Intervertebral Disc Disease Treatment

Question 1

When is conservative management appropriate? And what is the treatment?

Answer 1

Mild episode of neurological dysfunction or pain

Pain relief, strict cage rest, rehab, weight loss

Question 2

What are signs of failure of conservative treatment?

Answer 2

Uncontrolled pain
Progressive neurological deficits
Recurring episodes

Question 3

When is surgery undertaken for spinal disc disease?

Answer 3

Failure of conservative management

Category 3 or worse

Question 4

What surgical treatments are available?

Answer 4

Cervical- ventral slot- window 1/3 length 1/3 width of vertebra
Thoracolumbar- hemilaminectomy- small window on side of vertebra
Lumbosacral- dorsal laminectomy

Question 5

What is the post op care for spinal surgery?

Answer 5

Pain management and observation for 3 days
Bladder care
Cage rest 4-6 weeks
Total recovery 2-6 weeks

Question 6

What is the prognosis for disc disease if deep pain is preserved?

Answer 6

With surgery, 85-95% chance of full recovery

Question 7

What is the prognosis for disc disease if deep pain is lost?

Answer 7

Surgery within 24 hours- 50%

Ongoing 48 hours or more- less than 30%

Question 8

What is the recurrence rate of disc disease?

Answer 8

15% even with surgery, any other disc can rupture

50% in 1 year with conservative treatment

Question 9

What is the major concern in any animal that has grade 4 or 5 symptoms?

Answer 9

Myelomalacia occurs at a rate of 10%
Ascending necrosis of sensory and motor fibres progresses to respiratory failure

Viewed as a hyperintensity on MR