Intervertebral Disk Disease – IVDD – in dogs
What is Intervertebral disc disease (IVDD)?
Intervertebral disc disease (IVDD) is an umbrella term that is used by many clinicians, dog owners and breeders. IVDD includes disc degeneration, any type of herniation that this may cause, and all the pain and other problems caused by this.
Just like people, dogs have discs between the bone vertebrae of their spine. Disc herniation or IVDH (Intervertebral Disc Herniation) involves part of the disc moving away from its correct position. This can be a:
- disc “extrusion” (similar to a “slipped disc” in humans, and sometimes also called Hanson Type 1 herniation, or a disc “prolapse”). The centre of the disc explodes outwards through the disc’s outer fibres. Disc debris then presses against the spinal cord or nerve roots. Pain and other signs start quite suddenly
- disc “protrusion”, in which the centre of the disc shifts outward more gradually, stretching the disc’s outer fibres as it goes; or
- disc “bulge”, in which the outer fibrous part of the disc hypertrophies (becomes over-developed) making the disc bulge outward a little.
Extrusion, protrusion and bulge can all cause the disc to put pressure onto the spinal cord and nearby nerve roots. This causes the neurological signs (e.g. weak or paralysed legs, changes in skin sensation) and contributes to the pain. In severe cases of extrusion, the centre of the disc may explode out and hit the spinal cord so suddenly that this section of the cord is left concussed (damaged after being knocked), contused (bruised), or oedematous (swollen).
Some breeds of dog are “chondrodystrophic”, e.g. the dachshund, beagle, Pekingese, French bulldog, miniature schnauzer and cavalier King Charles spaniel. This means that their cartilage develops differently to that of other dogs. In these chondrodystrophic dogs, discs degenerate while the dog is still young, i.e. the centres of the discs harden and may calcify. This hardening of the discs doesn’t itself cause the dog any pain or clinical signs but can eventually cause the disc to herniate. These breeds of dog have increased chances of getting disc extrusion, though protrusion and bulge may also occur.
Breeds of dog that are not chondrodystrophic tend to get disc protrusion or disc bulge (both of these are Hanson Type 2 herniation) rather than disc extrusion (Hanson Type 1 herniation). These dogs, e.g. Labradors and German Shepherd dogs, tend to get the problem later in life once discs have degenerated over some years.
Signs of IVDD in dogs
Intervertebral disc disease (IVDD) is a painful condition that can cause weak, wobbly legs and difficulty walking. Dogs with severe IVDD may be unable to move their legs at all (paralysis) and may lose control of bladder and bowel function. Onset of clinical signs or symptoms can vary: Some dogs show mild signs which never progress, some dogs are found collapsed on the floor with no previous known problem while, in others, signs progress over hours or days.
Pain and other clinical signs or symptoms are caused by disc herniation. In most dogs, it’s very unusual for this to happen before two years old, but can occur commonly in male and female dogs of three years and over in smaller dog breeds like dachshunds, beagles, Pekingese, French bulldogs, miniature schnauzers and cavalier King Charles spaniels.
SIGNS OF PAIN REPORTED IN IVDD-AFFECTED DOGS
- Reluctance to walk, jump up or stand upright on hind legs
- Crying or flinching when touched
- Trembling, shaking and/or panting
- Arched back
- Crying or yelping when picked up
- Refusal to go down a small step or curb
- Change of mood or temperament
- Swollen or hard abdomen
- Reduced appetite
- Unable to do a full body shake
Some of the signs listed above can be easily confused with those caused by a gastric upset, cystitis, pancreatitis or other problems. It’s important that your vet checks your dog carefully as these dogs can be tricky to diagnose correctly. Dogs with a gastric upset certainly won’t want to be sent to a neurologist for spinal imaging. However, to be on the safe side, if there is a possibility of pain being due to IVDD then it is sensible to avoid running and jumping until your vet gives you the all-clear.
In addition to signs of pain, more severely-affected dogs also have difficulty walking. It is most common for only the rear end of the dog to be affected in short-legged breeds such as dachshunds, beagles, Pekingese, French bulldogs, miniature schnauzers etc., i.e. the front legs work normally but the hind legs are weak or paralyzed. Your dog may walk with a staggering gait almost as if your dog is drunk or intoxicated, and he or she may cross their paws over or place them upside-down at times. Some dogs are unable to walk at all, but may try to pull themselves along with the front legs while dragging the rear end along behind.
If disc herniation occurs in the neck instead of the back, then the dog may have neck pain and, in more severe cases, may have difficulty using all four limbs.
That’s way regular visits to your veterinarian are so important if your dogs breed is very prone to IVDD. Just by examining your dog closely, our veterinarians at the Animal Clinic of Billings and Animal Surgery Clinic will have enough information to be certain if your dog’s pain or odd gait are caused by IVDD.
However, before going ahead with spinal surgery, imaging would be needed both to confirm the diagnosis and to check exactly which disc or discs have herniated.
X-rays are a completely unreliable test for diagnosing disc herniation. If pain or other problems are thought to be due to IVDD, it’s therefore not a good idea to x-ray the dog’s spine.
Advanced imaging techniques on dogs with IVDD:
For dogs about to undergo spinal surgery, an MRI scan (magnetic resonance imaging scan) is extremely useful. It is an excellent way to confirm the diagnosis of IVDD and is very useful for surgical planning. Bear in mind that an MRI scan locates the spinal problem very precisely but it does not always give reliable information about the dog’s chances of recovery with or without surgery. For this, the dog’s clinical examination findings are more useful. However, in some dog breeds (e.g. boxers and German shepherds) presenting with certain clinical signs, advanced imaging (e.g. MRI scan) may be more helpful early in the course of some diseases to help rule out spinal tumors, infection and other conditions.
Learn more about our MRI services on our Special Diagnostic Imaging with MRI, CT, Ultrasound and X-Ray page.
Is spinal surgery necessary if my dog has IVDD?
If your dog has been diagnosed with IVDD (intervertebral disc disease) then you may be wondering what to do next. When considering whether or not to send your dog for spinal surgery, several factors need to be taken into account. These include how severely your dog is affected, other problems that your dog may have, your available budget, and time/ability to care for the dog during recovery. As a dog owner, it’s important not to panic if your dog is suddenly affected by IVDD. Our veterinarians at the Animal Clinic of Billings and Animal Surgery Clinic are here to help guide you though all of your options and figure out the best coarse of action for you and your canine companion.
If we determine your dog has IVDD, then how badly he’s affected makes a big difference to his prognosis (how likely he is to feel better and to walk again after treatment).
Dogs with IVDD in their back can be grouped into three main categories, each with a different prognosis:
- Mildly-affected dogs – These are dogs who can walk a reasonable distance without falling over, IVDD grades 1-2. For dogs that are able to walk, non-surgical treatment is usually a sensible option to start with. This is true even if the dog is quite ataxic (wobbly) when walking. If not referred for surgery, your dog should receive good-quality non-surgical treatment and should be checked regularly by the vet.
- A middle group of dogs – These are dogs who are more severely-affected and cannot walk unaided, IVDD grades 3-4. In general, if your dog cannot walk unassisted, then an operation will improve his chance of recovery. Dr. Brown and Dr. Sherburne are the Animal Clinic of Billings and Animal Surgery Clinic orthopedic spine surgeons and will help you determine the proper coarse of action if surgery is recommended. If you cannot afford the cost of surgery, or if your dog cannot have an operation for any other reason, then the next best option is good quality non-surgical treatment (starting either on an in-patient or outpatient basis). Whether or not your non-walking dog has an operation, you’ll need to learn some special skills to help him through recovery, e.g. sling-walking and, in a few cases, bladder expression.
- Most severely affected dogs – These dogs cannot walk or make any deliberate movements of their affected legs, and they also no longer have pain sensation in their toes, IVDD grade 5. For those who pursue treatment, an operation plus dedicated home aftercare will offer the best chance of recovery. Aftercare is likely to include lots of cleaning and TLC, sling-walking and, in many cases, expressing the dog’s bladder regularly. Even with surgery, we must warn you that a few of these worse-affected dogs deteriorate badly during the first few days. Some others seem to do okay at first but end up being managed as permanently disabled because they fail to walk again. With good home care, some dogs go on to live a happy life in wheels even if treatment fails. However, if there is no realistic treatment or means of care available, then euthanasia may unfortunately be the only kind option.
Before committing to surgery, there are a few points to bear in mind from the start:
- Whether or not your dog has an operation as he will need dedicated home care during recovery.
- Signs of IVDD may recur after treatment.
- Full recovery is not guaranteed with any type of treatment, especially for dogs with severe IVDD.
Having said all this, many dogs do make a fantastic recovery from this disease so don’t be disheartened.
Watch out for deteriorating dogs
Some dogs start off with a milder grade of IVDD which gets worse over the first few hours to days. Therefore it’s important to keep a close eye on your dog and to return to the vet for regular rechecks in the early stages. Use a large cage or indoor pen to restrict your dog whenever he’s not either in your arms or on a lead. We occasionally hear of dogs who start off mildly affected, but who then suddenly lose the ability to walk just after jumping off a sofa or chasing across a room. On the other hand, most cases of deterioration are nobody’s fault. It’s just that the disc has herniated over hours to days rather than all at once.
Important: If your dog seems to be getting worse and worse, then ask to speak to your vet immediately. There’s a possibility that urgent referral may be required.
EXERCISE AND ACTIVITY
Pets recovering from surgery should only have limited exercise. Access to stairs or situations which may cause injury should be avoided.
ABSOLUTELY NO PLAYING/ACTIVE INTERACTION WITH OTHER PETS FOR AT LEAST 1 MONTH
- Needs restricted activity – minimal running and jumping. Outdoor exercises should be restricted to leash walking for 7 to 10 days.
- Needs activity to be completely restricted for 30 days. Keep confined and quiet – No running, jumping, walks, or stairs. Your pet is only to be taken outside on a leash for periodic potty breaks.
- After completely restricting activity for 4 weeks and sutures have been removed, your pet needs restricted activity for 30 to 45 days. Minimal running and jumping indoor and outdoor exercises should be restricted to leash walking.
- Use a sling for support when walking.
Massage and range-of-movement is good for these dogs if done gently and safely. Ask your vet or one of our physical rehab therapists at the Animal Clinic of Billings and Animal Surgery Clinic to teach you the necessary skills. Basic exercises (e.g. standing practice) are essential for the IVDD-affected dog, and are best started early.
Your dog will need Physical Rehabilitation therapy (PRT) after surgery
Canine Physical Rehabilitation Therapy and Laser Therapy is also highly recommended to help your dog return to his/her normal self. The Physical Rehab and laser therapy treatment services at the Animal Clinic of Billings and Animal Surgery Clinic promotes a more rapid return to normal function by maintaining normal range of motion in the joints, by maintaining or increasing muscle development, and by improving balance and coordination. The Rehab program outlined below has been developed specifically for your pets post surgical recovery period. Rehab will help speed up recovery and increase the likelihood of an excellent outcome. It is very important that you contact one of our physical rehab therapists or veterinarians at the Animal Clinic of Billings and Animal Surgery Clinic if you have any concerns regarding the program or exercises outlined below. It is also extremely important that these exercises are performed in a manner that is not painful for your dog or dangerous for you to perform. Never force any therapy. If your dog seems excessively painful during any of the exercises please stop them and contact our hospital for further instructions.
PHYSICAL REHAB HOME EXERCISES AFTER SPINE SURGERY
Because your dog is uncoordinated, he or she could easily get hurt if allowed to roam free in the house especially around steps or stairs. We recommend you keep confined or under your direct supervision. Soft, dry bedding, at least 1 inch in thickness, must be supplied to prevent pressure sores from developing.
Superficial heat 2-3 times daily will be helpful. Place a towel over the area and between the warm pack. Remove in 15-20 minutes. When using heat check the skin every 2-3 minutes for redness or over heating. Following warm packing gentle massage should be done.
Passive range of motion exercises for all of your dog’s limbs will help to reduce atrophy and encourage use. Gently grasp your dog’s paw and move each limb in flowing, circular, forward to backward movements. This exercise may be done lying or sitting. Repeat for 10-15 repetitions, several times daily.
Weight shifting exercises will help your dog to regain balance and coordination. Stand your dog squarely on firm footing and gently nudge his or her side at the point of the hip to make the weight shift onto the other leg and support ones self. Alternate from side to side. At first some support may be necessary to avoid falling. If he or she knuckles his or her feet place them appropriately for her. As proprioceptive ability is regained the shifts may be made more challenging. Begin with a 30 second session and gradually increase to 5 minutes per session.
Sling walking should be done multiple times a day and for potty breaks. Try to help your dog place his or her feet when using the sling, offer as much support as need but as little as possible so that your dog is working to support his or herself.
Watch for any increased signs of lameness, decreased limb use or abnormal behaviors and tailor his/her exercises accordingly so not to overtax her system. If your dog shows any of these signs or worsening of neurological status, such as breathing difficulties, or change in movement in the front limbs, you should contact our hospital or your regular veterinary hospital immediately.
Sutures will need to be removed 3 weeks from the date of surgery.
At 1 month from surgery please schedule an appointment with your regular veterinarian to reevaluate your dog, asses his or her neurological status and evaluate restrictions. Until that time no running, playing, stairs or unsupervised activity.
If you can afford the additional cost and travel is not an inconvenience, we recommend setting up an appointment with our rehabilitation facility for a rehab session any time after your two week follow-up appointment.
Laser therapy may also be beneficial 1-2 times weekly if available at your regular clinic or at one near you. Please do not hesitate to call or email us at any time if you have any questions or concerns.
Please remember, you may observe a decrease in activity or appetite for one day. However, if your pet exhibits any of the following symptoms, please call the hospital at 406-252-9499 right away:
- Vomiting and/or diarrhea occurs
- The incision becomes red or swollen, or oozes blood or fluid
- Your pet chews or damages the incision, suture, or drain
- You cannot give the prescribed medication as directed
- Your pet seems depressed, lethargic, or refuses to eat for more than 24 hours
- There is any change in your pet’s general health or behavior
- You are unable to express your dog’s bladder and he/she is not urinating voluntarily.
Home care for the IVDD affected dog after surgery
If your dog has intervertebral disc disease (IVDD), then you may be looking for information on how to improve recovery. If your IVDD-affected dog is unable to walk, then nursing care is particularly important. In the weeks following spinal surgery, your dog will need care and attention from you at home to keep him or her safe and comfortable.
When helping your dog and moving him or her around, you can rest assured that standing and a little walking are safe, so long as these are only attempted on non-slip surfaces. Non-slip matting and runners are very useful. Be sure to lift your dog over any slick flooring and steps, and take care that he or she doesn’t rush off. If your dog cannot stand unaided, then use your hands to help him or her keep it’s balance in this position. A hand under your dog’s belly will help prevent them from toppling.
Many of these dogs have sore or ticklish spots, so be patient and gentle. Think of using your hands and arms to “contain” your dog rather than digging your fingertips into their body when lifting or moving your dog. It can be very useful to leave a harness on the dog during the day. Some people find that the top strap of a harness is a useful “grab handle”, helping them to adjust the position of their recovering dog.
During recovery, your dog will need a large crate, pen or perhaps part of a room set up as a recovery area.
Provide soft bedding and change it when needed to help keep your dog dry. A piece of covered orthopaedic foam with a layer of vet bed (fluffy washable matting) placed over the top is ideal. Foam padding is not essential for every dog: small breeds are sometimes comfortable enough just on vet bed so long as they are turned regularly.
In the early stages, you may also need to place an incontinence pad directly under your dog where he or she is lying (i.e. on top of the vet bed) to help keep your dog clean and dry.
Take your dog outdoors regularly for toilet breaks, even in the early stages when he or she may seem quite helpless. Outdoor time is essential for helping dogs to relearn normal toilet habits, and is also extremely important for their general well-being. You’ll need to carry your dog outdoors to a suitable patch of ground, then use a hindquarter sling to support their rear end.
If your dog is unable to move about unaided, then you should “turn” him at least every four hours to help avoid pressure sores. Your vet can advise you as to whether this is appropriate. To turn your dog, don’t flip him or her over as this may twist your dog’s spine. Instead, bring your dog out of the crate or pen (this is a good time for a toilet break and/or some physiotherapy, plus your dog may need a little clean-up), then replace them so that your dog is lying the other way. Do this every so often so your dog can lie resting on it’s right side for a few hours and then on it’s left side. If possible, position your dog supported on his front for part of the day too. Keep a frequent check on your dog’s skin for sores or other damage.
Your dog might be incontinent to start with, so be prepared to wash and change his bedding frequently. He might also need cleaning at times. Don’t attempt to run him a bath. Sponge him off while he’s resting on an incontinence pad, non-slip shower mat or on short grass. Disposable gloves, old towels, paper towels, a bowl or spray-bottle of water, cotton wool padding and unscented baby wipes may all come in useful. Take care to dry him off very carefully, especially between any skin folds.
Some severely-affected dogs need their bladder expressed at home (squeezed out), especially in the early stages of IVDD. Ask your vet whether this applies to your dog and, if so, how often you should be doing this.
Urinary incontinence – Some IVDD-affected dogs are incontinent to start with. The bladder tends to become over-full and then to overflow. It’s not your dog’s fault, so don’t scold him for indoor “accidents”. Your vet may advise you to express your dog’s bladder, to add in some special medication for the bladder or, in more severe cases, your vet may need to admit your dog to pass a urinary catheter. Despite these measures, incontinence may still be a problem. It’s useful to continue taking your dog outdoors for attempts to pee (you’ll need to support him with a sling), and to persevere with physical rehabilitation exercises to help him learn to stand. If the incontinence seems to be getting worse, contact us through our website or call us to schedule an appointment with your veterinarian immediately.
To help cope with the incontinence problem, some owners buy belly bands (for male dogs) and/or dog nappies. These help to keep indoor surfaces clean but, at least in theory, might reduce the chance of your dog learning to pee normally again. If you do resort to using belly bands or nappies, then continue regular outdoor “toilet breaks“, and of course, remove the band or nappy for these.
If your dog is unable to express his/her bladder on his/her own at this time, it is important that the bladder is manually expressed three to four times daily to prevent urine retention, development of a urinary tract infection, and urine scald from lying in urine. To express the bladder, place your hands on either side of the body, just behind the rib cage. Push your hands inward until your fingers are touching, then slowly move them backwards towards the tail until you feel a round, urine-filled bladder (like a water balloon). Once the bladder is between the fingers/palms of your hands, gently push your fingers/palms together, as well as backwards towards the tail. Continue expressing the bladder until it feels empty/small. If your dog or cat is urinating on his/her own, palpate the bladder after each urination to make sure that the bladder is emptying completely. Hopefully, as your dog improves, bladder expression will no longer be necessary.
Home care for dogs with IVDD – Some issues to watch out for:
Faecal incontinence – It is of course very frustrating if your dog deficatqes indoors. Some severely-affected dogs have poor bowel control. This sometimes improves once the dog can balance better in a standing position, though unfortunately some dogs do remain incontinent. It’s not your dog’s fault, so don’t scold him for indoor “accidents”. The surest way forward is just to continue taking him outdoors to try and poo regularly, and to support your dog in a standing position when they are out there. In some cases, it can help to change the diet gradually to an easily-digestible complete dog food containing good-quality fibre. Ask your vet for advice on diet and medication.
Skin sores – Pressure sores can happen if the dog is unable to get up and is not “turned” regularly. Skin can also get sore if not kept completely clean and dry, especially if the dog is incontinent. Nursing care or home care is essential in preventing this, including bedding, turning and cleaning. Check your dog’s skin regularly for pink/red patches, swelling or fur loss. Clean and dry any suspicious areas, and ask your vet for advice.
Sores can also appear on your dog’s legs or paws if he or she moves by dragging themselves along. Again, these should be checked by the vet. For prevention and to allow the sores to heal, do your very best to prevent your dog from dragging itself around. Set your dog up in a pen or crate with soft flooring and bedding. Whenever outside the pen, your dog should be either carried, or on a lead with it’s hindquarters supported by a sling so that your dog’s paws do not scrape along the ground.
If you are managing your dog as permanently-disabled, then you may need to protect it’s paws with non-slip dog socks and perhaps consider using a canine drag bag to protect other areas of skin when he or she is indoors. Socks and other paw-coverings are best avoided for long term use if you expect your dog to walk again. Drag bags should definitely be avoided if you hope that your dog will walk again. They encourage the dog to drag himself and discourage walking.
If you have any further questions about your dog’s IVDD, please email our hospital or call us to schedule an appointment with one of our veterinarians at the Animal Clinic of Billings and Animal Surgery Clinic.
Thank you for choosing Animal Clinic of Billings and Animal Surgery Clinic for your dog or cat’s medical needs.