Intervertebral disc disease, or IVDD, is one of the most common spinal disorders seen in canine patients. These patients will commonly present with back or neck pain on physical exam. However, often owners do not actually appreciate this pain. Instead, owners see the pet hesitating to jump, not wanting to walk as far, or not wanting to play. Owners may miss a slightly off head carriage or an intermittent limp. They may not realize the different ways back, or neck pain can manifest. But they recognize that something is off, triggering them to take the pet to the veterinarian or osteopath for evaluation.
In IVDD, the intervertebral disc material in the spine ruptures, affecting the pet's spinal cord. Think of the intervertebral discs as the cushions for the spine. Intervertebral discs, found between the bones (vertebrae) in the spine, act as shock absorbers helping to stabilize the spinal column (Béraud,2015; "IVDD In Dogs," 2020).
The disc material or nucleus pulposus under healthy conditions is flexible and easily compresses to aid in the body's movement. However, over time the material can become inflexible and brittle. Normally, bending with movement, these abnormal discs will bulge or rupture, putting pressure on the spinal cord's nerves, causing various signs from mild pain to complete paralysis ("IVDD In Dogs," 2020). While the disease progresses slowly over time, acute trauma to the spinal cord can suddenly cause this disc material to explode out of the space, sending the disc material fragments to the cord. This concussive action triggers the clinical signs (Béraud,2015).
Similar to when a human herniates a disc or ruptures a disc, IVDD affects various parts of the dog's spine.
Brooks (2019) reports that 15% of all disc herniations occur at the cervical spine level (neck). 80% of these cervical herniations (most commonly between C2-C3) occur in "dachshunds, beagles, or poodles" (para 8).
Brooks (2019) notes that T11-T12 and L2-L3 are the most seen sights of herniation. However, we also commonly see low back pain L4-S2 in dogs. Extrusions in this area account for 15% of all cases of Type I IVDD in dogs. Continue reading for a review of the types of IVDD. In clinical practice, the author generally appreciates pain in 3 general locations: the neck region(cervical), around T13-L2, and the lumbosacral area (near the tail).
In many cases, we have no idea what actually triggers the disc change at a specific moment. Owners may report that the dog fell off the couch or tripped down the stairs several days ago but had seemed fine. A day or even a week later started to limp or show other signs of pain or lameness.
Sometimes owners will report an episode where they heard the dog cry out. They may even have seen the dog limp for a day or two, and then it seemed to resolve on its own. But most of the time, we do not appreciate a specific incident to truly demonstrate a direct cause and effect.
Because dogs tend to tolerate pain differently from people, they often show it differently and may initially mask it. Perhaps there was a full resolution of clinical signs. Or maybe they simply didn't start showing signs of pain until it became serious enough to cause them to do so.
In osteopathy, we look at the whole patient. Knowing what risk factors your patient possesses from the get-go, including any known injuries or traumas, recognizing the breed predisposition, and any previous history of the disease, all help improve your diagnosis and treatment plan development moving forward.
Any dog of any body type at any age can develop IVDD. That being said, there are some poster children that veterinarians and veterinary professionals automatically think of when discussing this disease.
Chondrodysplasia, a genetic abnormality secondary to abnormal cartilage growth, is common in several breeds. The bones grow at different rates leading to limb deformities and shortening of the limbs. These dogs can be disproportionately dwarfed in stature secondary to this abnormal growth. They can have additional abnormalities to various skeleton parts, including the ribs and spine (Cruz-Rincon, 2017,p.; Vetstream, n.d.). See Figures1b, 1d, and 1e for examples.
Classically many think of chondrodysplastic breeds first when they picture IVDD. While their confirmation alone can increase these types of dogs' risk for IVDD, some dogs also have a genetic mutation. This mutation causes changes to the intervertebral disc's metabolism, leading to early disc degeneration (Thomas, 2014).
These breeds often have long bodies on very short stubby legs with additional conformational issues that predispose them to IVDD. Dachshunds, Lhasa Apsos, Pekingeses, and Basset Hounds, for example, fit into this classification ("IVDD In Dogs," 2020).
Dachshunds and beagles typically come to mind when thinking of IVDD for most veterinarians, but really IVDD can occur in any breed (Gregory, 2018).
While rarely occurring in dogs younger than1, it can occur at any age. It is often seen in ages 3-7 and then again in the older stages, ages 12 and up. Thus, age alone isn't enough to suggest the presence or absence of the disease.
The classification of the types of disc changes that occur have varied over the years but currently include Hansen Types I, II, or III.
Hansen Type I IVDD most commonly occurs younger in life and in chondrodystrophic dogs. Since genetics also plays a large role in this type of degeneration, it tends to affect younger to middle age dogs.
Type II IVDD tends to occur in older dogs secondary to normal aging processes and tends to occur in the larger breed dogs.
Type III AKA traumatic disc herniation, non-compressive IVDD, or high-velocity low-volume IVDD occurs at any age and in any breed. It causes the nucleus pulposus to suddenly shoot out a disc fragment into the spinal cord (Béraud,2015).
For a detailed review of the signs of pain in dogs, please review the blog entitled (Recognizing Canine Communication).
Some dogs with IVDD may demonstrate classic generalized signs of pain such as
- Hesitancy to jump onto or off furniture or in going up/downstairs
- Decreased energy or desire to play or exercise
- Change in behavior
- Change in appetite
- Vocalizing – Remember to educate your clients. Inform them that lack of vocalization doesn't mean they aren't in a lot of pain. For example, Pitbulls are often very stoic and may not show pain unless severe. On the other hand, Huskies are often wimpy and may stub a toe and behave as if they tore off an entire foot.
Other signs may be more specific or suggestive of back or neck pain. These may vary depending on where the disc abnormality resides in the spine.
Additional signs of pain or spinal cord damage may include
- Holding the tail low, not wagging it normally or as often
- Crouching or hunching postures (can mimic abdominal pain)
- Chewing on the tail or a leg(even to the point of causing trauma)
- Chewing can occur far from the actual injury site. This occurs due to referred pain, neurologic pain, or because it becomes a means for them to handle the pain.
- Merely being more guarded or not normally engaging with the owners or other pets in the home.
Suppose the damage causes compression of the spinal nerve root. In that case, it can cause pain (radicular pain) to be referred from the spine itself down a limb or other areas. Be aware that sometimes back pain presents as lameness in the hind-limb(s) without overt backpain (Rossmeisl, 2013).
- This author's own dog, Isabelle, a Rhodesian Ridgeback/Labrador mix, didn't know she was a 4-legged animal. She was active, athletic, in ideal body condition. She was long and lean and loved to stand on 2 legs. For 6 months, she was intermittently lame in her left hindleg. Radiographs were non-remarkable. Her physical exam revealed only muscle changes and tension bands along the spine, left hind leg, and intermittent strains to the iliopsoas muscles in the pelvic/groin area.
- Using a combination of laser therapy, ultrasound, massage, and physical therapy in addition to pain medications, she improved. It wasn't until 6 months later that she even showed any back pain signs and was only evident with the spine's deep palpation.
- Then, she responded to therapy and barely had real pain to severe back pain and vocalization overnight. She required surgical intervention and, thankfully, recovered, never looking back.
So, back pain can manifest in many ways. All too often, veterinarians FAIL to evaluate for it. Just because your patient went to the vet and the vet found nothing overtly wrong, make sure that you evaluate their gait and palpate for signs of back pain thoroughly on your physical assessment. Not everyone appreciates subtle signs of pain or thoroughly assesses for back pain, so take care to ensure you do so.
Additional clinical signs may suggest that your patient has a neurologic component and help you lean to a diagnosis of IVDD. These signs may include
- Varying degrees of paresis (weakness)or paralysis (inability to use a leg/legs)
- Crossing over with a leg when walking
- Stumbling
- Weakness
- Dragging a limb
Thankfully, society is becoming more accepting of adjunctive treatments in the veterinary community and the lay population. Our clients want to avoid medications unnecessarily, and who wants their pet to have surgery if it can be avoided? Finally, these therapies provide a great addition to post-op surgical care.
A combination of the various treatment options available should be employed to properly control pain and improve recovery chances. Sadly, factors including finances, access to services, dog acceptance of therapies, owner perceptions, and expectations play a role in what treatments are ultimately used and the success and failures of those therapies.
A canine osteopath may be the first professional that an owner comes to see. The pet may have an off gait or simply be hesitant to exercise. So, the owner knows something is wrong but cannot discern where the problem lies. An osteopath can perform a physical and visual assessment and determine what parts of the body are painful, and discern probable causes for the problem.
Pain can occur due to disc disease, muscular, bone, meningeal pain (membranes that protect the spine), or radicular pain (travels along the spinal root nerve). So, while discussing IVDD specifically here, make sure to assess the whole patient as there could be more than one area of dysfunction.
IVDD could be the primary problem at, for example, the lumbar spine. But don't forget to evaluate other areas for possible pain or dysfunction. When a dog attempts to compensate for pain, muscle tension and other biomechanical shifts often lead to pain in other regions of the spine, pelvis, legs, and musculature. These areas must not be forgotten as they too will significantly benefit from manual therapy, such that an osteopath can provide (Rossmeisl, 2013).
There is no single-word answer for this. All cases differ. Various factors play a role in the successful recovery of a patient, including owner expectations, quality of life, remaining neurologic deficits, life-long limitations, or restrictions. Prognosis also depends on the owner's commitment and willingness to follow strict adherence to the caregivers' directions and recommendations. This includes the veterinarian, surgeon (if performed),osteopath, rehabilitation veterinarian, and others.
Critical to the patient's recovery, all owners within a family need to follow all directions.
Some dogs may recovery 100% and never lookback. But many dogs will have a reoccurrence of the disease. Clinically, about 1/3of my patients have had reoccurrence at some point in their life. The presence of neurologic changes, uncontrollable pain, or an owner who fails to follow directions, a full return to function may not always be achievable.
NO MATTER WHAT WE DO, some pets will worsen and require surgical intervention due to clinical signs' progression, worsening neurological function, or intractable pain.
Yes and no. Some animals are simply predisposed. Short of keeping them in a bubble and not letting them be dogs, well, we can never prevent it 100%.
Obviously, if you see a patient with this disease, we are a bit too late to prevent onset. However, with high reoccurrence rates, while we still want a dog to be a dog, there are a few steps that owners can take to lessen the chance of recurrence (Béraud,2015; "IVDD In Dogs," 2020).
Provide your owners with handouts. Client handouts are great to remind owners about your recommendations, including any exercise restrictions, at-home exercises, and MOST IMPORTANTLY. It provides something they can refer back to later. Exactly how much each owner retains is unknown, but we know that no one hears everything we say. This means that valuable information gets lost in translation. Additionally, not all family members maybe present at the visit, so the handout can educate them about what is recommended. This handout can help ensure the successful care of the pet.
Dogs with back and neck pain commonly lead owners to visit a veterinarian or canine osteopath. Many owners fail to recognize pain signs and often cannot localize pain to the back or neck. Your job as a canine osteopath includes evaluating the patient and determining via gait analysis, physical exam, history, and clinical signs, what the primary clinical problem may be. The pet's signalment (age, breed, sex) may aid in your diagnosis. But remember that any breed of dog, at any age, and even an animal with an ideal body condition may present with clinical signs suggestive of IVDD.
Osteopathic therapy compliments the therapy provided by veterinarians, rehabilitation specialists, and surgeons (if surgery is indicated). Osteopathic therapy provides a crucial role in pain management. It can significantly assist your patients' recovery and prevent further disease reoccurrence.
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Figure 1a. Fotojogodka from Getty Images [Photographer]. Lhasa apso portrait [Digital photo].
Retrieved fromcanva.com/design
Figure 1b.VTLS from Getty Images [Photographer]. Dachshund standing. [Digitalimage]. Retrieved
fromcanva.com/design.
Figure 1c.Ozgurcoskun from Getty Images [Photographer]. Cocker spaniel standingagainst a white
background. Retrieved from canva.com/design
Figure 1d.Fotojogodka from Getty Images [Photographer]. Pekingese dog in stand[Digital Photo].
Retrieved fromcanva.com/design
Figure 1e.Studiotrapeza from Getty Images [Photographer]. Dog, basset hound, isolated[Digital Photo].
Retrieved fromcanva.com/design
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