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Mobile Veterinary Surgeon Dr. Paul Newman Disc Disease Treatment
Recommendations, Prognosis, and
Recurrence
Lets breakdown our back patients into clinical presentations with my recommendations
based upon 30 years of doing over a 1000 laminectomies with over 93% good to excellent
outcome in patients with deep pain perception. Please keep in mind recent studies that
show if a patient is going to have surgery (down, with deep pain, money not an issue,
surgeon available within 24 hours) not using cortisone has NO affect on outcome. 100
patients underwent laminectomy without any steroids and had the same 93% good
outcome as patients receiving steroids. Some studies put steroid complications and side
affects at near 100%, some fatal. Multiple studies show that only Methyl Prednisolone
Sodium Succinate (Solu-Medrol) had positive effects on cord swelling with minimal side
effects.
Back Pain Only, No Paresis, Acute Onset
These patients may have a mild bulge or rupture or just muscle spasms that are pinching
the peripheral nerves. These patients are commonly overweight or chondrodystrophoid
breeds. These patients need weight loss, strict rest and strict confinement for 4 weeks, and
NSAID’s and muscle relaxants to effect. If you send home robaxin the owner must give
a dose that shows relaxed muscles and the dose range is very wide! I do not recommend
sending home cortisone or giving a cortisone shot unless you keep the dog in a cage in the
hospital. One third to one half of all patients that I operate on had a history of going home
on cortisone, feeling good, being overactive, and then rupturing the disc further. Pain is
your friend and keeps the patient from doing things that they should not do!
If your patient has a non-responsive painful episode or multiple recurring episodes each
year, then surgery is indicated with fenestration being the procedure of choice.
Studies show that Glucosamin/Chondroitin and DermCaps started in young dogs with disc
disease predispositions have less episodes than normal.
Ambulatory, Back Pain with Paresis or Ataxia
Now the patient has disc material in the spinal canal. This is the only way to explain a
myelopathy. This means the annulus has ruptures and disc material is oozing into the
canal. As a general rule, we do not operate on ambulatory patients. The only exception is
when the patient has not responded to medical management over a period of weeks. Again,
NSAID’s, muscle relaxants, and strict confinement for 4 weeks is the treatment of choice.
Here is what my Small Animal Spinal Disorders textbook has to say about treating back
cases:
Mobile Veterinary Surgeon Dr. Paul Newman
“Many dogs will recover from moderate neurological deficits following either non-
surgical or surgical treatment. Certain generalizations can be made regarding the
advantages of each type of therapy. An algorithm for surgical decision-making is shown
below:
Non- Ambulatory, Deep Pain Perception Present
These patients need surgery fairly quickly. The fact is that if you operate today or two
weeks from today the prognosis is the same. The problem with this patient is if they lose
deep pain while waiting for surgery. If your patient is losing deep pain throughout the day
on serial neurological exams, waiting is not a good plan although I have found patients
that just lost deep pain and have surgery do better than patients that have had no deep pain
for 24 hours.
Non- Ambulatory, Deep Pain Perception Absent
There are studies showing up to 61% of no deep pain back cases recovering when operated
within 72 hours. Many believe these patients had deep pain perception but it was not
perceptible. Some say the outcome in true deep pain absent patients is near zero. I will not
operate a patient that has no deep pain for more than 72 hours and has a “dough belly”
with loss of all muscle tone in the abdomen, no rectum, tail or bladder. These patients
will not recover and spending upwards of $3000 and waiting for six weeks for nothing
to happen is not fair to the owners, the patient, you or me the surgeon. If a patient has no
deep pain and recovers deep pain with solu-medrol treatment, the prognosis improves
as well. Some folks will operate if only if deep pain returns which is a practical way to
approach these patients.
Methylprednisolone Sodium Succinate (MPSS) Solumedrol
Solumedrol comes in various size bottles with 1 gm treating your average Daschund
nicely. MPSS has received wide interest in human, and, to a lesser extent, veterinary
medicine in the past 10 years because of proposed benefits in spinal cord injury. After
acute injury, the blood supply to the spinal cord is progressively reduced. When the
injured tissue is reperfused, massive amounts of highly reactive chemicals called free
radicals are liberated. These free radicals are especially damaging to the plasma membrane
of cells via a process called lipid peroxidation. Free radical-induced lipid peroxidation
is now recognized as a key pathophysiological mechanism for irreversible tissue loss
following spinal cord trauma and ischemia.
The neuroprotective effect of MPSS is exerted by it actions as a free-radical scavenger.
These benefits are not due to its glucocorticoid activity and only in doses far exceeding
those that saturate all glucocorticoid receptors. The optimal neuroprotective dose of MPSS
has been determined to be 30 mg/kg, whereas doses of 60 mg/kg were detrimental and
doses of 15 mg/kg had no effect. Benefit has only been observed in humans with spinal
cord injury who received treatment within 8 hours of injury.
Mobile Veterinary Surgeon Dr. Paul Newman
In animals, the suggested dosage regimen is an initial IV bolus of 30 mg/kg MPSS,
followed by 15 mg/kg IV 2 and 6 hours later, then 2.5 mg/kg IV per hour for a further 24
hours. The bolus doses should be given slowly to avoid vomiting and hypotension. The
continuous IV dose is not widely used in small animal patients; humans are given an initial
bolus of 30 mg/kg followed by an infusion of 5.4 mg/kg/h for 24 hours.
No serious side effects were reported in one study using high dose MPSS therapy in 86
dogs with T-L disc disease. In another study 35 of 108 dogs developed complications
such as diarrhea or melena but none were considered serious and they usually resolved
without therapy. There have been many human studies that raise serious questions about
MPSS value and therapy with MPSS must therefore be looked upon at best as a way to
complement, but not replace, current veterinary surgical techniques.
Cervical Disc Disease
The spinal cord has much more room to swell in the neck so acute worsening with loss of
deep pain seldom occurs. Cortisone can be safely given to neck discs (Medrol tablets) with
muscle relaxants and strict rest. Replace collars with harnesses and raise up the food and
water on books or blocks to prevent head lowering while eating and drinking. CT scans
are much more useful for neck discs than myelograms and can be easily scheduled in
Nashville through Veterinary Imaging Partners at (615) 292-8355.
For neck pain only, we do a fenestration of all discs. For ventral ruptures we do a ventral
slot and fenestration. For rare lateral or dorsal disc ruptures, we do dorsal laminectomies.
Please fill out the form below if you want to schedule surgery.
Mobile Veterinary Surgeon Dr. Paul Newman Intervertebral Disc Disease Pre-Surgical
Questionnaire
What is the pet’s age? ______________ Owner Name? ________________ Is this the patient’s first incident of back problems? Yes / No If yes, please give date and description of previous incidents including whether it was just pain, paresis, or paralysis and how it was treated: _________________________________________________________________________________________________________________________________________________________________________________________ Is the patient just ataxic, paretic, paraplegic or paraplegic with loss of bladder function? _______________________________________________ How many days/hours ago did this episode begin? __________ If supported, can the patient maintain any support on the rear legs? Yes / No Is there any “tone” to the rear legs when flexed and extended? Yes / No 10. Does the patient have a “dough belly”, ie. no abdominal muscle tone Yes / No11. Are the patella reflexes normal, hyper, or hypo? ___________12. Does the patient have “mental perception” of toe pinching, not just a withdrawal reflex? ______________________________________________ 13. If there is no pain perception, please check every single toe on both feet. Is it still 14. If no pain perception, has this condition been present longer than 72 hours? Yes / 15. If no pain perception less than 72 hours, surgery has only a 50% chance of success so be sure the owner is still interested in surgery before continuing.
16. At what level does Panniculus reflex stop? _________17. At what level, if any, is there hyperpathia (pain on deep palpation of the 18. Have you started SoluMedrol (not Soludelta) treatment protocol? Yes / No19. If yes, has there been any response? (Response indicates cord swelling versus 20. If patient has been hospitalized for at least a day, is the neurologic condition deteriorating, improving, or stable? ___________________________ Mobile Veterinary Surgeon Dr. Paul Newman Please fax this to me at 615-595-5344 or call me at 615-519-0647

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