I received an email a couple of weeks ago and it has excited me tremendously!
I hope you do not mind me contacting you. I am currently a PhD student and resident in neurology and neurosurgery at the Queen’s Veterinary School Hospital in Cambridge and I was directed to your blog post on conservative management of intervertebral disc extrusions by another member of the team. I mainly wanted to get in touch because over the last two years we have been looking into conservative management of extrusions along with several other aspects such as resorption of disc material, calcification scoring for breeding and mineral analysis and thought you may be interested. Our aim is to show that conservative management is a valid treatment option and to try to identify which dogs absolutely require surgery to get better and which are likely to get better with conservative management. I know you are based in North America and so this is probably not directly useful to you but just thought you may be interested. If you would like to know more we have our own facebook page (@CambridgeIVDD) and please feel free to email me.
Sam Khan BVetMed MRCVS
PhD Student and Senior Clinical Training Scholar in Neurology and Neurosurgery
So, I looked it up, and, “Yeehaw!!!” They have been doing research on conservative management for IVDD, and their findings thus far have indicated that non-surgical management is as good and actually better than surgical management. They’re very careful not to phrase it that way… but that’s what they’re finding! This delights me to no end, because this is exactly what we have been finding in my clinic as well!
Lots of great info to direct you to:
The Facebook Page: https://www.facebook.com/CambridgeIVDD
Canine IVDD – Cambridge Research Update: https://www.youtube.com/watch?v=IfgFFpX-L_c
Cambridge Vet School IVDD Webinar: https://www.youtube.com/watch?v=xHCWhuNhFwk
Handouts for the presentation: https://www.dachshund-ivdd.uk/symptoms-treatment/cambridge-research/
IVDD Cambridge Vet School Q & A: https://www.youtube.com/watch?v=_OnpDM_FuGE
Just to whet your appetite, I went through all of the presentations and handout and decided to pick and choose some of the information to share.
Dog recruited to the study are less than 15 kg (this is what was said verbally in the last presentation, but I see it differs from the slide above), suspected of thoracolumbar IVD Extrusion, are non-ambulatory and can’t afford surgery. Evaluations as described in the picture are conducted on initial presentation and at 12 weeks. Intervention includes:
1. Strict rest especially for the first 4 weeks to prevent further extrusion. Crate rest (big enough to stand, stretch, or turn) is advised in order to prevent a dog from doing something dangerous. Physiotherapy activities are the only exception to this rule.
2. Bladder Management – owners are instructed in how to express the bladder. One take away point is to always have a second go at expressing even if you think you got it all.
3. Physiotherapy – The discussion around physio was about ROM and massage, but the researchers were quick to say that they could only touch on basics, and recommended working with a qualified veterinary physiotherapist / rehab practitioner.
Some of the preliminary findings (as of April 2021) were that they had 19 dogs in the study. 6/19 were grade 5 (paralyzed and deep pain negative). 4 of these had recovered the ability to walk by the end of the 12 weeks. In the remaining 13 dogs who were paralyzed but had deep pain sensation, 12/13 had recovered the ability to walk within 12 weeks. The one dog that hadn’t, simply hasn’t reached the 12-week mark yet. Time to walking is 17.5 days.
NOTE: What’s fascinating about the numbers above is that the typical reported success for surgery for grades 3 and 4 cases is 86% and for grade 5 cases, recovery is reported to be 60%.
Some of the other findings are that they are seeing spinal cord swelling on MRI, which seems to correlate with clinical signs. The amount of extruded disc material changes over time and is sometimes removed completely. However, removal of the disc extrusion isn’t necessary for recovery.
While MRI and surgery are still the standard, this research is showing that when surgery is not possible then there is still a chance for dos to regain walking and bowel and bladder (in the case of grade 5 neuro dogs). If deep pain is still present then (to me), conservative management appears to be better than surgery. The fear for any veterinarian or practitioner is the chance of further deterioration. However, the old adage of the ‘48 hours window in which to do surgery before permanent damages are incurred’, has been disproven.
The most recent webinar I watched (November 10, 2021) didn’t provide any additional statistics, however, it was noted that they had 48 dogs in the study so far and were hoping for another 50 or so within the next year.
So, if you are a practitioner in the UK with a new IVDE small dog that fits the criteria for inclusion in the study, pass along the contact details of the researchers. They can be found on the Facebook page or by calling reception at the Veterinary Hospital at the University of Cambridge.
How exciting is this!!!??? I’ll be following this work closely, as I can’t wait for the next update!
So, on that note, until next time…