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Have you read this study?  If you’re in rehab, you NEED to know about this study. 

Khan S, Jeffery ND, Freeman P. Recovery of ambulation in small, nonbrachycephalic dogs after conservative management of acute thoracolumbar disk extrusion. J Vet Intern Med. 2024 Jul 25.

This study by Khan, Jeffery, and Freeman investigates the recovery of ambulation in small, nonbrachycephalic dogs with acute thoracolumbar intervertebral disk extrusion (TL IVDE) managed conservatively. Conservative management typically involves providing analgesia, restricting movement, and managing bladder function, with recovery dependent on the resolution of spinal cord inflammation and neuroplasticity mechanisms. There is also evidence of natural resorption of compressive material, which may aid in recovery, although its prevalence and impact on recovery in dogs have not been fully studied.

While surgery is widely regarded as superior to conservative treatment, especially in dogs unable to walk, these claims lack systematic investigation. Furthermore, the notion that surgery leads to quicker and more complete recovery and reduces recurrence risk is often stated but has not been formally validated.

The study aimed to document the natural progression of TL IVDE in non-ambulatory dogs managed conservatively, focusing on the recovery rates of both Deep pain positive (DPP) and deep pain-negative (DPN) dogs, the time to recovery, and the potential association with spontaneous decompression over a 12 week time-frame.

Study Details:

• Subjects: 72 non-ambulatory dogs weighing under 15 kg. (Excluding brachycephalic dogs)
• Methods: Dogs underwent MRI at presentation and after 12 weeks, with conservative management including analgesia, cage rest, and physiotherapy.

Findings:

• Recovery Rates: 96% of deep pain-positive (DPP) dogs and 48% of deep pain-negative (DPN) dogs recovered ambulation within 12 weeks.
• Time to Recovery: Median times were 11 days for DPP dogs and 25 days for DPN dogs.
• Spinal Cord Compression: Reduction in compression was observed in some dogs but was not consistently linked to recovery.

Comparison with Previous Studies: 

The study's recovery rates for DPP dogs align with earlier reports, which had estimated a favorable prognosis for conservatively managed DPP dogs. However, the study observed a higher recovery rate for DPN dogs than previously documented, with prior studies showing lower success rates for conservative management. The reasons for these discrepancies are unclear, though they may relate to differences in study design, such as the retrospective nature of prior studies or differences in patient selection criteria.

Recovery Comparisons between Conservative and Surgical Management: 

The recovery rates observed in this study are comparable to those reported for dogs undergoing decompressive surgery, suggesting that surgery is not the only effective treatment pathway. The time to recovery for DPP dogs was consistent with some previous studies but varied widely, underscoring the need for patience in assessing recovery outcomes.

Conclusion: 

The results strengthen the evidence that a significant number of small dogs with TL IVDE can recover without surgical intervention, including many that are DPN and those with severe spinal cord compression. The study also confirms that disk extrusions in dogs can regress, although this regression and spontaneous decompression are not always necessary for functional recovery. Together, these findings suggest that when surgical decompression is not feasible due to financial or geographic limitations, conservative management remains a viable option. More research is needed to establish the specific clinical and MRI characteristics that determine which dogs require surgery.