Laurie's Blogs.

I went down a rabbit hole recently after coming across a paper about return to ambulation times in cases of dogs with intervertebral disc disease. Recent research highlights prognostic indicators, surgical considerations, conservative management outcomes, and adjunctive therapies that can enhance recovery. This blog post synthesizes key findings from studies to provide actionable insights for rehabilitation specialists treating dogs with IVDD.  Now, that being said, I then further went down the rabbit hole to look for post-operative rehab specifics.  (More on that in a later instalment!)

Key Prognostic Indicators for Time to Ambulation

Postoperative Voluntary Motor Function

The presence of voluntary motor function after surgery is a strong predictor of faster ambulation recovery. A retrospective study of 112 non-ambulatory dogs with Hansen type-I disc extrusions found that dogs with postoperative voluntary motor function regained ambulation in an average of 7.9 days, compared to 16.4 days for those without (Davis & Brown, 2002). 

Neurological Grade at Presentation

The severity of neurological deficits at presentation, typically evaluated using the Frankel scale, significantly impacts recovery speed. A prospective study of 151 dogs showed that dogs with higher neurological grades (e.g., grade IV) had slower ambulation recovery compared to those with milder deficits (Vicens Zanoguera et al., 2023). Similarly, preoperative neurological grade was the primary determinant of outcomes such as pain sensation, urinary continence, and ambulation in a retrospective series (Upchurch et al., 2020). 

Deep Pain Perception

Deep pain perception is a critical prognostic factor, particularly in conservatively managed dogs. A prospective cohort study of 72 non-ambulatory dogs treated conservatively reported that 96% of deep pain-positive dogs recovered ambulation within 12 weeks (median 11 days), compared to only 48% of deep pain-negative dogs (median 25 days) (Khan et al., 2024). This highlights the need for accurate pain sensation assessments to inform treatment decisions and predict recovery potential.

Surgical and Perioperative Factors

Surgical Timing and Duration

The timing of surgical decompression relative to the onset of clinical signs appears to have limited impact on ambulation recovery, provided surgery occurs within a reasonable timeframe. A study of 151 dogs found no association between delays up to 72 hours and time to ambulation, although only 14.5% of cases had delays ≥6.5 hours (Vicens Zanoguera et al., 2023). Similarly, the duration of clinical signs before surgery did not affect outcomes (Upchurch et al., 2020). However, shorter surgical duration was linked to faster recovery, suggesting that efficient surgical techniques may enhance outcomes (Vicens Zanoguera et al., 2023).

Epidural Steroid Application

Local epidural administration of methylprednisolone acetate during surgery may accelerate ambulation. A randomized controlled trial of 41 dogs demonstrated that the treatment group receiving methylprednisolone (1 mg/kg) achieved ambulation in a median of 3 days, compared to 7 days for the saline control group (Natsios et al., 2024). However, one dog developed discospondylitis, indicating a need to balance benefits against potential risks. 

Adjunctive Surgical Techniques

Durotomy, an adjunctive surgical technique to decompress a swollen spinal cord, shows promise in severe cases. A study of 116 paraplegic, deep pain-negative dogs with thoracolumbar IVDD found that 56.9% of those receiving durotomy with hemilaminectomy recovered ambulation, compared to 38.5% with hemilaminectomy alone (Lewis et al., 2020). Notably, no dogs in the durotomy group developed progressive myelomalacia, unlike 14 in the control group. Extended durotomy over four vertebral lengths also showed favorable outcomes, with 16 of 22 dogs recovering ambulation within 6 months (Lewis et al., 2020). These findings suggest that durotomy may be particularly beneficial for severely affected dogs, though further research is needed to optimize patient selection and assess long-term effects.

Adjunctive Therapies in Rehabilitation

Low-Level Laser Therapy (Photobiomodulation)

Low-level laser therapy (LLLT) has emerged as a promising adjunctive therapy for IVDD. A prospective study of 36 dogs with acute paraparesis or paraplegia due to IVDD found that postoperative LLLT (5 × 200-mW 810-nm, 25 W/cm² for 5 days or until ambulation) reduced the time to achieve a modified Frankel score of 4 (independent ambulation) to a median of 3.5 days, compared to 14 days in the control group (Draper et al., 2012). However, a conflicting blinded, randomized study found no significant benefit of LLLT with or without physical rehabilitation (Lewis et al., 2020). Differences in study design, laser parameters, and sample size may explain these discrepancies. Despite mixed results, LLLT’s potential to enhance neuronal metabolism and reduce inflammation warrants further investigation, with no adverse events reported.

Acupuncture

Acupuncture, including electroacupuncture, can enhance ambulation recovery when integrated into postoperative physiotherapy. A study of 41 dogs showed that those receiving acupuncture alongside physiotherapy were more likely to regain ambulation compared to those receiving physiotherapy alone (Antonucci et al., 2025). Acupuncture’s analgesic and anti-inflammatory effects may support neurological recovery.

Physical Rehabilitation and Psychological Considerations

Physical rehabilitation is crucial for maintaining muscle elasticity, joint mobility, and nerve health in non-ambulatory dogs. Beyond physical benefits, the psychological state of the dog may influence rehabilitation outcomes, as observed in human medicine (Thomovsky & Ogata, 2021). Factors such as breed, age, personality, and prior experiences may affect a dog’s response to therapy, though canine-specific data is limited. 

Lesser Researched Therapies

Therapies such as pulsed electromagnetic field (PEMF) therapy and local hypothermia show potential but require further validation. PEMF reduced postoperative pain and possibly improved neurological outcomes in a small trial of paraplegic dogs (Lewis et al., 2020). Local hypothermia, applied experimentally, improved functional outcomes in dogs but is technically demanding and untested in naturally occurring IVDD (Lewis et al., 2020). These modalities may complement rehabilitation but need larger, controlled studies.

Conservative Management Outcomes

Conservative management can be effective, particularly for dogs with intact deep pain perception. The study by Khan et al. (2024) reported a 96% ambulation recovery rate in deep pain-positive dogs within 12 weeks, with spinal cord compression reduction varying but not correlating with recovery. This suggests that structured rehabilitation, including controlled activity and pain management, is a viable option when surgery is not pursued.

Complications to Monitor

Deep surgical site infections (SSIs) are rare (1.1% incidence) but can delay recovery. SSIs typically present within 2 weeks with spinal hyperesthesia and neurological deterioration, but most cases resolve with treatment (To et al., 2025). 

Implications for Veterinary Rehabilitation

All in all, based on the 10 studies included here, it would appear that neurological status, which is outside of our control, is a major factor impacting return to ambulation in dogs with IVDD. Acupuncture, laser therapy, PEMF, and local hypothermia may have beneficial impact. It will be interesting to look at exactly which rehab tools and what kind of rehab programs were most beneficial in post-operative (or non-operative) return to function.  Hold onto that thought!  This is just part one!

In the meantime, check out the references!

Cheers,

Laurie

References

1.  Antonucci, M., Passarini, E., Bruno, E., Dalmonte, T., & Spinella, G. (2025). Clinical Study on the Application of Acupuncture in the Postoperative Rehabilitation of Dogs Affected by Acute Thoracolumbar Disc Herniation. Animals (Basel), 15(8), 1154.

2.  Davis, G. J., & Brown, D. C. (2002). Prognostic indicators for time to ambulation after surgical decompression in nonambulatory dogs with acute thoracolumbar disk extrusions: 112 cases. Veterinary Surgery, 31(6), 513-518.

3.  Draper, W. E., Schubert, T. A., Clemmons, R. M., & Miles, S. A. (2012). Low-level laser therapy reduces time to ambulation in dogs after hemilaminectomy: a preliminary study. Journal of Small Animal Practice, 53(8), 465-469.

4.  Khan, S., Jeffery, N. D., & Freeman, P. (2024). Recovery of ambulation in small, nonbrachycephalic dogs after conservative management of acute thoracolumbar disk extrusion. Journal of Veterinary Internal Medicine, 38(5), 2603-2611.

5.  Lewis, M. J., Granger, N., Jeffery, N. D., & the Canine Spinal Cord Injury Consortium (CANSORT-SCI). (2020). Emerging and Adjunctive Therapies for Spinal Cord Injury Following Acute Canine Intervertebral Disc Herniation. Frontiers in Veterinary Science, 7, 579933.

6.  Natsios, P., Golini, L., Park, B. H., & Steffen, F. (2024). Effect of local epidural application of methylprednisolone acetate on time to ambulation in non-ambulatory dogs with thoracolumbar intervertebral disc disease: A prospective randomised, blinded control trial. Veterinary Record, e4962.

7.  Thomovsky, S. A., & Ogata, N. (2021). A Canine’s Behavior and Cognitive State as It Relates to Immobility and the Success of Physical Rehabilitation in the Non-ambulatory Spinal Cord Patient. Frontiers in Veterinary Science, 8, 599320.

8.  To, A. Y. K., Cherubini, G. B., & Caine, A. (2025). Clinical presentation, magnetic resonance imaging characteristics, and short-term outcome of deep surgical site infection following thoracolumbar decompressive spinal surgery for intervertebral disc herniation in dogs. Frontiers in Veterinary Science, 12, 1645491.

9.  Upchurch, D. A., Renberg, W. C., Turner, H. S., & McLellan, J. G. (2020). Effect of Duration and Onset of Clinical Signs on Short-Term Outcome of Dogs with Hansen Type I Thoracolumbar Intervertebral Disc Extrusion. Veterinary and Comparative Orthopaedics and Traumatology, 33(3), 161-166.

10.  Vicens Zanoguera, L., Pauciulo, C., Corlazzoli, D., Cauduro, A., & Motta, L. (2023). Does surgical timing affect the rapidity of recovery in deep pain-entire non-ambulatory dogs with thoracolumbar intervertebral disk extrusion? Journal of Small Animal Practice, 64(3), 136-141.