Dr. Peter Maguire DVM, MS
Board certified Vet specialist Neurology/Neurosurgery
Most experienced veterinarians will agree that when a dog has neck pain from intervertebral disk problems (‘disk disease’ ), one of three scenarios follow:
1. The medically managed dog will often get better with time, rest, and symptomatic medications (often a combination of anti-inflammatories, pain medications and sometimes muscle relaxants). In fact, we know that ~40% of dogs who are experiencing neck pain for the first time from a “slipped or bulging disk”, will get better with medical management. 35% of these dogs will have painful recurrent episodes at some point in the future; subsequent episodes are typically worse. ~20% of medically managed dogs will fail to respond necessitating surgery or euthanasia for intractable pain or neurological deterioration.
2. Some dogs will have surgery to ‘repair’ the disk problem and will make a speedy complete recovery (99% of the time in one study!). These dogs will return to normal or near normal, often within a few days of surgery, and only have a 10% or less chance of recurrent signs in the future.
3. Some dogs will have surgery to ‘repair’ the disk problem, but have a protracted and incomplete recovery. Sometimes they are worse after surgery, and often the signs recur…the surgery did not seem to really help, or made things worse.
Why these different scenarios for the same problem…‘disk disease’? And more importantly, how can your predict which scenario will apply to your dog should they suffer from neck pain?
As to why scenarios differ with the same problem (disk disease), the answer is straight- forward…NOT ALL DISK DISEASE IS THE SAME. We use catchall phrases like ‘bulged, ruptured, prolapsed, herniated disk’, but they are not all the same. A “bulging” disk is not the same as a “ruptured” disk. Moreover, the location of the disk problem in the neck can be critically important in determining which of the three scenarios will follow. In some cases, the most severely effected dogs, those that seem likely to have a poorer prognosis, actually have the best prognosis! Dogs with milder may have the worst prognosis.
So, there are many nuances of ‘disk disease’ that will influence the signs and outcome in your dog. Understanding these nuances and being able to recognize which dog has which nuance is key to helping the pet owner decide between medical management and surgery, and accurately predicting the outcome for the course of action chosen. The more experience the vet has in managing neck pain, the more they are able to recognize the nuances of disk disease. The more they are able to recognize the nuances, the more success they will have in recommending a course of action.
Here is an example of such a case.
“Koda” is a 6 yr old Labrador Retriever who went from normal one day to limping on a front leg the next, to being unable to walk on the next day. Koda could not stand or walk on his own and had neck pain. The video below is of Koda 3 days after his problem began. Even with help and encouragement, he was unable to stand and walk.
Based on Koda’s age, his breed, the signs and the history, I was able to deduce that Koda most likely had an acutely ruptured disk in the lower part of his neck (C5-C7). Some disk problems at this level of the neck in mid to larger sized dogs are very problematic with a good chance of poor outcome with both medical and surgical treatments. The nuances of Koda’s case helped me to recognize that with surgery, he would have a great chance of recovery, even as severely effected as he was. Although Koda’s owners loved him dearly as a family member, they did not want to see him suffer and could not manage a dog who could not walk—they were considering euthanasia. My confidence that Koda could be ‘fixed’ encouraged them to try, and Koda was off for an MRI.
The MRI showed us what I suspected; that Koda had an intervertebral disk at C6-C7 that had acutely ruptured into his spinal canal. The ruptured disk fragments were compressing his spinal cord, causing his inability to walk. That the disk was ruptured and not bulging, that Koda was a Labrador and that this was all an acute event, meant that his prognosis with surgery was favorable—these are the nuances that are important.
So Koda had surgery.
And Koda made a beautiful recovery. He was up and walking 3 days after surgery and getting stronger every day thereafter.
This is Koda two weeks after his surgery after getting his stitches out………….
Moral of the Story:
We are able to do some pretty neat things in veterinary medicine. Despite our best efforts, amazing technology and advanced knowledge, sometimes we fail to achieve the desired outcome. Success or failure can be as simple as recognizing or failing to recognize the nuances in the cases we evaluate.