Surgery for IVDD

Introduction to Surgery for IVDD

Our neurology team may recommend surgery to address your pet’s intervertebral disc disease. Surgery is often recommended in pets with more severe symptoms, pet’s who do not adequately recover from conservative management or in for pets with have recurrent symptoms. The goal of these surgeries is to remove the disc material that is putting pressure on your pet’s spinal cord and nerves. Having IVDD is a like having a rock in your shoe. Surgery is what we do to remove that rock.

Surgery is recommended for disc disease for a couple of different reasons. Severity of symptoms is usually the first thing we look at. Pets that are unable to walk, unable to feel their legs or are in pain despite medications are all excellent candidates for surgery. However, we also sometimes do surgery on dogs with milder symptoms. For instance, some pets have had multiple episodes of back pain or weakness. Others have tried conservative management and either symptoms were not resolving or they are getting worse. Some pet parents also choose surgery early on for more practical reasons. For example, surgery has an overall higher success rate in both the short and long term across all levels of symptoms, and some pet parent’s wish to use the most effective treatment first. At your neurology appointment, our team will discuss your pet’s symptoms and our recommendations.

There are a couple of different surgeries that can address intervertebral disc disease. The exact location of your pet’s injury as seen on MRI will determine which surgery is appropriate for your pet.

Prognosis

The neurology team will discuss your pet’s prognosis at your appointment, as several factors come in to play.

The first and most important factor is the severity of your pet’s symptoms. Most pets, even pets who are completely paralyzed, will functionally recover with surgery. What is functional recovery you might ask? Not all pet’s are 100% perfect after a spinal injury and surgery, as the spinal cord is not very good at healing. However, it is a reasonable goal in the majority of patient to be free of pain, and be able to walk and use the bathroom on their own. Many pets will recovery to the point that only a very careful observer will notice any disability. More than 95% of pets have a functional recovery with surgery. Our physical rehabiliation service is here to help your pet get the best recovery possible. After surgery, it is also less likely that your pet will have IVDD in the future.

Pet’s with total loss of function, who can neither move nor feel any pain in their feet, unfortunately do not have as good of a chance of recovery. The appearance of the spinal cord on MRI can help us understand more, but most dogs with this level of symptoms have about a 60% chance of recovery. In very rare circumstances a severe level of injury to the spinal cord can result in a catastrophic and progressive injury called myelomalacia. This condition can develop days to weeks after the surgery despite our best efforts. When this happens, the spinal cord progressively dies. This is very painful, and as it progresses it will paralyze the muscles that are necessary for breathing. Therefore, when we see evidence of this, we unfortunately must recommend euthanasia. Thankfully this is a rare condition seen in less than 10% of very severely affectd patients.

The other factor that comes in to play in prognosis is how long the symptoms have been there. In our experience, pets with more long term damage (months to years) often do not make as complete of a recovery. In general our goal with pets with long term damage is to treat pain and stop progression of signs. In general, we see pets return to the level of function that had a month or two before surgery, but this varies. Physical rehabilitation is strongly recommended post operatively for dogs with more chronic injury.

Surgery Day

Please do not give your pet any food or treats the morning of surgery, with the exception of a small bite to take any needed medication. Unless otherwise instructued, please give all medications as normal the morning of surgery. If your pet’s surgery is an emergency and they ate breakfast, please let the team know. This does increase their chance for pneumonia, but we will take extra steps to help prevent this.

Please bring your pet’s medications, and assistive devices you have (harnesses, slings), as well as their food if they are on a special diet or have a sensitive stomach. We cannot accept raw food diets due to the risk of bacterial contamination. You can bring toys or blankets with you to the hospital, however there is a chance they may be lost. Pets will often soil their bed as they recover from surgery, and we do a large amount of laundry a day. Please do not bring your pet’s irreplaceable toy, as we would be heartbroken if it got lost.

Most of these surgeries take our neurology team about an hour to perform. Pet’s will usually stay in the hospital 1 to 2 nights after surgery. Overnight, our patients are watched by experienced veterinary technicians, and there is a doctor on call if there are any concerns.

You can expect an update from the doctor directly after surgery, and then someone from the neurology team will update you daily. You are also welcome to call for updates from 9am-5pm.

Common Surgeries

Hemilaminectomy

This is a surgery that is typically performed for IVDD from the shoulder blades down, but also occasionally in the neck. In this surgery, the incision is right along the topline of your pet, down the middle of the back. Exactly what surgery is being performed and your pet’s size will determine the size of the incision, but generally incisions are about 5 inches on smaller dogs, and 7 inches on bigger dogs.

The muscles are moved from the side of the spine. Using a drill, we make a small window is made in the bone. This allows the doctor to gently remove any disc or hemorrhage that may be pressing on the spine. Your doctor also might perform a preventative procedure called a fenestration.

Ventral Slot

This is the most common surgery used to address intervertebral disc disease in the neck. In this surgery the incision on the bottom of the neck, and will be about 6 inches long in small dogs, and 9 inches long in big dogs. We move all the important structures out off to the side, so we can accessbottom of the vertebrae.

Once there, we make a small window in the middle of the bone on either side of the disc. This allows the doctor to pass an instrument around the spinal cord to sweep away any disc or hemorrhage. Your doctor also might perform a preventative procedure called a fenestration on other disc spaces in the neck.

Surgical Recovery

In general, full recovery from these procedures takes 8 to 12 weeks. Every pet heals at their own rate, but in general we see 80% of the recovery we are going to see in these first few months. After that, further recovery is certainly possible, but the speed of recovery tends to slow.

The first month of recovery is focused on rest. You pet has just had a major procedure, and needs to recover. Also, because we have taken bone away from the spine, your pet needs to make scar tissue to stabilize and heal this area. Before this scar tissue is made the spine is more fragile. Excessive movement, jumping, etc can cause bleeding, swellings of fluid called seromas and sometimes further extrusion of disc material. In the worse case your pet can even break bones in their spine before it heals. It only takes a second for a pet to jump off the sofa and do a lot of damage to themselves. This can mean your pet needs another surgery. If you pet is resistant to crate rest, please let us know so we can discuss sedatives or other methods of rest. Our post-operative instructions will walk you through the details of recovery.

After this inital rest period, we will focus on gradually increasing your pet’s freedom and mobility. Our return to activity handout details the schedule for these changes. If at any point your pet seems painful, rest them and reach out to our neurology team to chat.