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Cervical Intervertebral & Degenerative Disk Diseases in Dogs

My little dog was suddenly unable to turn her head to the side.  She was diagnosed with a bulging intervertebral disk in her neck. I want to know more about this condition.

cervical-ivdd-in-dogs

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The spine is like a string of pearls with boney vertebrae separated by intervertebral disks. The intervertebral disks allow movement in the spine and act as shock absorbers between the vertebrae. Each disk is composed of a central gel-like area called the “nucleus pulposus” and an outer fibrous ring called the “annulus fibrosis.”  If the disk degenerates or is damaged in some way, the disk may bulge and put pressure on the spinal cord and/or the roots of the spinal nerves that come off the sides of the spinal cord. This pressure can cause symptoms ranging from severe pain to weakness to paralysis.

The bulging disk may be from the bulging of the annular ring (protrusion), or from a rupture of the annulus where the nucleus material bulges out (extrusion). A disk that bulges without rupturing is more typical of chronic disk degeneration and is called a Hansen type II. The acutely ruptured disk is called a Hansen type I.

Is there any genetic or breed predisposition for cervical intervertebral disk disease?

There are several breeds that seem to experience a higher frequency of the condition, but it is unknown whether it is inherited genetically. Dog breeds with long backs, and shortened and bowed legs, like the Pekingese and Dachshund, have faster disk deterioration than other breeds.

Are there breed differences or age differences between the dogs more likely to get Hansen type I versus Hansen type II disk disease?

Hansen type I disk disease is most common in the breeds with long backs and short legs.  It occurs most commonly in younger dogs, 3-6 years of age. The most commonly affected breeds are Dachshunds, Beagles, and Poodles.

In contrast, Hansen type II disk disease is most common in large-breed dogs like the Doberman Pinscher.  These dogs tend to be a bit older, ranging in age from 8-10 years of age.

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Are the signs of cervical disk disease always as sudden as what happened to my dog?  Are the signs always the same?

The severity of a dog’s clinical signs depends upon several factors, including the rate and volume of disk protrusion or extrusion, the pressure on the spinal cord and/or nerve roots, and the violence of the disk material extrusion.

The most common signs include:

  • Stiff neck with reluctance to move the head and neck
  • Neck pain
  • Altered gait
  • Lowered head stance with muscle spasms of the head, neck, and shoulders
  • 10% of affected dogs are weak or partially paralyzed in all four limbs (known as “tetraparesis”)

Examination will reveal neck pain with both flexion and extension of the neck, turning the neck from side to side, or by deep palpation of the cervical muscles. Over time, there will be a loss of muscle mass over the shoulders. There may be front leg lameness such as knuckling or weakness as a result of pressure on the nerve roots.

A more severe disk disease scenario involves partial paralysis in both front and/or rear legs. The nervous system symptoms may be confined to only one side of the body involving the front leg and rear leg on that side.

Aside from the breed predispositions for the two types of disk disease, are there other risk factors for bulging or ruptured intervertebral disks?

 Both obesity and repeated traumatic events in the predisposed breeds may enhance the risk of disk disease.

I was told that cervical intervertebral disk disease may be treated either conservatively or with surgery. How is the decision made between these approaches? And what happens after treatment?

Conservative management with pain relievers and anti-inflammatory medication is recommended with a gradual onset of clinical signs or when clinical signs are limited to pain and/or a mildly wobbly gait. Surgery is recommended when there are repeated episodes of neck pain, when neck pain is severe, when there are severe nervous system deficits, or when the dog has not responded to conservative treatment. It is important to monitor a dog’s ability to urinate and defecate normally. With or without surgery, physiotherapy is a critical part of healing and recovery. Physiotherapy may include acupuncture, therapeutic laser, passive range of motion to prevent loss of muscle mass, massage, and hydrotherapy.

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All affected dogs should be fitted with a harness instead of a neck collar, and they should have their activity limited, at least early in the recovery period. Strict rest is required in the first 3-6 weeks following a disk protrusion or rupture, with or without surgery. Your veterinarian will help to prescribe increasing levels of activity as healing progresses.

If surgery is needed, the goal is to remove disk material from the space surrounding the spinal cord. This surgery usually provides immediate pain relief and long-term restoration of nervous system function. The surgical approach is typically through the bottom side of the neck, gently moving the tissues of the neck aside to provide access to the spine.

Is long-term follow-up required?

Initially, veterinary rechecks will be frequent until clinical signs are resolved. Getting the dog to a healthy weight if needed, and keeping him there, will help him recover more quickly and maintain an active lifestyle. Unfortunately, there is no way to prevent intervertebral disk disease.

Long-term complications are uncommon, but may include persistent neck pain, or a deterioration in standing and/or walking. For most patients, the long-term outlook is favorable. Dogs with chronic disk disease, or with multiple disk involvement, are likely to have a recurrence of clinical signs. Dogs with cervical disk disease should always be walked using a harness rather than with a leash attached to a collar.

What is a disc, and what is its purpose?

The spinal cord is one of the most important and sensitive organ systems in the body. If it is damaged, the nerve cells do not regenerate but are replaced with fibrous or scar tissue. Spinal cord injuries usually result in permanent, irreversible damage. To protect it from damage, the spinal cord runs through a bony canal within the spine and is surrounded by protective bone everywhere except the junction of the vertebrae. These junctions are filled by rubber-like cushions called intervertebral discs. The individual vertebrae and intervertebral discs allow the back to move up and down and sideways without allowing contact between the bones of the spinal column. This extreme protection of the spinal cord reflects its importance and fragility.

What does it mean for a disc to rupture, and how does it happen?degenerative_disc_3

The disc is composed of two parts. The outer covering (fibrous ring) is much like a thick shell. It is comprised of tough fibers that protect and contain the central part (pulpy nucleus). The disc is thinnest at the top. This thin area is located just below the spinal cord. The central part of the disc is much softer than the outer part and has the consistency of thick toothpaste.

Degenerative disc disease causes spontaneous degeneration of the outer part of the disc, resulting in sudden disc rupture or herniation (also called a “slipped disc”). It may not be related to injury, although the rupture frequently occurs after some sort of traumatic event, such as a fall or a relatively small jump. Although this act is frequently blamed for the disc rupture, the injury actually occurred due to chronic disc degeneration. Most dogs with degenerative disc disease are middle-aged, from three to seven years old. There is likely a genetic predisposition to this disease. Certain breeds, especially the Dachshund, Poodle, Pekinese, Lhasa Apso, German shepherd, Doberman and Cocker Spaniel have a high incidence of intervertebral disc disease.

When the outer shell degenerates, it allows the central part of the disc to escape. Since the disc is thinnest near the spinal cord, disc material that escapes through the tear usually goes upward, putting pressure on the spinal cord. Because the spinal cord is encased within its bony canal, it cannot move away from the pressure and it becomes “pinched”.

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degenerative_disc_1How does a slipped disc affect the spinal cord?

The spinal cord is like a telephone cable carrying thousands of tiny wires. When it is crushed, transmission of information through the wires is slowed or stopped. When the disc degenerates and ruptures, it crushes the spinal cord and the nerves that leave the spinal cord over the discs (i.e. spinal nerves). Pressure on the spinal nerves results in pain. Pressure on the spinal cord results in pain and/or loss of information transmission, causing partial or complete paralysis.

Most disc ruptures occur in the middle to lower part of the back. However, they may also occur in the neck. Back injuries often cause paralysis without severe pain while neck injuries usually cause severe pain without paralysis. If paralysis affects all four legs, the disc rupture must be in the neck. Due to the way nerve tracts are arranged in the spinal cord, disc ruptures in the neck may affect the rear legs first and may not involve the front limbs.

How fast do intervertebral discs degenerate and rupture?

Disc degeneration occurs relatively slowly, and a rupture may occur slowly and gradually, so that degenerated disc material slowly escapes from the disc over several days or weeks. In these cases, the dog often experiences pain and is reluctant to move. It may lie around for a few days allowing the body to try to heal the injury, often without the owner being aware that a problem existed.

However, discs may also rupture very acutely. Some dogs will go from normal walking to total paralysis in less than one hour.

How is a slipped disc diagnosed?

A presumptive diagnosis of disc disease will be based on the dog’s history of neck or back pain, uncoordinated walking, or paralysis, with or without a history of recent trauma. If the dog is one of the high incidence breeds, this disease will be high on the list of potential causes of the patient’s symptoms.degenerative_disc_2

In some cases, plain radiographs (x-rays) may assist the diagnosis. However, plain radiographs may show no abnormalities, since neither the disc nor the spinal cord is readily visible on an x-ray. If the diagnosis is in doubt or if the patient will undergo surgery, a myelogram may be performed. This procedure involves injecting a special dye around the spinal cord of the anesthetized dog and then taking a series of radiographs. The dye will outline the spinal cord. A break in the dye column means that there is pressure on the spinal cord at that point. If available, computed tomography (CT) scans and magnetic resonance imaging (MRI) may be used to diagnose intervertebral disc herniation.

How do you know if the pressure on the spinal cord is due to a disc or something else?

It is possible that the pressure is due to a blood clot or tumor. Both are possible but rare, especially when compared to disc ruptures. If the patient is a high-risk breed and there has been a sudden onset of paralysis without severe trauma, there is an approximately 95% chance that a disc rupture is causing the clinical signs. However, the diagnosis is not definite until the time of surgery.

Are all disc ruptures treated with surgery?

Not necessarily. The recommended treatment is based on the stage of the disease:

  • Stage I disc disease produces mild pain and is usually self-correcting in a few days.
  • Stage II disc disease causes moderate to severe pain in the neck or lumbar (lower back) area.
  • Stage III disc disease causes partial paralysis (paresis) and results in the dog walking in staggering or uncoordinated movements.
  • Stage IV disc disease causes paralysis but the ability to feel is present.
  • Stage V disc disease causes paralysis and loss of feeling.

These stages tend to overlap in some dogs, and dogs may move from one stage to another over a period of hours to days. Dogs with Stage II and III disease are usually treated with anti-inflammatory drugs, pain relievers, and exercise restriction. If the pain or lack of coordinated movements persists after four to seven days of treatment or if the neurological status declines from one day to the next, surgery may be required. The time of confinement will vary based on each patient’s condition.

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Dogs with Stage IV disease should have surgery, although a small percentage will recover without it. Dogs with Stage V disease should have surgery immediately. The sooner that surgery is done, the better the prognosis. Ideally, these dogs should be operated on within the first 24 hours of the onset of paralysis.

What is the purpose of surgery?

The goal of surgery is to remove pressure from the spinal cord. If the disc rupture occurs in the lower back, a “window” (called a fenestration) is made in the side of the vertebral bone to expose the spinal cord. This window allows removal of disc material and relieves pressure from the cord. If the disc rupture occurs in the neck, a window is made in the bone exposing the spinal cord. This may be done from either the top or the bottom, depending on the situation and the veterinarian’s preference.

What is the success rate for treating disc disease with and without surgery?

Stage Recovery without Surgery Recovery with Surgery
I: up to 1 week 80-90% 90-95%
II: past 1 week 60-70% 90-95%
III 30-40% 85-95%
IV: up to 3 days < 25% 85-95%
IV: past 3 days < 20% 60-70%
V: up to 24 hours < 5% 50%
V: past 24 hours < 5% < 20%

 

When will we know if the surgery is successful?

Unfortunately, success cannot be determined immediately. The return of neurological function, walking ability and relief from pain may not occur for several days to weeks after surgery.

When can my dog go home?degenerative_disc

Following surgery, your dog will be hospitalized for several days. Bladder and bowel control are often lost when the dog is paralyzed. It is better for your dog to remain hospitalized until control of these functions has returned. It is generally better not to extend hospitalization beyond seven days because regaining the ability to walk partly depends on exercise and motivation. Since motivation is such an important part of the recovery process, we encourage you to visit your dog starting a few days after surgery.

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If paralysis was present before surgery, your dog may not be able to walk when it is discharged from the hospital. You will be given detailed instructions on the procedures that should be performed. Recovery is dependent on four factors: whether permanent damage was done before surgery, if the surgery relieved the pressure quickly enough, if physical therapy can be performed at home, and if the dog is motivated to recover.

Can my dog slip a disc again?

The answer is “yes”. However, as discussed above, not all disc herniations require surgery.

What if the myelogram is normal?

The purpose of the myelogram is to identify pressure on the spinal cord. If the myelogram is normal, there is no pressure on the spinal cord. This has several important implications. First, it means that surgery will generally not be appropriate. Second, it means that one of the following conditions is likely to exist:

Spinal Shock. This is a temporary loss of spinal function that is generally associated with trauma. It occurs suddenly and is somewhat like a concussion of the brain. It may leave permanent damage or full recovery may occur. Recovery from spinal shock generally occurs within a few hours to a few days.

Fibrocartilaginous Embolism. In this condition, a small amount of disc material ruptures and gets into one of the blood vessels leading to the spinal cord. As the vessel narrows, the disc material obstructs it, depriving a certain segment of the spinal cord of its blood supply. Without proper blood supply, that segment of the spinal cord dies, resulting in paralysis. Surgery will not help these dogs because there is no pressure on the spinal cord. Often, paralysis involves only one rear leg, or one rear leg is more severely affected than the other is. Complete recovery may occur in a few days to weeks, or there may be permanent damage to a portion of the spinal cord. Diagnosis of fibrocartilaginous embolism is based on the correct clinical signs and a normal myelogram. Unfortunately, a definitive diagnosis can only be made by performing a spinal cord biopsy after death.

Degenerative Myelopathy. This is a condition where the spinal cord is slowly dying. It results in progressive paralysis that begins with the dog dragging its rear feet as it walks. This is called “knuckling over” and results in the toenails of the rear feet being worn because they drag the ground with each step. It progresses to weakness of the rear legs, then paralysis. It generally takes several weeks before paralysis occurs, and generally occurs in large breeds of dogs, especially German shepherd dogs. It is often referred to as “German Shepherd Dog Disease” or “Alsatian Disease”. There is no treatment and ultimately causes loss of urine and bowel control. Diagnosis of degenerative myelopathy is based on clinical signs, breed and a normal myelogram. Confirmation requires a biopsy of the spinal cord at time of death. (for further information on this disease, please see the Client Education Handout “Degenerative Myelopathy”)

A normal myelogram in a dog with slowly progressive paralysis is very frustrating because the two most likely diseases, Fibrocartilaginous Embolism and Degenerative Myelopathy, cannot be confirmed without a necropsy (an autopsy on an animal).

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Robin Downing, DVM, DAAPM, DACVSMR, CVPP, CRPP
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