Treatment options for dogs who can walk
Non-surgical treatment: For dogs who can walk, good-quality non-surgical treatment is usually the most sensible option to start with. This is true even if the dog is quite wobbly when walking. These dogs have a very good chance of doing well without an operation Levine et al 2007, Mann et al 2007, Sedlacek et al 2022. If the dog’s condition deteriorates, if they fail to improve over several weeks, or perhaps if the problem keeps recurring, referral for surgery may however become the best option.
Non-surgical treatment mostly involves home care, though treatment may be started on an in-patient basis (see below). The aim of non-surgical treatment is to keep the dog as comfortable, strong and coordinated as possible while preventing any rushing about, running and jumping. Your dog will need a recovery area (typically a crate or pen) and a routine involving gradual increase of controlled exercise as supervised by your vet or physiotherapist.
Recurrence of IVDD clinical signs is quite common after initially recovery, so you may find yourself back at the clinic months or even years later.
Spinal operation plus aftercare: Surgery is available for dogs who can walk and usually has a very good eventual outcome. Bear in mind though that these dogs usually have a very good chance of recovering without an operation. And not every spinal operation is a success: some mildly-affected dogs ( grades 1 and 2) have been reported to be unable to walk for a couple of weeks after spinal surgery (i.e. they get worse for a while) and, unfortunately, a tiny percentage of dogs deteriorate badly after surgery Aikawa et al 2012
If your dog can walk and you’re considering an operation, discuss these issues with your surgeon who will help you make an informed decision. Some types of spinal surgery can reduce the risk of the IVDD signs coming back, though the problem does still recur in many dogs.
Is treatment an emergency?
If your dog has IVDD but is able to walk, they are unlikely to need an operation on an emergency basis. However, they should be seen as soon as possible by your vet for assessment and prescription of painkillers. Ask for the next available appointment.
Do ask to speak to a vet straight away if your dog seems to be getting worse and worse. A few cases deteriorate and may need more urgent help.
Important: If your dog seems to be getting worse and worse, ask to speak to your vet immediately. They may need urgent referral.
Above: Sybil the dachshund was able to walk but was shaking with pain. IVDD-affected dogs are painful and should see the vet asap for painkillers and assessment. Video courtesy of M. Lucas.
Is it worth having my dog admitted to the first-opinion clinic?
Some dogs may do better if started off with in-patient care, whereas others do well with home care from the start. In-patient care involves painkillers (intravenous if needed) and regular monitoring. With your dog safe in a hospital kennel, you have a chance to set up a recovery area (usually a large cage or pen) ready for when your dog comes home. Your dog will need to be kept comfortable and given plenty of TLC from the start, so only have him admitted for in-patient care if the clinic has good round-the-clock staff and resources.
Watch out for deteriorating dogs: A few dogs start with mild signs which then get worse as the spinal disc continues to herniate. The problem may get worse gradually or suddenly. Therefore it’s important to keep an eye on your dog and to be prepared for a change of treatment plan, especially in the early stages. Deterioration is generally nobody’s fault. It’s just that the disc has herniated over hours to days rather than all at once. As far as possible, prevent your dog from running and jumping during early recovery (see below for more guidance on this). We occasionally hear of dogs who start off mildly-affected, but then suddenly lose the ability to walk just after jumping off a sofa or chasing across a room.
Above: Here is a video of a dachshund with grade 2 IVDD. Unfortunately, this little dog got much worse and became paralysed six hours after the video was taken. He eventually made a good recovery following spinal surgery and dedicated home care.
Treatment options for grade 3 and 4 dogs
Treatment options are:
Spinal surgery
If your dog cannot walk, an operation might improve their chance of recovery. Spinal surgery should only be performed by someone with specialist training. If your dog is to go for surgery, ask your vet to refer them to a neurologist.
The neurologist assesses the dog and then, under a general anaesthetic, uses advanced imaging (MRI or in a few cases CT or myelography) to confirm which disc spaces are affected and on which side of the spine. Surgical techniques vary depending on these findings.
These days, most spinal surgery procedures involve the removal of disc material that is pressing on the spinal cord. An example of this is the ‘hemilaminectomy’ procedure. To surgically decompress the spine, the surgeon removes a section of vertebral bone overlying the spinal cord and then very carefully removes herniated disc material so that it no longer presses on the spinal cord. In some cases, a ‘fenestration’ procedure is also performed on the affected disc and/or adjacent discs. Fenestration may reduce the risk of the problem recurring. It involves removing the centre of the disc (the nucleus pulposus) via a little window cut out of its side.
After successful spinal surgery, it usually takes these dogs about 1 to 3 weeks to start walking. A few dogs take much longer than this. Dogs usually stay in the hospital for a few days. They are discharged once they are fairly comfortable and can be managed at home. You’ll need to set up a safe indoor recovery space (crate, pen or possibly a recovery room) ready for when your dog comes home. Be prepared – your dog might not yet be able to walk and they might not have perfect bladder and bowel control on returning home.
Above: Home care following surgery typically includes on-lead toilet breaks with sling walking if needed to help support the dog’s hindquarters. Darcy Dolittle needed support from a sling for a few days on coming home to prevent falls. A scarf makes a useful temporary sling.
Non-surgical treatment. Non-surgical treatment can be a reasonable option for these dogs. Most grade 3 and 4 dogs will recover, even without a spinal operation. Recent studies have demonstrated good results without surgery. For example, in a study on dachshunds recovering without surgerySedlacek et al 2022, all the grade 3 dogs, and 7/9 grade 4 dogs made a good recovery. Further studies looking at non-surgical recovery are ongoing.
Non-surgical treatment involves good pain-relief, a comfortable recovery area, exercise therapy, nursing care and, if needed, help with bladder management. Any exercise therapy is best tailored to the dog and supervised.
Initially, it may be worthwhile having your dog admitted to a veterinary hospital for intravenous fluids and oxygen (both of which may benefit the damaged spinal cord) and for top-quality pain-relief and nursing care. This may also give you a chance to set up a safe indoor recovery space (crate, pen or recovery room) ready for when your dog comes home. If your clinic does not offer in-patient care, or if you cannot afford this, then your vet may send your dog home straight away with pain-medication and you can make a start with home care.
You’ll need to learn some special skills for helping your dog if they cannot walk. These include sling-walking, supporting your dog in a standing position, and expressing their bladder if they cannot pee unaided. See your vet regularly for advice and monitoring. A next-day check-up is a good idea to start with.
Physiotherapy is particularly important for IVDD-affected dogs who cannot walk. These dogs recover mainly through neural plasticity (the ability of the central nervous system to adapt to meet functional demands) Fouad & Tetzlaff 2012. Improvement will therefore not happen while the dog is lying in a cage or dragging themselves about, but will be triggered by practice of coordinated movements and postures. Exercises aim to achieve this improvement, but must be performed correctly and safely. Physiotherapy referral is a good idea during the first week. Tip: Ask your physiotherapist to start teaching you how to do the exercises with your dog, so that you can continue the good work between physio sessions. To get in touch to book your dog’s IVDD assessment and supervised home physiotherapy and rehabilitation program, click here.
Is treatment an emergency?
If your dog has just gone down with IVDD and is unable to walk, they should be seen as soon as possible by your vet for assessment and treatment including painkillers. Ask for the next available appointment. Ask to speak to a vet straight away if your dog seems to be getting worse and worse. A few cases deteriorate (see below) and may need urgent help.
Important: If your dog seems to be getting worse and worse, ask to speak to your vet immediately. There’s a possibility that urgent referral may be required.
Unless your dog is getting worse and worse, there is no need to rush into surgical referral for IVDD. Most studies show that delaying the operation does not affect the dog’s outcome Davis & Brown, Kazakos et al 2005, Ito et al 2005, Jeffery et al 2016. You should generally have a chance to consider all options and to check your financial position before going for surgery. It can be sensible in some cases to start with non-surgical treatment and then progress to an operation if your dog is not improving. If surgery is delayed, then excellent pain-medication is important, and your dog should either be admitted to the clinic or have frequent repeat visits for monitoring.
A few dogs start with mild signs which then get worse. The problem may get worse gradually or suddenly. Therefore it’s important to keep an eye on your dog and to be prepared for a change of treatment plan, especially in the early stages. Unless these dogs get really bad, then this won’t change the eventual outcome. However, there’s a big difference in outlook for grade 4 dogs (can’t walk, paralysed hind legs) and grade 5 dogs (can’t walk, paralysed hind legs and no deep pain sensation in toes). If your dog is in the ‘middle group’ (grade 3-4) and you are considering an operation but hoping to avoid one, have your vet keep a close eye on them for the first few days.
If your dog is rapidly-deteriorating, quick referral for surgery might be wise, ideally before they lose toe pain-sensation.
Deterioration is generally nobody’s fault. It’s just that the disc has herniated over hours to days rather than all at once. As far as possible, prevent your dog from running and jumping during early recovery (see below for more guidance on this). We occasionally hear of dogs who start off mildly-affected, but then suddenly get much worse just after jumping off a sofa or chasing across a room.
I know Gretel has Intervertebral Disc Disease (IVDD) – the spinal disease common in Dachshunds. I know that she will be dealing with pretty much the same situation as I am with my bad back. There will be periods in her life where she can be active with no problems. There will also be periods where she will have flare-ups and setbacks. There will be times when she needs to reduce, sometimes significantly, her activity level to recover.
Gretel got the go-ahead to progress the difficulty of her rehab exercises and free rein to continue our hike training.
For a long time, strict crate rest – keeping a dog largely immobile – for 6-8 weeks has been the “best”, and most recommended, treatment for back injuries for a long time. That’s changing though. Veterinarians are discovering that crate rest WITH active rehabilitation speeds and improves recovery. The goal nowadays is to get a dog up and moving as soon as they can to help make them stronger and reduce the chance of re-injury.
So off we go on our trail adventures again. Strangely, as a lot of things along this IVDD journey have been, was a positive. Now I know what a setback from being over-worked looks like. I feel more confident that I’ll know what to do if it happens again.
Being active is a mindset – a lifestyle choice. Every active person knows they will not be operating at 100% all of the time. Active people know there will be injuries and there will be setbacks. They do it anyway.
How to Care for a Dog After IVDD Surgery | Instructions Guide
I’ve been dealing with a back problem for over 10 years. Since the injury, my life has been a series of active periods and recovery periods. That’s the way it is with most active people. Some people are young and lucky (I was that person once too) and they can go full-out, all of the time, with no pain or in spite of the pain. Most are not so lucky though.
Being active is a mindset – a lifestyle choice. Every active person knows they will not be operating at 100% all of the time. Active people know there will be injuries and there will be setbacks. They do it anyway.
That’s me. That’s my attitude. My end goal is to be healthy, active, and enjoy life but I know that journey will always be two steps forward and one step back (or sometimes one step forward and two steps back) but I keep my eye on the bigger goal. I’m in this for the long haul. My attitude is “How can I make this happen?” and “What tools and resources are available to make it happen?”
Some say that a person’s pet is a reflection of themselves – that the attitude of the owner determines how their pet lives. That is definitely true for Chester and Gretel.
Since they can’t speak for themselves, and probably don’t think too far beyond the next meal, it’s up to me to make choices for them, advocate for them, and protect them.
As most of you know by now, Gretel injured her back a couple of months ago. I chose to go with modern science and take a proactive approach to her recovery. You can read more about the science behind my decision HERE.
For a long time, strict crate rest – keeping a dog largely immobile – for 6-8 weeks has been the “best”, and most recommended, treatment for back injuries for a long time. That’s changing though. Veterinarians are discovering that crate rest WITH active rehabilitation speeds and improves recovery. The goal nowadays is to get a dog up and moving as soon as they can to help make them stronger and reduce the chance of re-injury.
Yes, every dog is different and you should go with what your vet tells you. However, rehab vets are seeing dogs who underwent back surgery walking within a couple of weeks using this active recovery method.
Gretel recently had her 11-week post injury checkup. Her rehab vet was super impressed at how well she was doing. The circumference of her thigh muscles had increased by 1 cm, indicating that she was becoming stronger. Even better was that the circumference of both thighs was the same, indicating that she was getting stronger in a balanced way. Developing symmetry and balance in muscle strength is extremely important so the muscles don’t pull things out of whack.
Gretel got the go-ahead to progress the difficulty of her rehab exercises and free rein to continue our hike training.
I’ve been taking Gretel to a dog rehab gym once a week to help her learn how to do the rehab exercises and teach me to better communicate with her better. She was doing great there. She was so smart and picking up on everything she was being asked to do. She was working so hard to do the exercises.
[youtube https://www.youtube.com/watch?v=Kr6gkkEtMDE]It was my fault it happened. I had signed up for a 45-minute session but didn’t say anything when the trainer ran over time. Gretel was doing so well that we increased the difficulty on an exercise she had already been doing. We also tried a couple of new ones. There were no signs that she was getting sore or tired.
As soon as walked out the door, something was strange. I tried to walk her across the parking lot to go potty and she was very hesitant. I thought that was weird but not alarming. However, by the time we got home, it was clear she was in pain. She was squinting a little and she was making small, quiet grunts when I picked her up. I did the test where you fold over their toes and she seemed to be righting her feet ok but I was still concerned she was having a problem with another disc. A couple of phone calls later, we were back in the doggy ER.
The vet couldn’t find any pain points in her spine and there was still no delay in righting her feet. They sent us home with more Tramadol for pain and the ant-inflammatory Meatcam. I feared that we would have to start the crate rest and rehab all over again but they said that she was probably just sore from the workout. I was told to decrease her activity for 10 days. I asked if I should put her on crate again and they stressed that it was only necessary to back off on the hiking and rehab exercises. I think they didn’t want me to keep her in the crate because it might undo some of the progress we had made in her strength.
So, here we are. My eye is still on the goal of keeping Gretel active but we’ve had to take it back a notch for almost two weeks. Now we can cautiously start where we left off. It’s just a blip in her journey to recovery. I’ve always known this was a possibility and was mentally prepared.
I know Gretel has Intervertebral Disc Disease (IVDD) – the spinal disease common in Dachshunds. I know that she will be dealing with pretty much the same situation as I am with my bad back. There will be periods in her life where she can be active with no problems. There will also be periods where she will have flare-ups and setbacks. There will be times when she needs to reduce, sometimes significantly, her activity level to recover.
This won’t be our last setback. In fact, I am well aware that she could rupture another disk. Next time we might not be so lucky and she could have some paralysis and need surgery. Thank goodness I have pet health insurance that will cover that if we need it.
I won’t let my fear of that happening stop us from being active though. Besides the studies I cited in my last article about ACTIVE recovery being beneficial, a survey of Dachshund owners by Dachshund Health UK also found that ” Dogs over the age of 3 that were highly or moderately active were half as likely to have suffered an IVDD incident as dogs described as mildly or not at all active.”
I’m not using these survey results to say it’s guaranteed that more active dogs suffer less IVDD episodes. There are a lot of other factors that play into whether an IVVD dog will have an episode or not (one of the biggest being whether a dog is overweight or not. Click here to see how you can tell if a dog is overweight). However, Gretel’s super-smart and experienced rehab vet feels very sure that an active dog with stronger muscles is less likely to suffer re-injury from IVDD. As an active person myself who does way better with pain and injury when I am strong and in shape, that makes logical sense to me.
So off we go on our trail adventures again. Strangely, as a lot of things along this IVDD journey have been, was a positive. Now I know what a setback from being over-worked looks like. I feel more confident that I’ll know what to do if it happens again.