ACVIM consensus statement on diagnosis and management of acute canine thoracolumbar intervertebral disc extrusion

J Vet Intern Med, 2022 · DOI: 10.1111/jvim.16480 · Published: May 26, 2022

Spinal Cord Injury Neurology Veterinary Medicine

Simple Explanation

Thoracolumbar intervertebral disc extrusion (TL-IVDE) is a common spinal issue in dogs that can cause paralysis, but clear guidelines for managing it are lacking. This consensus statement aims to provide veterinary professionals with evidence-based recommendations for diagnosing and treating TL-IVDE in dogs. A panel of experts reviewed existing research to develop clinical recommendations, noting that most available studies were observational. The recommendations address key aspects of diagnosis, medical vs. surgical management, and post-operative care. The consensus highlights areas where more research is needed, such as determining the best timing for surgery, comparing surgical and medical outcomes, and understanding the impact of specific surgical techniques on recovery and the development of progressive myelomalacia.

Study Duration

Not specified

Participants

None

Evidence Level

Majority of available literature described observational studies

Key Findings

1
MRI, CT, CT-myelography, or myelography are reasonable modalities for diagnosing TL-IVDE, but MRI provides more detailed information about the spinal cord injury and prognosis, especially in severe cases.
2
Surgery is generally recommended for non-ambulatory dogs and those with loss of deep pain perception, while medical management may be appropriate for ambulatory dogs with pain, considering the risk of recurrence.
3
Fenestration (removal of disc material) of the affected disc and adjacent degenerated discs during surgery is recommended to minimize the risk of recurrence.

Research Summary

This ACVIM consensus statement provides up-to-date information on the diagnosis and management of acute canine thoracolumbar intervertebral disc extrusion (TL-IVDE). It summarizes the current literature and formulates clinically relevant evidence-based recommendations. The panel of experts recommends imaging modalities, surgical versus medical management, and various treatment options based on the severity of the condition. They also address post-operative pain management, urination management, and physical rehabilitation. Future studies should focus on prospective studies and randomized controlled trials to address identified gaps in knowledge and to develop cost-effectiveness and number needed to treat studies supporting various aspects of diagnosis and treatment of TL-IVDE.

Practical Implications

Diagnostic Imaging Guidelines

Veterinarians should use MRI for detailed spinal cord evaluation and prognostication, especially in severe cases, but CT is acceptable for initial diagnosis of mineralized disc extrusions.

Treatment Selection

Guide treatment decisions based on the dog's neurologic status (ambulatory vs. non-ambulatory, presence of deep pain), considering surgery for severe cases and medical management for mild cases with activity restriction and analgesia.

Surgical Technique Recommendations

Incorporate fenestration of affected and adjacent degenerated discs during surgery to reduce recurrence risk, and consider durotomy in severe cases to potentially improve outcomes and reduce the risk of progressive myelomalacia.

Study Limitations

1
Paucity of high-level evidence for many aspects of managing this condition limits the power of our recommendations
2
The majority of available literature described observational studies
3
The extent of time delay before presentation often is not well reported by owners

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