Evidence and Choices in Treatment of Acute Thoracolumbar Disc Herniation in Dogs

Presentation Description / Summary: Decompressive surgery is now considered standard of care for acute severe thoracolumbar disc herniations. For several decades, multiple disc fenestration was the primary method of surgical treatment, but when 3-D imaging became widely available and clearly demonstrated spinal cord compression associated with acute disc herniation, decompression became preferred.

Acute disc herniation creates two types of injury to the spinal cord: contusion and compression. Whilst it is clear from multiple experimental studies that contusion is hugely injurious there is comparatively little evidence to suggest that concomitant compression has an additive effect. Evidence for the importance of spinal cord decompression is largely derived from laboratory studies which apply decompression within a very short (and usually clinically unattainable) period following injury. Clinical reports on residual compression after surgery and comparison of complete and partial decompression add some additional support.

However, reported recovery across multiple case series following fenestration alone is almost identical to that following decompression, and there has been no direct comparison of decompressive surgery with either fenestration or conservative management. A meta-analysis comparing surgically and conservatively managed dogs, often cited to support the superiority of decompression included only 4 studies and a total of 122 dogs in the conservative category, with limited case descriptions.

Recently, several publications have reported excellent results with conservative management across all grades of injury, no benefit from early decompression, or equivalent recovery rates with alternative non-surgical methods, suggesting additional reasons to doubt the value of urgent decompressive surgery.