Research Update: Recovery from disk surgery without intraoperative methylprednisolone sodium succinate

In this prospective clinical study from a private practice referral hospital, the recoveries of 51 nonambulatory dogs with thoracolumbar intervertebral disk disease treated with hemilaminectomy and without methylprednisolone sodium succinate were evaluated. Diagnoses were made by using myelography and were verified at surgery. Dogs underwent surgical decompression between four and 18 hours after presentation. Patients were evaluated preoperatively, at discharge, 10 days after surgery, and by owner phone interview or questionnaire six and 16 weeks after surgery.

Dachshunds were the most common breed affected (24 cases). Of the 51 dogs, 26 were paralyzed (lack of hindlimb muscle movement) and 25 were paretic (hindlimb muscle movement). Deep pain sensation was present in 98% (50/51). Fecal and urinary continence was not noted in all cases on admission, and previous drug histories were not delineated.

About 10 days after surgery, 90% of the dogs were ambulatory, 98% were pain-free, and 82% were continent. By 16 weeks after surgery, all the dogs were ambulatory, 96% were pain-free, and 88% were completely continent. The mean time to ambulation for all dogs was about seven days. The authors concluded that methylprednisolone sodium succinate may not be necessary for treating nonambulatory patients with intact deep pain undergoing hemilaminectomy and that hemilaminectomy alone is effective in returning nonambulatory, small-breed dogs with deep pain to full function.

COMMENTARY

Intervertebral disk disease is a common neurologic problem in dogs. Treating nonambulatory dogs usually involves anti-inflammatory and analgesic medications, as well as decompressive spinal surgery after myelography or advanced imaging of the spine. During the past 10 years, methylprednisolone sodium succinate has been used frequently to ameliorate compressive spinal cord lesions, although recent studies in people and animals question the efficacy and validity of this therapy. Although limited by the lack of a treatment control and the small case numbers, this study's results indicate that recovery is possible in most operative patients without methylprednisolone sodium succinate. Unfortunately, the study fails to clearly delineate preadmission drug therapies and duration of signs. The data from this report reveal a remarkable recovery rate for nonambulatory patients. Although difficult to document in a clinical referral setting, recovery rates for dogs that do not undergo surgery would be interesting to note as well.

Bush WW, Tiches DM, Kamprad C, et al. Functional outcome following hemilaminectomy without methylprednisolone sodium succinate for acute thoracolumbar disk disease in 51 non-ambulatory dogs. J Vet Emerg Critical Care 2007;17:72-76.

The information in "Research Updates" was provided by Veterinary Medicine Editorial Advisory Board member Joseph Harari, MS, DVM, DACVS, Veterinary Surgical Specialists, 21 E. Mission Ave., Spokane, WA 99202.

Joseph Harari, MS, DVM, DACVS