Intervertebral disc disease (IVDD)—what some call a “slipped disc”—can smolder or it can strike full-blown, leaving your dog in excruciating pain and unable to walk. Initially, signs that a dog is afflicted can be subtle: a hesitation about going up or down stairs, paws that knuckle under or cross over, nail scuffing, an arched back, a tense abdomen. Dogs may shy from their food bowls to avoid bending their necks, or cry when picked up.
IVDD causes compression of the spinal cord and leads to weakness, pain and sometimes paralysis, and is divided into two categories: Hansen Type I and II. Type I often swoops in suddenly, usually in younger, smaller dogs ages three to six. The center jelly of the vertebral disc, called the nucleus pulposus, degenerates, then ruptures and presses on the spinal cord. Not surprisingly, the chondrodystrophic breeds (dogs with short legs and longbacks)—Dachshunds, Corgis, Lhasa Apsos, Shih Tzus and Beagles—are predisposed to this type.
Type II, which is typically seen in large dogs like German Shepherds, Labradors and Dobermans ages eight to ten, progresses more slowly. Though the disc doesn’t burst its center, it bulges between the vertebrae and impinges on the spinal cord, causing chronic pain and weakness.
To rule out fractures, bone infections and cancers, your vet will start with X-rays, but a contrast myelogram, CT or MRI (all of which are often done at specialty centers) is needed to visualize the spinal cord and determine the nature and location of the problem.
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In addition to type, IVDD is described by level of severity. Roughly, grade I involves pain; grade II, unsteadiness; grade III, weakness that prevents standing or walking; grade IV, paralysis but able to feel deep pain when the toes are pinched; and grade V, complete paralysis with loss of deep pain.
Dogs with grades 1 through IV will likely be managed with pain meds, muscle relaxants and strict rest for up to a month, and are often referred for physical therapy or Class IV laser treatments. Depending on the duration of neurological deficits and amount of pain, surgery may also be recommended for dogs with grades II, III and IV. Because the disease can change quickly, even dogs diagnosed with lower-grade IVDD need sequential exams to ensure that the condition is not progressing.
When a dog is completely unable to walk, decisions have to be made swiftly. Dogs who stay in the grade V stage longer than 48 hours often remain paralyzed despite intervention, while up to 50 percent of those who have surgery in the first 24 hours may regain their ability to walk.
IVDD surgery removes compromised discs, hemorrhage and adjacent bone compressing the spinal cord. With severe disease, it’s the best chance for a dog to walk again. It does, of course, also entail expenses and risks that not everyone is able or willing to undertake. What other options do we have?
Thankfully, veterinarians have been studying other modalities to treat IVDD, acupuncture among them. In 2007, a team lead by A.M. Hayashi found that dogs of all IVDD grades recovered more quickly with electroacupuncture (EAP) combined with a standard Western medical approach than Western treatment alone (JAVMA 231: 913–918).
In 2009, A. Laim et al. reported that dogs receiving EAP and pain medications after surgery for acute IVDD were less likely to need higher doses of pain meds during the first 12 hours than those who received meds alone. These patients also had significantly lower pain scores 36 hours after treatment (JAVMA 234: 1141–1146).
A 2010 study compared three options for IVDD dogs with severe neurologic deficits of greater than 48 hours’ duration: decompressive surgery (DSX), EAP, and DSX followed by EAP (DSX + EAP). The study, led by J.G.F. Joaquim, showed that EAP was more effective than DSX + EAP, and that DSX alone was the least successful. These dogs had severe, long-standing IVDD in the thoracic and lumbar (thoracolumbar) spine, and in the past, their prognosis would have been dismal. (JAVMA 236: 1225–1229).
How does acupuncture work? While there is some debate over definitions, it’s generally accepted that acupuncture points (acupoints) concentrate clusters of free nerve endings, small blood and lymphatic vessels, and mast cells, part of the immune system. A veterinarian certified in acupuncture inserts small, sterile needles into specific points to stimulate muscles, nerves, circulation and the immune system. For IVDD, one needle may be placed at the top of the spine by the shoulders, and a second above the pelvis, which moves the qi and stagnated energy caused by the disc disease.
Functional MRIs reveal that acupuncture activates pain-associated brain stem regions. The specific mechanism of acupuncture on IVDD has not yet been fully explained, but it’s surmised that it reduces local swelling, inflammation and pain; decreases cord compression, scar formation and tissue oxygen deprivation; and restores damaged nerves.
When compared to the use of needles alone, EAP has been found to increase the body’s response to acupuncture. In EAP, needles in the skin are connected by metal clips; electro-impulses move between the clips and into the needles, producing sensations that range from a tingling to a vibration. Frequency and intensity are determined by the type of condition being treated. Sessions usually last from 10 to 30 minutes, and dogs often fall asleep during treatment.
EAP has a cumulative effect and is typically prescribed as a series of treatments, every one to two weeks for at least a few months. Appropriate Chinese herbal formulas are often prescribed at the same time to reduce pain and enhance the effects of acupuncture. Dogs then proceed to maintenance acupuncture at one- to three-month intervals to prevent recurrence.
Ideally, your dog will never go through the pain of IVDD, and you won’t have the worry. But if you do find yourself up against a down dog, it’s good to know that adding acupuncture to the treatment repertoire may help your friend get back on all fours.