Type I IVDD is a premature hardening of the nucleus pulposus of the vertebral disk associated with a weakness of the annulus fibrosus. There is rupture of the annulus fibrosus, and the nucleus pulposus extrudes against the spinal cord.1 The pain and neurologic signs attributable to IVDD are probably related to both compression and inflammation of the spinal cord.2
Intervertebral disk disease affects most of the breeds of chondrodystrophic dogs, with the highest incidence in dogs between 3 and 6 years of age.3 In these breeds, > 85% of the dogs with IVDD have involvement of the region from the T11-12 disk to the L2-3 disk and 50% have involvement of the region from the T12-13 disk to the T13-L1 disk. In large-breed dogs, the disease mainly affects the L1-2 disk.4 Primary clinical signs are pain in the vertebral region, somatosensory and motor deficits of the pelvic limb, and genitourinary dysfunction. However, IVDD may affect various areas of the vertebral column, with a wide range of clinical signs.
Treatment options usually are based on clinical experience of the clinician, rather than being based on results of controlled scientific studies.3,5 Recovery of neurologic function may be achieved with nonsurgical or surgical treatment. Nonsurgical treatment typically involves rest in a confined space and judicious use of analgesics and anti-inflammatory drugs. Surgical decompression is the principal mode of treatment for IVDD; however, precise diagnostic imaging equipment and a surgeon with the necessary expertise may not be available because of the necessity (in many cases) for emergency surgical intervention. It is highly recommended to perform surgical intervention as quickly as possible after the onset of the neurologic signs because the success rate is greatly reduced when surgery is delayed ≥ 48 hours after there is no deep pain perception.6,7
Acupuncture has been used for the treatment of IVDD in dogs.8–10 It is indicated for pain relief and to restore motor and somatosensory function and bladder control.11–13 Few controlled studies14,15 have been conducted to compare the efficacy of acupuncture with that of conservative treatment in dogs. To our knowledge, no studies have been conducted to compare the effect of acupuncture for dogs with IVDD with that of surgical treatment in this species.
Therefore, the objective of the study reported here was to compare the effect of DSX, EAP, and DSX + EAP for treatment of thoracolumbar IVDD in dogs with long-standing severe neurologic deficits. It was hypothesized that EAP would be more effective for improvements in neurologic function and recovery of ambulation in dogs, compared with results for surgery, when performed ≥ 48 hours after the onset of clinical signs of IVDD.
Intervertebral disk disease
Magnetic resonance imaging
Shealy P, Thomas WB, Immel L. Neurologic conditions and physical rehabilitation of the neurologic patient. In: Millis DL, Levine D, Taylor RA, eds. Canine rehabilitation & physical therapy. St Louis: Saunders, 2004;388–403.
Sharp NJH, Wheeler SJ. Thoracolumbar disk disease. In: Small animal spinal disorders. Diagnosis and surgery. 2nd ed. Beijing: Elsevier-Mosby, 2005;121–160.
Cudia SP, Duval JM. Thoracolumbar intervertebral disk disease in large, nonchondrodystrophic dogs: a retrospective study. J Am Anim Hosp Assoc 1997;33:456–460.
Seim HB III. Surgery of the thoracolumbar spine. In: Fossum TW, Hedlund CS, Johnson AL, eds. Small animal surgery. 3rd ed. Missouri: Elsevier-Mosby, 2007;1460–1490.
Scott HW, McKee WM. Laminectomy for 34 dogs with thoracolumbar intervertebral disc disease and loss of deep pain perception. J Small Anim Pract 1999;40:417–422.
Laitinen OM, Puerto DA. Surgical decompression in dogs with thoracolumbar intervertebral disk disease and loss of deep pain perception a retrospective study of 46 cases. Acta Vet Scand 2005;46:79–85.
Janssens LAA. Acupunture treatment for canine thoraco-lumbar disk protrusions: a review of 78 cases. Vet Med Small Anim Clin Pract 1983;37:1580–1585.
Janssens LAA. Acupuncture for thoracolumbar and cervical disk disease. In: Schoen AM, ed. Veterinary acupuncture—ancient art to modern medicine. 2nd ed. St Louis: Mosby-Year-book Inc, 2001;193–198.
Longworth W, McCarthy PW. A review of research on acupuncture for the treatment of lumbar disk protrusions and associated neurological symptomatology. J Altern Complement Med 1997;3:55–76.
Joaquim JGF, Luna SPL & Torelli S, et al. Study of 43 dogs with neurological disease: a western and eastern view of the neurological pattern of diseases, in Proceedings. 29th Annu Int Cong Vet Acupunct 2003;289–297.
Hayashi AM, Matera JM, Fonseca Pinto AC. Evaluation of electroacupuncture treatment for thoracolumbar intervertebral disk disease in dogs. J Am Vet Med Assoc 2007;231:913–918.
Takahashi T, Nakayama M & Chimura S, et al. Treatment of canine intervertebral disk displacement with chondroitinase ABC. Spine 1997;22:1435–1439.
Schulz KS, Walker M & Moon M, et al. Correlation of clinical, radiographic, and surgical localization of intervertebral disk extrusion in small-breed dogs: a prospective study of 50 cases. Vet Surg 1998;27:105–111.
Sherman KJ, Cherkin DC, Hogeboom CJ. The diagnosis and treatment of patients with chronic low-back pain by traditional Chinese medical acupuncturists. J Altern Complement Med 2001;7:641–650.
Hwang YC, Limehouse JB. Canine acupuncture atlas. In: Schoen AM, ed. Veterinary acupuncture—ancient art to modern medicine. 2nd ed. St Louis: Mosby-Yearbook Inc, 2001;127–148.
Goodman LA. Simultaneous confidence intervals for contrasts among multinomial populations. Ann Math Stat 1964;35:716–725.
Dhupa S, Glickman N, Waters DJ. Reoperative neurosurgery in dogs with thoracolumbar disk disease. Vet Surg 1999;28:421–428.
Duval J, Dewey C & Roberts R, et al. Spinal cord swelling as a myelographic indicator of prognosis: a retrospective study in dogs with intervertebral disk disease and loss of deep pain perception. Vet Surg 1996;25:6–12.
Gambardella PC. Dorsal decompressive laminectomy for treatment of thoracolumbar disk disease in dogs: a retrospective study of 98 cases. Vet Surg 1980;9:24–26.
Ferreira AJ, Correia JH, Jaggy A. Thoracolumbar disk disease in 71 paraplegic dogs: influence of rate of onset and duration of clinical signs on treatment results. J Small Anim Pract 2002;43:158–163.
Olby NJ, Levine J & Harris T, et al. Long-term functional outcome of dogs with severe injuries of the thoracolumbar spinal cord: 87 cases (1996–2001). J Am Vet Med Assoc 2003;222:762–769.
Kazakos G, Polizopoulou ZS & Palsikas MN, et al. Duration and severity of clinical signs as prognostic indicators in 30 dogs with thoracolumbar disk disease after surgical decompression. J Vet Med 2005;52:147–152.
McKee WM. A comparison of hemilaminectomy (with concomitant disk fenestration) and dorsal laminectomy for the treatment of thoracolumbar disk protrusions in dogs. Vet Rec 1992;130:296–300.
Still J. Analgesic effects of acupuncture in thoracolumbar disk disease in dogs. J Small Anim Pract 1989;30:298–301.
Still J. Acupuncture treatment of grade III and IV canine thoracolumbar disk disease (hind limb paralysis). Am J Acupunct 1988;26:179–187.
Maigne JY, Rime B & Royer P, et al. X-ray computed tomographic study of the outcome of lumbar disk hernia after conservative medical treatment (34 cases). Rev Rhum Mal Osteoartic 1991;58:355–359.
Martin MD, Boxell CM, Malone DG. Pathophysiology of lumbar disk degeneration: a review of the literature. Neurosurg Focus 2002;13:1–6.
McCarron RF, Wimpee MW & Hudkins PG, et al. The inflammatory effect of nucleus pulposus. A possible element in the pathogenesis of low-back pain. Spine 1987;12:760–764.
Chen YX, Kong KM & Wang WD, et al. Functional MR imaging of the spinal cord in cervical spinal cord injury patients by acupuncture at LI 4 (Hegu) and LI 11(Quchi), in Proceedings. Conf Instit Electric Electron Eng Eng Med Biol Soc 2007;91:3388–3391.
Ulett GA, Han S, Han JS. Electroacupuncture: mechanisms and clinical application. Biol Psychiatry 1998;44:129–138.
Lai A, Chow DH & Siu WS, et al. Effects of electroacupuncture on a degenerated intervertebral disk using an in-vivo rat-tail model. Proc Inst Mech Eng [H] 2008;222:241–248.
Davis GJ, Brown DC. Prognostic indicators for time to ambulation after surgical decompression in nonambulatory dogs with acute thoracolumbar disk extrusions: 112 cases. Vet Surg 2002;31:513–518.
Birbilis TA, Matis GK, Theodoropoulou EN. Spontaneous regression of a lumbar disk herniation: case report. Med Sci Monit 2007;13:121–123.
Nakagawa H, Kamimura M & Takahara K, et al. Optimal duration of conservative treatment for lumbar disk herniation depending on the type of herniation. J Clin Neurosci 2007;14:104–109.