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If your dog is showing signs of back problems, your veterinarian will likely perform general and neurological examinations. 

Your veterinarian may initially believe the problem is in the belly rather than the back. If pain is the only sign, a set of tests (abdominal X-rays, lab tests, etc.) may be recommended, looking for the causes of pain. Once the problem is recognized as spinal, your veterinarian may perform a neurologic exam to locate the cause. If examining reflexes and sensations identifies the spinal cord region as the source of the signs, the severity will be assessed.

Spinal X-rays (radiographs) are commonly recommended. Standard X-rays can show other causes of spinal problems, such as fractures (broken vertebrae), bone tumors, or signs of infection. However, X-rays may not be of much value for diagnosing Intervertebral Disc Disease (IVDD), especially in chondrodystrophic dogs (short-legged, long-bodied dogs), where intervertebral disc herniation (IVDH) is considered the most likely diagnosis. Standard X-rays cannot provide a definitive diagnosis, and knowing the exact disc involved will not affect the treatment choices. No further diagnostics are needed if signs are mild and non-progressive, and the plan is for non-surgical treatment.

Treatment

Conservative Treatment

If a dog shows pain or signs of pain due to IVDH, treatment often starts with non-surgical methods.

The key to successful treatment is strict activity restriction. The goal is to reduce inflammation and allow healing while watching to see if the signs improve. Your dog should be confined in a crate, limiting movement to bathroom breaks on a leash for two to four weeks, even if they seem to improve.

Your veterinarian may prescribe painkillers, anti-inflammatory drugs, muscle relaxants, or sedatives, but these only manage signs. Crate rest is essential to prevent relapse, even if your dog seems better. If signs persist or return or pain becomes disabling, surgery might be needed. 

Dogs with mild neurological signs (like weakness or incoordination) may start with conservative treatment, but if there is no improvement, surgery should be considered. 

Advanced Diagnostic Imaging

If your dog’s signs are more severe or worsening, a referral to a surgeon is indicated for treatment. The surgeon will then use advanced diagnostic imaging tools to achieve an accurate diagnosis. 

• X-rays: If your veterinarian has not already done them, and if the surgeon is concerned that something other than IVDH could be causing your dog’s signs, they may take standard X-rays to start.
• Myelogram: This is an X-ray technique that uses contrast dye injected into the fluid around the spinal cord. The dye is seen on X-rays, allowing any deformities to be seen. It is performed under general anesthesia and is not used as often as it once was prior to the availability of MRIs and CT scans.
• MRI: Magnetic resonance imaging is a reliable, non-invasive procedure that produces high-quality images of the spinal cord and nerve root problems. This requires general anesthesia.
• CT: (Also known as a “CAT scan”) This can often be done quickly with heavy sedation. It is usually adequate for identifying the location of any compressive mass (including herniated disc material), suggesting whether the cause is IVDH or something else, and confirming the side of greatest compression, which is crucial information for the surgeon.
• Combined CT/myelogram: A combined CT/myelogram requires general anesthesia, a spinal tap, and injection of contrast medium into the cerebrospinal fluid as described above. It can be as diagnostic as MRI with faster results.

None of these imaging options — standard X-rays, myelogram, CT, CT/myelogram, or MRI — are recommended unless surgical treatment is planned. Knowing the exact location and specific cause of the problem won’t change the non-surgical treatment options.

Surgical Management

Treatment for IVDH is generally based on the severity of the signs, progression of signs, history (previous bouts of similar signs), and response. The severity of signs can be ordered from least to most concerning as follows:

• Back pain
• Ataxia (incoordination, swaying, tripping, stumbling)
• Ambulatory paresis (weakness in the hind limbs but still able to walk with no or little help)
• Non-ambulatory paresis (unable to walk but still able to voluntarily move the hind limbs)
• Paralysis (unable to walk or voluntarily move the hind limbs)     
• Loss of superficial pain sensation from the hind limbs (only reacts to very painful stimuli such as the veterinarian squeezing a toe with a pinching instrument)
• Loss of deep pain sensation from the hind limbs (no conscious response to even the most painful stimuli)

As the signs of IVDH progress, it is less likely that a dog will recover without surgery, and the prognosis for recovery with surgery also becomes less likely.

Surgical Procedures

The goal of IVDH surgery is to decompress (take the pressure off) the spinal cord and nerve roots. Surgery generally cannot fix any internal spinal cord injuries but hopes to end the signs from compression or deformation of the spinal cord and nerve roots and to allow better blood flow to the spinal cord for healing and recovery of function.

The surgical procedure will depend on the nature of the injury or condition. Your dog's veterinary surgeon will explain the planned surgical procedure and discuss expectations for recovery and prognosis. Surgery is usually performed directly after the surgeon’s examination and diagnosis.

Recovery After Surgery

Recovery times vary. Factors that influence the outcome, recovery time, and prognosis of surgical intervention include the severity of the spinal cord injury, duration of the compression, completeness of the surgical decompressive procedure, and severity of signs preceding surgery.

Eighty to ninety percent of dogs that are paralyzed but still have deep pain walk again after surgery. For dogs without deep pain, the odds of recovery with surgery drop to about 50%, with worsening of this prognosis for those with longer periods of negative deep pain before surgery.

Recovery of Sensation

Some dogs show almost immediate improvement. For others, there may be no signs of improvement for two to three weeks before any change is noted. Usually, recovery in paralyzed dogs follows a standard pattern — the first improvement expected would be recovery of sensation if that was compromised before surgery.

Voluntary Movement of Limbs and Tail/Recovery of Bladder and Bowel Control

The next improvement expected is the ability to voluntarily (not just reflexively) move the limbs and tail. Once voluntary limb movement returns, bladder and bowel control usually follows. However, until your dog can voluntarily control going to the bathroom, a critically important part of patient care is bladder management to ensure the bladder is being emptied regularly and often. This may initially require in-hospital management, but eventually, owners are taught how to meet this need at home.

Ability to Walk

Following the ability to move the limbs will be the ability to walk. Initially, this may require some help. Your dog will appear uncoordinated, veering, falling, and stumbling on the top of their paws.  Even as strength improves, this lack of coordination (ataxia) may persist for quite some time. The nerves that send information to and from the brain that control fine coordination are the ones that take the longest to fully recover. Some dogs may be left with mild residual deficits in coordination.

Formal Physical/Rehabilitation Therapy

Many facilities offer formal physical and/or rehabilitation therapy staffed by veterinarians and nurses certified in these fields or physical therapists from the human field working under a veterinarian’s supervision. Patients recovering from spinal surgery will likely be referred to such a facility. While there may be core components to rehabilitating dogs after such surgery, programs are usually tailored to individual patient requirements and tolerance.

For more information, please see: Thoracolumbar/Lumbosacral and Coccygeal (Tail) Intervertebral Disc Disease (IVDD) in Dogs