Vet360 Vol 4 Issue 4 August 2017 Vet 360 | Page 23

hunds, beagles, cocker spaniels and basset hounds.
In large breeds, Labrador retrievers, Weimaraners and
German shepherds have a higher incidence of type 1
versus type 2 disease. The patients are typically young
(3 to 5 years old) and present with acute pain and
some degree of ataxia in either two or four legs. They
can progress quickly or stay stagnant over several
weeks to months.
The grade of disease is the most important prognos-
tic indicator for whether your patient will respond to
conservative therapy. Tthe prognosis of patients that
have lost deep pain is about 50:50 with surgery and
essentially 0% without surgery. With increasing severi-
ty, patients will have less of a chance of responding to
conservative therapy and, as the grade worsens the
success rate of conservative management goes down
10-15%.
The success rate for surgical management of type I
IVDD is > 95% and 60% to 80% with type 2 IVDD, de-
pending on ambulatory status. 1
Be warned that on initial assessment, you cannot dis-
criminate between patients that have spinal shock,
which is an acute and typically self-limiting functional
change in the spinal cord, versus those that have my-
elomalacia, which is ascending haemorrhage and ne-
crosis that occurs secondary to severe intervertebral
disc extrusion.
If a patient with a T3-L3 spinal cord injury presents
with loss of deep pain, a high panniculus response
and decreased reflexes in the pelvic limb instead of
upper motor neuron signs, then be suspicious of my-
elomalacia or spinal shock. Spinal shock patients will
get better, myelomalacia patients will not. Counseling
the owner on the possibility of both for up to five days
after presentation is recommended.
COMMUNICATE THE PAIN
Many clients are unaware of the signs of chronic
pain in dogs and cats. They think with their whole
heart that unless a dog is crying out in pain, it isn’t
painful. We all know that the signs of chronic dis-
comfort in a dog are subtle, and even more so in
cats. I find that when I educate clients about how
the signs of chronic discomfort in dogs are differ-
ent that the signs of acute pain, they demonstrate
immediate concern that their best friend has been
suffering in silence and are much more motivated
to talk about how to fix it. If they believe in the value
of a recommended treatment, many clients have
less of an issue with the price of a surgery and more
of a concern with affordability. When I counsel
them beforehand, I am often surprised that clients
I thought would not go for surgery elect to pursue
treatment.
The location of the lesion is key. Cranial cervical mye-
lopathy patients frequently present with pain and nor-
mal neurologic function. Caudal cervical myelopathy
typically presents as thoracic limb weakness with both
ataxia and weakness in the pelvic limbs. These signs
are commonly seen in older Dobermans with disc-as-
sociated Wobbler’s syndrome (DAWS). Reflexes in the
thoracic limbs are inaccurate approximately 30% of
the time. 2 In these cases, Dr. Pancotto recommends
assessing the muscle tone of the limb. Dogs with cau-
dal cervical lesions tend to have more “floppy” limbs,
and dogs with cranial cervical lesions tend to have in-
creased extensor tone.
The most c