Rethinking conservative management of IVDD in Dachshunds
There has been a noticeable shift in the way we talk about intervertebral disc disease (IVDD) in dogs.
For many years, a Dachshund that suddenly became unable to walk because of a thoracolumbar disc extrusion would almost automatically have been considered a surgical patient. More recently, however, there has been increasing interest in conservative management, including for dogs with quite severe neurological deficits.
There are good reasons for this change. We have probably underestimated the ability of the spinal cord to recover without surgery, and it is increasingly clear that some dogs who cannot walk can regain useful function with rest, analgesia, nursing care and rehabilitation alone.
That is important, particularly for owners for whom surgery isn’t possible.
However, there is a danger that the pendulum swings too far.
The fact that a dog can recover without surgery does not necessarily mean that conservative management and surgery are equivalent choices.
And perhaps we have started asking the wrong question.
“Will my dog walk again?”
Understandably, this is often the first thing an owner wants to know.
It is also the outcome most commonly reported in studies of IVDD. Dogs are classified according to whether they regain the ability to walk independently. But walking again is quite a low bar for defining success.
For an owner faced with a young Dachshund that has suddenly lost the use of its back legs, there are many other questions that matter:
- How quickly is my dog likely to recover?
- How much nursing will be required?
- Will bladder function recover?
- Could things get worse before they get better?
- Will my dog be left with neurological deficits?
- And perhaps most importantly, what is the chance of this happening again?
A dog taking independent steps again tells us something important. However – it doesn’t tell us the whole story.
What actually happens when a disc extrudes?
In the common form of IVDD seen in Dachshunds, degenerate material from inside an intervertebral disc suddenly ruptures into the vertebral canal – and that “suddenly” is important.
This produces two related problems:
First, the spinal cord receives a sudden impact – rather like a bruise or contusion.
Second, the extruded disc material may remain within the vertebral canal, compressing the spinal cord.
The severity of the neurological signs depends on several factors, including the force of the initial impact and the degree of subsequent spinal cord injury.
With conservative management we provide pain relief, restrict activity, nurse the patient and give the nervous system time to recover. And remarkably, it often does.
Extruded disc material can also shrink or disappear with time. However, this is variable. In some dogs, considerable material may remain within the vertebral canal despite neurological improvement.
Surgery is different because it allows us to physically remove the compressive disc material from around the spinal cord. This doesn’t magically reverse the initial spinal cord injury. The spinal cord still has to heal, but it removes a component of the problem that conservative treatment cannot immediately address.
Not every case of IVDD is the same
This is perhaps the most important point.
Talking about whether “IVDD” should be treated surgically or conservatively is a little like asking whether a broken leg should be treated with rest or surgery, without saying what type of fracture it is.
A Dachshund that is painful but walking normally is very different from one that is wobbly or weak. A dog that can move its back legs but cannot stand is different again.
At the severe end of the spectrum are dogs that are completely paralysed and have lost deep pain perception – the ability to consciously perceive a strong painful stimulus applied to the affected limbs. These dogs have sustained a very severe spinal cord injury and are also at risk of developing progressive myelomalacia, a devastating condition in which spinal cord damage progresses beyond the original site of injury.
So, there cannot sensibly be one rule for every dog with IVDD. For a dog with spinal pain but no neurological deficits, conservative management may be an entirely reasonable first treatment. As neurological deficits become more severe, however, the decision becomes increasingly important.
Conservative management is not simply “some pain relief
and rest”
There is another problem with the way conservative management is sometimes discussed.
Good conservative treatment is an active treatment plan.
Depending on the severity of the neurological deficits, it may involve:
- Strict activity restriction
- Appropriate analgesia
- Bladder management
- Careful nursing
- Prevention of pressure sores and urine scalding
- Assisted standing and rehabilitation
- Close monitoring for deterioration.
For an otherwise bright Dachshund that cannot use their back legs, this can be demanding.
Pain relief can also create a slightly deceptive situation. A dog may appear dramatically better because they are more comfortable, while the underlying disc injury has not disappeared. Allowing activity to increase too quickly risks further problems.
This is why, when we recommend conservative treatment, we usually prescribe a period of genuine restriction rather than simply “taking things easy”.
Are we always sure it is IVDD?
There is another important difference between published evidence and everyday clinical practice.
In studies investigating conservative management, dogs may have had advanced imaging to confirm that they really do have a disc extrusion.
In general practice, a young or middle-aged Dachshund presenting with back pain or hindlimb weakness is often presumed to have IVDD without imaging. Most of the time that may be a perfectly reasonable clinical suspicion, but a Dachshund can develop other spinal diseases too.
So, evidence showing that dogs with confirmed disc extrusions can recover conservatively shouldn’t automatically be interpreted as evidence that every Dachshund presenting with spinal pain or weakness should simply be rested.
Sometimes MRI isn’t just about deciding whether to operate. It is about establishing what we are treating in the first place.
What happens next time?
This is the part of the discussion that I think can easily become lost.
Dachshunds don’t simply develop a single “slipped disc”. They have a predisposition to degeneration of their intervertebral discs, and several discs may be abnormal.
Consequently, getting through today’s episode doesn’t necessarily remove tomorrow’s risk.
After conservative treatment, recurrence is a significant concern. A useful figure when discussing this with owners is that recurrence may occur in around half of dogs, whereas following surgical treatment incorporating appropriate preventative fenestration, the risk can be reduced considerably – to approximately one in ten.
Neither approach guarantees that IVDD will never happen again, but that difference matters.
Imagine a three-year-old Dachshund presenting with its first significant disc extrusion.
The question isn’t simply:
“Can we get this dog walking again without surgery?”
It is also:
“What gives this dog the best chance of getting through the next ten years without us having to face this situation repeatedly?”
And the next episode may not necessarily be as mild as the first.
There is also a danger in waiting for deterioration
For mildly affected dogs, monitoring during conservative treatment can be perfectly appropriate, but owners need to understand what deterioration looks like.
Signs of progressively more severe spinal cord injury include:
- Increasing wobbliness
- Weakness
- Loss of the ability to stand or walk
- Loss of voluntary movement
- Ultimately, loss of deep pain perception
That means conservative management shouldn’t become:
“We’ll wait until things get really bad and then operate.”
If surgery is being considered, neurological deterioration should prompt urgent reassessment. This is particularly important in Dachshunds because deterioration can sometimes occur quickly.
So, should every Dachshund with IVDD have surgery?
Absolutely not. Conservative management has an important place in treating IVDD.
A mildly affected dog may do extremely well without surgery. Some more severely affected dogs will also recover without an operation, and this is enormously important when financial, geographical, anaesthetic or other considerations mean surgery isn’t possible.
We should never imply that euthanasia is the only alternative when an owner cannot pursue surgery, but the reverse is equally important.
Evidence that dogs can recover without surgery shouldn’t be translated into the much broader claim that surgery offers no advantage – those are two very different statements.
The consultation should be about choices, not rules
Ultimately, there shouldn’t be a universal rule saying that every Dachshund with IVDD needs surgery, or that every Dachshund should be given the opportunity to recover conservatively first. Instead, treatment should be individualised.
We need to consider the dog’s neurological status, severity and progression of the clinical signs, pain, age, previous episodes, nursing requirements and the owner’s circumstances. Where appropriate, advanced imaging can tell us what has actually happened to the disc and spinal cord.
Then we can have a proper conversation about the advantages and limitations of each approach.
Because the most important question isn’t:
“Could this dog recover without surgery?”
Quite often, the answer to that question is yes.
The better question is:
“Which treatment gives this particular dog the best chance of the outcome we want – both now and in the future?”
For some dogs, that will be conservative management. For others, particularly Dachshunds with significant neurological deficits, surgery may still offer important advantages that shouldn’t be overlooked simply because recovery without it is possible.
At Movement Referrals, our aim isn’t to operate on every dog with IVDD. Nor is it to avoid surgery whenever possible. It is to help owners understand the choices, the limitations of each approach and the short- and long-term consequences of those choices.
Because with IVDD, getting a dog walking again is important, but it isn’t the only outcome that matters.