Dr. Michael Wong discusses treatment options with a client at Southeast VeterinaryNeurology in Miami, Fla. PHOTOS COURTESY SEVN Intervertebral disc disease (IVDD) is one of the most common neurological emergencies in small animal practice, particularly in dogs. It is a condition every general practitioner will encounter at some point, and it can be one of the most challenging to manage without an MRI in-house. Owners arrive anxious and distressed, patients often present in pain or unable to walk, and decisions need to be made quickly about whether medical or surgical treatment is the best course of action. For many veterinarians, that decision can feel daunting. Yet, with a structured approach and evidence-based decision making, general practitioners can confidently guide clients through one of neurology’s most time-sensitive conditions. This article will review the current thinking on medical versus surgical management of IVDD, including what signs should trigger an urgent referral. With a practical grading system, recovery expectations, and client communication strategies, this guide is designed to give general practitioners confidence in handling one of the most stressful situations their clients may face. Understanding IVDD IVDD occurs when the intervertebral discs that cushion the vertebrae degenerate and herniate, causing compression of the spinal cord. Type I disc disease, most common in chondrodystrophic breeds (e.g. Dachshunds and French bulldogs), involves acute extrusion of nuclear material. Type II disc disease is more chronic and typically seen in older, larger dogs. No matter the type, the hallmark clinical sign is spinal cord compression, which can lead to pain, limited mobility, or even paralysis. Symptoms depend on where the herniated disc is located and the extent to which the spinal cord is being compressed. IVDD can occur anywhere along the spine. The most affected region is the thoracolumbar spine, which can cause neurological signs in the pelvic limbs, often resulting in weakness, ataxia, or paralysis. Cervical IVDD, on the other hand, can cause neurological signs in all four limbs, but typically presents with neck pain and reluctance to move the head. Understanding the presentation and progression of these cases is critical for determining management. Veterinary neurologist Dr. Wong performs a neurological exam on a senior pug. Medical vs. surgical management: What the evidence says Without timely and appropriate treatment, IVDD can quickly progress and cause irreversible damage. The severity of neurological signs is the single most important factor in determining treatment. Dogs with pain only or mild, ambulatory weakness, are generally good candidates for medical therapy. This includes strict cage rest for at least four weeks along with anti-inflammatory medications, pain management, and muscle relaxants when needed. Client compliance is paramount, as even a short burst of activity outside of the crate can cause further damage. Once patients become non-ambulatory, the likelihood of medical management alone leading to recovery decreases sharply. At this stage, surgical intervention significantly improves the chances of regaining function. Early surgery, within 24 to 48 hours of losing ambulation, can mean the difference between full recovery and permanent paralysis. Dogs that present as paraplegic without deep pain sensation pose the greatest challenge. Prognosis is guarded even with surgery, with only about 50 percent regaining the ability to walk. Delayed intervention beyond 48 hours further lowers those odds. Clear communication with owners about prognosis, costs, and recovery expectations is critical in these cases. Using the clinical grading scale to guide treatment Symptoms of IVDD are generally graded on a scale of I-V (Table 1), providing a reliable framework for decision making. General practitioners should feel confident in performing a focused neurological exam, of which evaluating gait, proprioception, and spinal pain are key components. Knuckling tests, withdrawal reflexes, and checking for deep pain with firm pressure can help distinguish between grades. Table 1: IVDD Clinical Grading Scale Grade I Pain only ● Able to walk normally ● Exhibiting signs of spinal pain such as reluctance to jump or move, walking carefully, crying, shivering, muscle spasms, arched back, or lowered head Medical management and cage rest. If progressing or no improvement within one week, refer. Grade II Ambulatory paraparesis/tetraparesis ● Still able to walk, but weak in the limbs ● May cross, splay out, or stumble over legs or walk with paws knuckled under Grade III Non-ambulatory paraparesis/tetraparesis ● Too weak in the limbs to stand or walk ● Still able to move limbs and wag tail Refer for imaging and surgical consult Grade IV Paraplegia/tetraplegia with intact deep pain perception ● Cannot stand or walk ● Cannot move limbs ● Still able to feel limbs Urgent surgical referral Grade V Paraplegia/tetraplegia with no deep pain perception ● Cannot stand or walk ● Cannot move limbs ● Cannot feel limbs Emergency surgical referral and discuss guarded prognosis When and what to image The neurological exam and advanced imaging help us achieve the most accurate diagnosis. Plain radiographs are, unfortunately, of limited value in diagnosing IVDD. MRI is the preferred modality for evaluating both the spinal cord and intervertebral discs to determine that a patient is experiencing IVDD versus another neurological disorder with similar signs, including meningitis/myelitis, spinal tumors, trauma, infection, and malformations. Referral for advanced imaging should be prioritized for any non-ambulatory patient, those showing rapid progression of signs, or any case where deep pain sensation is absent or questionable. In these scenarios, delays can significantly alter prognosis. A veterinary technician prepares an IVDD patient for MRI at Southeast VeterinaryNeurology in Jupiter, Fla. Post-treatment recovery and prognosis The expected outcome depends heavily on neurological grade, treatment method, and timeliness of treatment. Grades I-II. Medical management often leads to full recovery around 55-65 percent of the time, depending on the degree of neurological symptoms. However, when compared to those that are treated with surgery, they may take longer to improve, are at risk of worsening, and have a higher risk for recurrence (as high as 50 percent in some breeds). Surgical patients, by contrast, have recovery rates of up to 95 percent with significantly lower recurrence rates in the hands of an experienced neurosurgeon. It will be obvious whether medical management is working within the first week of treatment. Grade III-IV. With surgery, the chances of making a functional recovery are about 95 percent. A highly skilled surgeon may also perform a preventative procedure during the operation to reduce the likelihood of recurrence. Medical management alone carries a much lower chance of success in these cases, with recovery rates closer to 50-60 percent, and a significantly higher risk of deterioration over time. Grade V. Prognosis is guarded. For grade V IVDD, the chances of recovery are significantly lower at 50 percent. Surgery should be performed as soon as possible for the best chance of recovery. If deep pain does not return within six weeks following surgery, recovery is unlikely. Recovery with medical management is exceedingly rare, with rates reported at less than five percent. Supportive care is crucial for both medical and surgical cases. Strict cage rest is mandatory. Physical rehabilitation can improve a functional recovery, and paraplegic patients require diligent bladder management. Owners should receive clear, detailed instructions on how to support their pet during this critical period. Client communication: Setting expectations Explaining IVDD to owners requires both clarity and compassion. Many clients are overwhelmed by the sudden onset of neurological signs in their pet. Key points to emphasize include: Prognosis depends on neurological grade at presentation as well as the method of treatment elected. Medical management can be successful for mild cases, but strict adherence to crate rest is essential. Surgery offers the best chance of recovery for all patients, but especially those that are non-ambulatory. Early intervention is critical when neurological signs are progressing. Even with optimal treatment, recurrence or residual deficits are possible. Unfortunately, with or without surgery, dogs that have lost feeling in their limbs are at risk for developing myelomalacia, an extremely serious condition that is typically progressive and fatal. Addressing cost early is also important. Owners may feel blindsided by the expense of advanced imaging and surgery. By framing options transparently, veterinarians can help clients make informed decisions that balance veterinary best practices with financial realities. Dr. Wong performs a hemilaminectomy on an IVDD patient at Southeast VeterinaryNeurology in Miami, Fla. Making confident IVDD decisions Intervertebral disc disease remains one of the most common neurological challenges in small animal practice. Yet, with a structured approach, general practitioners can assess patients and counsel clients with confidence. Recognizing the importance of neurological grading, knowing when to pursue referral, and setting realistic recovery expectations empower veterinarians to provide the best possible care and outcomes. Early recognition and decisive action matter most. With evidence-based management, many dogs with IVDD will go on to regain mobility and enjoy quality of life. Practical tips for general practitioners Keep a standardized neurological exam sheet in the clinic to ensure consistent documentation. Establish referral relationships with local neurologists and surgeons to streamline neurological emergencies. Encourage clients to record videos of their pet’s gait at home, as changes may be subtle. Provide written instructions for cage rest, supportive care, and medication schedules. Partner with rehabilitation specialists for support. Michael Wong, DVM, DACVIM (Neurology), graduated magna cum laude from the University of Florida (UF) College of Veterinary Medicine and while there, founded the UF Veterinary Business Management Association. He also went on to complete a medical and surgical internship at Red Bank Veterinary Hospital in Tinton Falls, N.J.. Dr. Wong subsequently received his neurology and neurosurgery training at North Florida Neurology. After completing his residency, Wong became board-certified in veterinary neurology in the same year. Wong has lectured at the local, state, and national levels and has instructed veterinary students at UF.
