Intervertebral Disc Disease (IVDD)

What you might notice

• Crying out, yelping or flinching when you pick your dog up or touch along the back or neck
• A hunched or arched back, a tense belly, or holding the head low and stiff
• Suddenly not wanting to jump, use stairs, or get on the couch - or, in the slow form, gradually becoming stiffer and slower over weeks to months
• Wobbly back legs, scuffing the toenails, crossing the back legs, or knuckling over
• Dragging the back end, or not able to stand or walk on the back legs at all
• If the disc is in the neck: neck pain and a low, stiff head carriage, a yelp when the neck is moved, limping or 'root signature' where one front leg is held up, wobbliness or weakness in the FRONT legs as well as the back, or being down on all four legs
• A tail that hangs limp and does not wag
• Not able to pee on their own, a firm swollen belly, or urine leaking out
• Soiling without seeming to know it, a limp open back end, or losing control of bowel movements
• Trembling, panting, hiding, restlessness or going off food - in dogs these are pain signs

Standard of care

1. Grade the dog first - everything else follows from the neurologic grade

   Approved / guideline-backed

   Assign severity (spinal pain only, ambulatory paraparesis, non-ambulatory paraparesis, paraplegia DPP, paraplegia DPN) and localise the lesion before discussing options or prices with the owner. The ACVIM panel's outcome table by grade is the single most useful clinical decision tool in this disease, and it only works if the grade is accurate. Give the owner the two numbers for their dog's grade in plain language - the grade-specific prognosis is the information the person funding surgery, or considering euthanasia, most needs, and withholding it to the clinician tier is not honesty.

   ACVIM consensus statement, systematic review of the post-1983 literature; recommendations by grade supported by low to high-level evidence depending on the grade. The panel's own summary states that 'Most recommendations made by the panel were supported by a low or moderate level of evidence' (dog).

   Olby NJ, Moore SA, Brisson B, Fenn J, Flegel T, Kortz G, Lewis M, Tipold A. ACVIM consensus statement on diagnosis and management of acute canine thoracolumbar intervertebral disc extrusion. J Vet Intern Med. 2022;36(5):1570-1596. PMID 35880267. DOI 10.1111/jvim.16480

2. Surgical decompression for paraplegic dogs, and especially for dogs that have lost deep pain perception

   Approved / guideline-backed

   Published success by grade, medical versus surgical (ACVIM Table 3): spinal pain only and ambulatory paraparesis 80% (115 dogs) vs 98.5% (336 dogs); non-ambulatory paraparesis 81% (131 dogs) vs 93% (341 dogs); paraplegia deep-pain-positive 60% (67 dogs) vs 93% (548 dogs); paraplegia deep-pain-negative 21% (48 dogs) vs 61% (502 dogs). ACVIM verbatim for DPN dogs: 'In paraplegic DPN dogs, success with medical management is largely poor with an increase in the frequency of PMM. Surgical management is recommended.' Also verbatim: 'Surgical treatment should not be declined simply because the dog has been paralyzed for an extended period, because the literature documents that recovery of ambulation may occur for dogs that present with DPN status and have been paralyzed > 1 week before surgery.' That quote must never be presented alone, because on its own it reads as permission to wait, and the panel itself says the two questions are separate: 'The influence of surgical timing on locomotor outcome should be considered independently of its influence on development of PMM.' On the PMM clock, delay is a measured risk - in 197 dogs with complete sensorimotor loss, surgery more than 12 hours after loss of ambulation was associated with PMM (OR 3.4, CI 1.1-10.5, p = 0.03 for 12-24 h; OR 4.6, CI 1.3-16.6, p = 0.02 for >24 h, versus 12 h or less), and disc extrusion at the lumbar intumescence was also associated with PMM (OR 3.02, CI 1.3-7.2, p = 0.01) (Castel et al., BMC Vet Res. 2019;15(1):433, PMID 31796017, DOI 10.1186/s12917-019-2186-0). So: a long-standing paralysis is not a reason to decline surgery, and it is also not a reason to take your time. Hemilaminectomy is the standard approach. On durotomy: one retrospective series reported dogs undergoing durotomy 3.32 times more likely to regain ambulation, with 0% progressive myelomalacia versus 21.5% after hemilaminectomy alone (the consensus reports the two group sizes inconsistently between its own sections, 51 and 65, so no group size is asserted here), and a prospective cohort of 26 paraplegic DPN dogs treated by laminectomy and durotomy reported 16 of 22 followed up (72%) regaining independent ambulation with 1 (5%) developing PMM. These are single-centre, uncontrolled or retrospective figures, and the ACVIM panel makes NO recommendation for or against durotomy - it lists 'impact of durotomy on locomotor outcome and development of progressive myelomalacia' among its areas of high need for further study. Do not read the encouraging numbers as a recommendation, and do not ask a surgeon for a durotomy on the strength of them.

   Named products: Not a drug intervention. Perioperative analgesia is covered in the analgesia step below. For brachycephalic dogs, especially French Bulldogs, the anaesthetic and recovery plan is a separate conversation with the anaesthesia team; the consensus also notes a retrospective association between prolonged anaesthetic time and worse neurologic outcome in paraplegic DPN dogs.

   For paraplegic DPP dogs the consensus recommendation carries the label 'Supported by moderate-level evidence'; for paraplegic DPN dogs the label is 'Supported by moderate to high-level evidence' (both verified against the recommendation boxes in the published consensus). The panel's overall summary nonetheless states that most of its recommendations were supported by a low or moderate level of evidence, and the underlying data are observational studies pooled by systematic review, not randomised trials. The durotomy figures inside this step are NOT graded recommendations and carry no evidence level (dog).

   Olby NJ et al. J Vet Intern Med. 2022;36(5):1570-1596. PMID 35880267. DOI 10.1111/jvim.16480; Castel A, Olby NJ, Ru H, Mariani CL, Munana KR, Early PJ. Risk factors associated with progressive myelomalacia in dogs with complete sensorimotor loss following intervertebral disc extrusion: a retrospective case-control study. BMC Vet Res. 2019;15(1):433. PMID 31796017. DOI 10.1186/s12917-019-2186-0

3. Multimodal analgesia - and NSAIDs rather than steroids

   Approved / guideline-backed

   For medically managed dogs the ACVIM options are an NSAID, gabapentin or pregabalin for neuropathic pain, and possibly a muscle relaxant such as methocarbamol or diazepam; dogs whose pain requires opioids should be hospitalised until pain is controlled. The recommended postoperative protocol is IV or SC opioids for 24-48 hours (longer if needed), a fentanyl patch for 3-5 days, and an NSAID for 7 days, with pregabalin q8h as a possible addition. Honesty note: in one RCT (n=63) adjunctive gabapentin 10 mg/kg q12h gave no benefit over placebo for 5 days postoperatively, so gabapentin is a reasonable option, not a proven one; the consensus says a q8h interval 'might be beneficial, although evidence to support that assumption currently is lacking'. Two non-negotiables whenever an analgesic goes home with an owner. (1) Never combine an NSAID with a corticosteroid, and never let a dog receive an NSAID in the days after a steroid was given elsewhere without the prescribing veterinarian knowing about it and deciding on a washout - every US canine NSAID label carries this instruction in some form. (2) Owners must be told, in writing, not to supplement with human analgesics and not to give the dog a medicine dispensed for another animal, and to phone before changing any dose.

   Named products: Five NSAID-class analgesics are approved by the US FDA for use in DOGS: carprofen (Rimadyl), meloxicam (Metacam), deracoxib (Deramaxx), firocoxib (Previcox) and grapiprant (Galliprant, an EP4 prostaglandin receptor antagonist, mechanistically distinct from COX inhibitors). NONE of them is approved for intervertebral disc disease or acute spinal pain, so use in IVDD is extra-label BY INDICATION for all five - the same extra-label caveat that applies to gabapentin, pregabalin, methocarbamol and diazepam (which additionally have no canine approval at all, and are therefore extra-label by drug as well). Label indications, verified against the current US labels: carprofen - 'indicated for the relief of pain and inflammation associated with osteoarthritis and for the control of postoperative pain associated with soft tissue and orthopedic surgeries in dogs'; firocoxib - 'the control of pain and inflammation associated with osteoarthritis and for the control of postoperative pain and inflammation associated with soft-tissue and orthopedic surgery in dogs'; deracoxib - osteoarthritis pain and inflammation plus postoperative pain following orthopedic and dental surgery; meloxicam oral suspension - 'the control of pain and inflammation associated with osteoarthritis in dogs' ONLY; grapiprant - 'the control of pain and inflammation associated with osteoarthritis in dogs' ONLY, with no acute-pain or postoperative-pain indication, which makes it the weakest of the five for a step about acute and perioperative spinal pain. Label contraindications and limits: each is contraindicated in dogs with known hypersensitivity to that drug; every label directs that concomitant use with other NSAIDs or corticosteroids be avoided, and the firocoxib label names the drugs explicitly - 'PREVICOX should not be given with other NSAIDs (for example, aspirin, carprofen, etodolac, deracoxib, meloxicam, or tepoxalin) or corticosteroids (for example, prednisone, cortisone, dexamethasone, or triamcinolone)'; the grapiprant label likewise states it 'should not be used with other NSAIDs or corticosteroids'. Age and weight limits: safe use of carprofen has not been established in animals less than 6 weeks of age, in pregnant, breeding or lactating dogs; deracoxib has not been evaluated in dogs younger than 4 months, in breeding, pregnant or lactating dogs; meloxicam oral suspension has not been evaluated in dogs younger than 6 months; firocoxib cannot be accurately dosed in dogs weighing less than 12.5 lb (5.7 kg); grapiprant cannot be accurately dosed in dogs weighing less than 8 lb - which matters in exactly this breed population. Species limits are on the labels too: carprofen states 'For use in dogs only. Do not use in cats'; meloxicam states 'Do not use METACAM Oral Suspension in cats' and carries a boxed warning that 'Repeated use of meloxicam in cats has been associated with acute renal failure and death. Do not administer additional injectable or oral meloxicam to cats'; deracoxib is for oral use in dogs only and is not to be used in cats. These are US FDA approvals only - approval status, product names and permitted indications differ in the EU, the UK, Colombia and elsewhere, so never write 'approved' without naming the regulator. Specific NADA numbers were NOT verified in this research pass and must be confirmed against animaldrugsatfda.fda.gov before any are published on a product or protocol page.

   Medical-management analgesia supported by low-level evidence; postoperative protocol supported by RCT-level evidence for individual components. In 88 dogs with presumptive cervical disc herniation managed medically, NSAID administration was associated with success (P = .035, OR 2.52) (dog).

   Olby NJ et al. J Vet Intern Med. 2022;36(5):1570-1596. PMID 35880267. DOI 10.1111/jvim.16480; Levine JM, Levine GJ, Johnson SI, Kerwin SC, Hettlich BF, Fosgate GT. Evaluation of the success of medical management for presumptive cervical intervertebral disk herniation in dogs. Vet Surg. 2007;36(5):492-9. PMID 17614931. DOI 10.1111/j.1532-950X.2007.00296.x; US FDA-approved labels for Rimadyl (carprofen), Metacam (meloxicam) Oral Suspension, Deramaxx (deracoxib), Previcox (firocoxib) and Galliprant (grapiprant), as published on DailyMed

4. Do NOT use corticosteroids routinely in the acute phase

   Approved / guideline-backed

   ACVIM verbatim: 'Corticosteroids are not recommended for routine use in medical management of the acute phase of presumptive TL-IVDE. In the chronic phase, a short course of anti-inflammatory doses of corticosteroids may be of benefit for some dogs.' In 223 dogs managed medically for presumptive thoracolumbar disc herniation, glucocorticoid administration was negatively associated with treatment success (P = .008, OR 0.48) and with owner-assessed quality of life (P = .004, OR 0.48). Methylprednisolone sodium succinate and dexamethasone are both listed by the panel among neuroprotective strategies not currently recommended for routine use. This is a negative recommendation and it must be stated as plainly on a client-facing page as on a clinician-facing one, and in Spanish as plainly as in English. It also has a practical corollary for the common real-world sequence in which a primary-care visit gives a steroid injection and the referral centre then adds an NSAID: ask explicitly what has already been given, record it, and do not stack the two.

   Named products: Named agents NOT recommended for routine use: dexamethasone, methylprednisolone sodium succinate (MPSS). Fatal colonic perforations have been described in dogs treated with high doses of dexamethasone, and dogs treated with dexamethasone are more likely to develop urinary tract infections and diarrhoea than dogs given other or no glucocorticoids.

   Supported by moderate-level evidence (ACVIM). Underlying data are retrospective with owner-questionnaire follow-up. One retrospective case-control study of dogs with complete sensorimotor loss reported corticosteroid treatment as negatively associated with PMM (OR 3.1, CI 1.3-7.6, p = 0.01) and its authors concluded that corticosteroid use 'warrants further investigation' - this is a single unreplicated observational signal in one direction against a graded negative recommendation in the other, and it does not license routine steroid use (dog).

   Olby NJ et al. J Vet Intern Med. 2022;36(5):1570-1596. PMID 35880267. DOI 10.1111/jvim.16480; Levine JM, Levine GJ, Johnson SI, Kerwin SC, Hettlich BF, Fosgate GT. Evaluation of the success of medical management for presumptive thoracolumbar intervertebral disk herniation in dogs. Vet Surg. 2007;36(5):482-91. PMID 17614930. DOI 10.1111/j.1532-950X.2007.00295.x; Castel A et al. BMC Vet Res. 2019;15(1):433. PMID 31796017. DOI 10.1186/s12917-019-2186-0

5. At least four weeks of strict activity restriction

   Approved / guideline-backed

   ACVIM verbatim: 'A least 4 weeks of restricted activity is recommended, putatively to promote healing of the annulus fibrosus. This period should include confinement to a restricted area (crate ideally, or a small room without furniture) except for when performing rehabilitation exercises or outdoor toileting. There should be no off-leash walking, no jumping on or off furniture and no access to stairs during this time.' The same four weeks is recommended after surgery. Be honest with owners about the evidence: in 223 medically managed dogs, duration of restricted activity from none to more than 4 weeks was not associated with outcome, and the panel graded this recommendation as low-level evidence. Activity restriction does not mean skipping rehabilitation exercises. Include handling instruction in the same conversation, because most of the risk in this period is in how the dog is picked up and put down: support the trunk along its whole length, keep the spine in line, never lift under the abdomen alone, lift in and out of the car and off furniture rather than letting the dog jump, and for a cervical lesion walk in a harness rather than a neck collar.

   Supported by low-level evidence (ACVIM consensus agreement rather than trial data) (dog).

   Olby NJ et al. J Vet Intern Med. 2022;36(5):1570-1596. PMID 35880267. DOI 10.1111/jvim.16480

6. Bladder management and urinary tract infection vigilance

   Approved / guideline-backed

   Retention incontinence is a core component of the disease, not a side issue, and recovery of bladder function lags behind the return of voiding. Reported time to urination by grade: ambulatory paraparesis 1.9 days, non-ambulatory paraparesis 2.9 days, paraplegia DPP 6 days, paraplegia DPN 15.5 days. Cystometry shows maximum bladder pressure and leak-point pressure still abnormal at 42 days. A dog that has started to void has not necessarily recovered normal bladder function - check residual volumes rather than assuming. Owner-side, two things must be taught rather than assumed: manual expression is only done by an owner who has been shown the technique on their own dog by a veterinarian or nurse, because forceful expression risks bladder rupture; and the owner needs the signs of urinary tract infection in plain words (foul, bloody or cloudy urine, straining, discomfort, fever, new leaking) because retention is what predisposes to it.

   Prospective and retrospective cohort studies summarised in the ACVIM consensus statement; no randomised data (dog).

   Olby NJ et al. J Vet Intern Med. 2022;36(5):1570-1596. PMID 35880267. DOI 10.1111/jvim.16480

7. Basic rehabilitation - and do not oversell intensive rehabilitation

   Approved / guideline-backed

   ACVIM verbatim: 'At a minimum, a basic rehabilitation protocol can be recommended to include cryotherapy, PROM, massage, assisted standing and walking, which can be performed with no specialized equipment or training.' Two RCTs showed that in-hospital, staged, intensive physical rehabilitation for 10-14 days postoperatively is well tolerated but does NOT improve recovery of ambulation compared with basic passive range of motion and assisted walking. Rehabilitation can safely start as early as 24 hours postoperatively; hydrotherapy or underwater treadmill from 3 days (with incision protection) to 14 days. A clinic selling an intensive rehabilitation package should know that the controlled evidence does not support it as superior to the basic protocol.

   Inclusion of basic exercises supported by moderate-level evidence; superiority of intensive protocols contradicted by 2 RCTs (dog).

   Olby NJ et al. J Vet Intern Med. 2022;36(5):1570-1596. PMID 35880267. DOI 10.1111/jvim.16480

8. Fenestration of the herniated disc at surgery, and consideration of prophylactic fenestration in predisposed breeds

   Approved / guideline-backed

   ACVIM verbatim: 'Fenestration of the herniated disc space at the time of surgical decompression is recommended to minimize risk of recurrence at the site of herniation.' On adjacent discs, verbatim: 'Fenestration of adjacent, degenerated but non-ruptured disc spaces, should be considered. In breeds predisposed to IVDE such as dachshunds and French bulldogs, fenestration is recommended even if the discs are not mineralized.' Reported recurrence was 17.89% with single-site fenestration and 7.45% with multiple-site fenestration; recurrence at new disc spaces is reported in up to 19% of all dogs undergoing decompression, with breed-specific rates of 25% for Dachshunds and 44% for French Bulldogs, and most (87.5%) of these late recurrences develop within 1 to 2 disc spaces of the original extruded disc. Recurrence after medical management ranges from 15% to 66%. The trade-offs the panel names are additional surgical trauma, increased anaesthetic time and cost, plus reported complications including extrusion of additional disc material, potential vertebral instability, increased morbidity at L5-6 and L6-7, and pneumothorax or haemothorax.

   Supported by moderate-level evidence (ACVIM); retrospective comparative data (dog).

   Olby NJ et al. J Vet Intern Med. 2022;36(5):1570-1596. PMID 35880267. DOI 10.1111/jvim.16480

9. Weight control and sensible lifestyle counselling

   Early evidence

   Overweight dogs had 1.67 times the adjusted odds of owner-reported IVDD (95% CI 1.38-2.01) in 43,517 US dogs. In the same study, higher daily active time, being fed a commercial diet, and regular use of a staircase were associated with REDUCED odds. The staircase finding is counter-intuitive and cross-sectional - it is an association in owner-reported data, plausibly reflecting that dogs already unwell avoid stairs, and it must not be published as advice to make a Dachshund use stairs. What is defensible is weight control, which is also the one modifiable factor with a coherent mechanism and a supporting nutritional guideline.

   Cross-sectional observational association only; no interventional trial of weight loss for IVDD prevention or outcome was located (dog).

   Wee C, Nin DZ. J Am Vet Med Assoc. 2025;263(5):1-9. PMID 39813820. DOI 10.2460/javma.24.08.0553; AAHA Nutrition and Weight Management Guidelines for Dogs and Cats. J Am Anim Hosp Assoc. 2021. PMID 34228790. DOI 10.5326/JAAHA-MS-7232

10. Breeding and screening advice for predisposed breeds

    Early evidence

    For breeders, this is the only genuinely preventive lever identified. Radiographic screening for intervertebral disc calcification plus 12-FGF4 retrogene genotyping is feasible and the calcification count correlates with overall MRI-graded disc degeneration; 24-48 months of age is a suitable screening age. In 193 radiographically screened Finnish Dachshunds that had reached at least 10 years of age, an owner questionnaire reported clinical IVDD in 31%, strongly associated with calcification grade (P < 0.001) - a single cross-sectional survey of older screened dogs, not a prospective follow-up.

    Prospective blinded imaging study (n = 21 asymptomatic Dachshunds, 546 discs) plus a cross-sectional owner questionnaire (n = 193 Dachshunds aged at least 10 years at the time of the single survey); no breeding-program outcome trial (dog).

    Reunanen VLJ, Jokinen TS, Hytonen MK, Junnila JJT, Lappalainen AK. Acta Vet Scand. 2023;65(1):42. PMID 37752484. DOI 10.1186/s13028-023-00702-0; Lappalainen AK, Vaittinen E, Junnila J, Laitinen-Vapaavuori O. Acta Vet Scand. 2014;56(1):89. PMID 25523328. DOI 10.1186/s13028-014-0089-4

How it is diagnosed

• Full neurologic examination to localise the lesion (T3-L3 versus L4-S3, or cervical) and to assign a severity grade: spinal pain only / ambulatory paraparesis / non-ambulatory paraparesis / paraplegia with deep pain perception (DPP) / paraplegia without deep pain perception (DPN). This grade, not the imaging, is what drives prognosis and the surgical decision (Olby et al. 2022, PMID 35880267).
• Deliberate, careful assessment of deep pain perception (nociception) as a distinct test - a limb withdrawal reflex is not the same as conscious perception, and the DPP/DPN distinction separates an approximately 93% surgical success rate from approximately 61%.
• Rule out the mimics before committing to a disc diagnosis: acute non-compressive nucleus pulposus extrusion (ANNPE), ischaemic myelopathy / fibrocartilaginous embolism, vertebral fracture or luxation and other trauma, discospondylitis, spinal neoplasia and aortic thromboembolism. Take a deliberate trauma history, because a fracture or luxation changes handling and immobilisation before it changes anything else. In 123 dogs with suspected IVDE managed on clinical reasoning alone at one referral hospital, 81% had a successful outcome without imaging, but 3% proved to have an alternative diagnosis or were euthanised (Scalia & Freeman, Animals. 2024;14(7):1017, PMID 38612256).
• Advanced imaging when surgery is on the table or the diagnosis is unclear. ACVIM verbatim: 'When extruded material is mineralized, especially in young to middle-aged adult, chondrodystrophic dogs, CT is sensitive in diagnosis and treatment planning. It therefore can be recommended as a first-line advanced imaging modality when acute TL-IVDE is suspected.' MRI (diagnostic sensitivity >98.5%) is preferred where intramedullary lesion definition, prognostication, or a non-IVDE diagnosis matters; minimum sequences are T2W sagittal and transverse.
• Survey spinal radiographs cannot confirm an extrusion, but they screen for discospondylitis, fracture and vertebral neoplasia and allow counting of mineralised discs.
• Baseline bloodwork and urinalysis before NSAIDs and general anaesthesia; urine culture if there is retention or a catheter, because retention incontinence predisposes to urinary tract infection.
• Serial re-examination rather than a single assessment, starting at presentation. Progressive myelomalacia was already evident at first evaluation in 17 of 51 dogs, declared within 48 hours in 25 of 51, and began as late as 5 days after presentation in the remainder (Castel & Olby, PMID 28961348); the ACVIM consensus states that it 'usually develops within days (24 hours up to 14 days) of an acute IVDE-associated injury' and 'is not always apparent at time of presentation'. Read those two together rather than as an interval in which the first day is safe. Signs to actively re-check include cranial advancement of the cutaneous trunci reflex cut-off, loss of patellar reflexes, weak anal tone, loss of abdominal tone, Horner syndrome, thermodysregulation and hypoventilation.