INTERVERTEBRAL DISK DISEASE INTERVERTEBRAL DISK DISEASEPrincipal Natural Treatments
Acupuncture
Other Natural Treatments
Homeopathics, antioxidants
Intervertebral disk disease is a common cause of neck or back pain and/or paralysis in small breeds of dogs. Large breeds of dogs and cats are less commonly affected by intervertebral disk disease. While any breed of dog (or cat) can be affected, the dog breeds most commonly affected include Dachshunds, Shih Tzus, Lhasa Apsos, and similar breeds.
The disorder occurs as a result of degeneration of the shock-absorbing disks located in between the bones (vertebrae) of the back (spinal column). In Type I disk disease (the type most commonly seen in small breeds, although at least one author reports an increased incidence in Doberman Pinschers), the outer part of the disk (the annulus fibrosis) degenerates and ruptures, allowing the inner part of the disk (the nucleus pulposus) to extrude into the spinal canal. The extruding nucleus puts pressure on the spinal cord. The amount of pressure determines the signs seen. Minor pressure usually causes pain and possibly mild proprioceptive defects (causing a wobbly gait). More severe pressure can cause sudden and severe paralysis.
Diagnosis is made by clinical signs, radiography (x rays), and specialized radiographic procedures (myelogram, MRI). Conventional therapy can involve medical therapy or surgical therapy. Medical therapy, consisting of strict confinement (cage rest) with corticosteroids and/or muscle relaxants, is indicated for pets with mild clinical signs. However, the incidence of recurrence of disk disease is greater in pets treated medically rather than surgically. Estimates are that 30 to 40% of dogs treated medically have a recurrence at some time.
Acute paralysis, or chronic recurrence of mild signs, indicates the need for surgical removal of the disk. Pets with acute paralysis present a true emergency. In the presence of paralysis with the retention of deep pain on neurological examination, surgery should be performed within 12 to 24 hours. In the presence of paralysis but the absence of deep pain on neurological examination, surgery is less successful and the prognosis is poor.
The most common natural treatment therapy for pets with disk disease is acupuncture.
Acupuncture is without a doubt one of the most field-tested techniques available in complementary medicine. While it is hard to pinpoint exactly how long acupuncture has been around, evidence indicates that it is easily more than 4,000 years old, having been used in Asian and Indian cultures for many centuries. For skeptics who question the effectiveness of this popular complementary therapy, a large amount of empirical as well as experimental information and studies show the effectiveness of acupuncture. Certainly a therapy that is a mainstay of Traditional Chinese Medicine (TCM) could not have survived if it were not effective. The theory of Traditional Chinese Medicine has in fact served as the basis of acupuncture instruction for over 4,000 years. While there is certainly no substitute for well-documented research using controlled clinical studies, we cannot ignore thousands of years of clinical experience.
One stumbling block to the Western-trained mind trying to understand acupuncture is the lack of scientific explanation as to exactly how acupuncture works. The explanations offered by Traditional Chinese Medicine suffice for practitioners of this ancient art, but confuse the traditional Western mind. However, while a number of physiological theories have been proposed to explain how acupuncture works (to follow), we must remain open-minded to the effectiveness of this therapy (and, of course, to all complementary therapies).
The wise reader will remember that while we may not know exactly how acupuncture (or other complementary therapies) actually work, we also do not know exactly how certain modern Western medical treatments work. (For example, even Pfizer’s own literature states that exactly how their bestselling nonsteroidal drug Rimadyl works is not known.) If we can use traditional drug therapies without formal proof of how they work, we can also use therapies such as acupuncture without formal proof of how they work.
We do know that acupuncture points lie over free nerve endings wrapped in connective tissue or within the walls of blood vessels; this anatomy may help explain why stimulation of acupuncture points elicits therapeutic effects. Additionally, there is a high concentration of tissue-secretory mast cells in and around acupuncture points. The release of histamine (and probably other chemicals) may explain an important part of acupuncture by causing dilation of surrounding blood vessels and stimulating adjacent nerve terminals.
Exactly how does acupuncture work? There are in fact several proposed theories that attempt to explain how acupuncture exerts its effects. No one theory fully explains how acupuncture works; the actual mechanisms are complex and likely interrelated.
The theories that explain the workings of acupuncture include:
Gate Theory. Inhibitory neurons close a “gate” to ascending pain fibers and thus prevent pain from reaching the higher brain centers that allow conscious recognition of pain. There is a large amount of evidence that acupuncture can induce local pain relief; acupuncture points with the highest proportion of type A nerve fibers relative to type C nerve fibers provide the best regional pain relief. However, while probably accounting for some of the action of acupuncture, the gate theory does not explain the delayed onset of some of the effects seen with acupuncture therapy.
Humoral Theory. Local anesthesia results from some combination of endogenous chemicals including opioids, serotonin, and cholinergic and adrenergic compounds. These compounds are increased as a result of acupuncture. Additionally, humoral immunity is enhanced during acupuncture treatment.
Autonomic Nervous System. Stimulation of acupuncture points can cause autonomic nervous system dilation of blood vessels (the so-called “somatovisceral reflex”). This helps explain why stimulating points on the skin can exert strong influences on internal organs. Acupuncture may produce these effects by stimulating cyclic AMP (cAMP) which causes release of catecholamine hormones from the adrenal gland; the catecholamines then affect cellular functions such as dilation of blood vessels.
Local Effects. Acupuncture produces local effects including increased local tissue immune function, increased blood supply, and muscle and tissue relaxation as well as local pain relief.
Bioelectrical Theory. Acupuncture channels (called “meridians”) allow transmission of nervous impulses because of their low electrical impedance (electrical impedances can be measured at acupuncture points). Acupuncture points boost the DC signals carried by the meridian, which short-circuits the current and blocks the pain impulse.
In its purest sense, acupuncture involves the placement of tiny needles into various parts (acupuncture points) of a pet’s body. These needles stimulate the acupuncture points, which can effect a resolution of the clinical signs.
In traditional acupuncture, the acupuncturist places tiny needles at various points on the pet’s body. These points are chosen based on diagnostic tests and/or traditional “recipes” or formulas that are known to help pets with specific problems. As mentioned, these acupuncture points correspond to areas of the body which contain nerves and blood vessels. By stimulating these points, acupuncture causes a combination of pain relief, stimulation of the immune system, and alterations in blood vessels, causing a decrease in clinical signs.
While traditional acupuncture uses tiny acupuncture needles to stimulate the specific acupuncture points chosen, other forms of acupuncture also exist. These other forms of acupuncture are often chosen to provide the pet more prolonged stimulation of acupuncture points, as they produce a higher and more continuous level of stimulation. They include:
Laser therapy. Acupuncture points may be stimulated by low intensity or cold lasers to promote positive physiologic effects associated with healing and decreased pain and inflammation.
Aquapuncture. Aquapuncture utilizes the injection of tiny amounts of fluid (often vitamins, but also sterile water, antibiotics, herbal extracts, analgesics, local anesthetics, corticosteroids, nonsteroidal medications, or electrolyte solutions) at the acupuncture site for a more prolonged effect.
Implantation. To achieve a more prolonged and intense stimulation of acupuncture points, various objects (usually beads made of gold, silver, or stainless steel) are surgically implanted at acupuncture sites.
Electroacupuncture. This form of acupuncture therapy uses a small amount of non-painful electricity to stimulate the acupuncture site for a more intense effect.
Moxibustion. Moxibustion is the burning of an herb (typically Artesmisia vulgaris) on or above acupuncture points. The heat from the burning herb gives additional stimulation to the acupuncture points. Care must be taken to avoid burning the patient!
Acupressure. Acupressure involves applying pressure with the fingers to specific acupuncture points. Owners can be taught to apply acupressure at home to the acupuncture points that have been used during veterinary treatments to augment the acupuncture treatments to give further relief from pain and inflammation.
As a rule, acupuncture compares quite favorably with traditional therapies. In some cases, acupuncture may be preferred when conventional therapy is ineffective or potentially harmful. At other times, acupuncture may be used when an owner cannot afford traditional therapy.
Side effects from acupuncture are rare. Accidental puncture of an underlying vital organ can occur. When this happens, it is usually because the incorrect needles (the needles come in various sizes and the correct length of needle must be chosen that corresponds to the size of the pet and the area to be treated) are placed in an area in which there is minimal soft tissue that covers the underlying organs (such as the abdomen). Infection can occur at the site of needle insertion; needles should not be placed in areas in which the skin is infected or inflamed. In rare instances, the needle can break (due to patient movement and incorrect needle placement and removal), and surgery may be needed to remove it.
Some pets require sedation in order to allow insertion of the acupuncture needles. In some animals, clinical signs may worsen for a few days before they improve. (This is not unusual in pets treated with complementary therapies and is explained by the body going through the healing process. In addition, some animals treated with conventional medications also get worse before the medication “kicks in” and the pet begins to show signs of improvement.)
Many owners worry that acupuncture is painful and that their pets will suffer. Usually acupuncture is not painful. Occasionally, the animal will experience some sensation as the needle passes through the skin. Once in place, most animals will relax and some may become sleepy. Fractious animals (especially cats and nervous dogs) may require mild sedation for treatment. Alternatively, a complementary therapy to calm the pet (such as an herbal remedy or the flower essence called Rescue Remedy) can be used prior to and during acupuncture treatment.
In addition to acupuncture, cage rest is critical to prevent additional stress to the spinal cord, which could increase clinical signs of symptoms. When acupuncture therapy is chosen, the use of corticosteroids should be avoided whenever possible as corticosteroid administration decreases the effectiveness of acupuncture. However, if corticosteroids are needed to provide immediate relief (decreased pain and inflammation), they should be used. In this case, additional acupuncture treatments may be needed.
The number of acupuncture treatments that a pet will require varies from pet to pet. Usually, owners are asked to commit to 8 treatments (2 to 3/week) to assess if acupuncture will work. On average, treatments last about 15 to 30 minutes for needle acupuncture, and 5 to 10 minutes for aquapuncture or electroacupuncture. If the pet improves, acupuncture is done “as needed” to control the pet’s signs. As previously mentioned, other therapies may be used to decrease the number of visits to the doctor’s office for acupuncture.
Acupuncture can be effective for pets with neurological disorders such as intervertebral disk disease. While the effectiveness of acupuncture treatment compares favorably with corticosteroids and surgical therapy, for pets in whom surgery is indicated, acupuncture should not replace therapy unless the patient is a poor surgical candidate or the owner is unable to afford surgery. Simply put, pets that require surgery to treat or cure a problem should have surgery and not a complementary therapy unless there are valid reasons that surgery should not or cannot be performed.
Intervertebral disk disease commonly affects the middle to lower back (thoracolumbar area) or the neck (cervical area).
Pets with intervertebral disk disease of the thoracolumbar area (thoracolumbar disk disease) are graded based upon clinical signs; the grading allows a more accurate prognosis to be given. The four grades of thoracolumbar disk disease are:
Grade I: Pets have back pain as their only clinical sign.
Grade II: Pets have back pain plus rear leg paresis (partial paralysis) and ataxia (wobbly gait).
Grade III: Pets have back pain and rear leg paralysis (total paralysis), and some dogs and cats may not have control over bladder and colon function.
Grade IV: Pets have paralysis and no conscious pain perception in the rear legs.
Pets with intervertebral disk disease of the neck area (cervical disk disease) are also graded based upon clinical signs; the grading allows a more accurate prognosis to be given. The three grades of cervical disk disease are:
Grade I: Pets have only neck pain present.
Grade II: Pets have neck pain plus show proprioceptive deficits (ataxia, or a wobbly gait), of the front or rear legs.
Grade III: Pets have neck pain and paralysis of the front and rear legs, and some dogs and cats may not have control over bladder and colon function.
The mechanism of how acupuncture works for pets with intervertebral disk disease of the neck or back are not yet fully understood. Acupuncture may eliminate trigger points (local points of tenderness and muscle spasms and tightness) and abolish muscle pain and stiffness. Acupuncture may also augment endogenous release of corticosteroids to relieve pain and inflammation, but this is disputed by some holistic veterinarians.
How does disk disease respond to treatment with acupuncture?
Grade I back disk disease: For pets with thoracolumbar intervertebral disk disease, 90% recover after 2 to 3 acupuncture treatments over a 1- to 2-week treatment period.
Grade II back disk disease: For pets with grade II disk disease, approximately 90% of treated pets receiving 3 to 4 treatments over 3 weeks of treatment recovered.
These results indicate that for pets with grade I or II thoracolumbar intervertebral disk disease, the results of treatment with acupuncture are comparable to therapy with conventional medications (corticosteroids) or surgical disk decompression. However, while acupuncture can effectively relieve the clinical signs (pain, wobbly gait, and so forth) seen in pets with disk disease, surgery may be preferred for pets with recurring clinical signs as only surgery can prevent recurrence of the problem by removing the damaged disks. (Of patients treated with acupuncture, 10 to 25% may have recurrences of their clinical signs and require surgery.)
Grade III back disk disease: For pets with grade III thoracolumbar intervertebral disk disease, 80% recover after 5 to 6 acupuncture treatments over a 6-week treatment period.
Grade IV back disk disease: For pets with grade IV thoracolumbar intervertebral disk disease, less than 25% of patients recover after 10 or more treatments over 3 to 6 months of treatment.
Acupuncture is only half as effective as immediate decompressive surgery for pets with grade IV intervertebral disk disease. Since few dogs with Grade IV thoracolumbar intervertebral disk disease recover from their clinical signs (paralysis, lack of deep pain) regardless of treatment, the prognosis for these dogs is quite grave. However, even for those pets with this grave prognosis, acupuncture is recommended if the owner chooses not to have surgery done in the possible (although slight) chance that the pet might recover.
Grade I neck disk disease: For pets with grade I cervical intervertebral disk disease, approximately 80% recover after 3 to 4 treatments over 1 to 2 weeks.
Grade II neck disk disease: For pets with grade II disk disease, 67% recover after 5 to 6 treatments over 3 to 4 weeks of therapy.
Grade III neck disk disease: As of this writing, too few grade III cervical intervertebral disk disease patients have been described to evaluate results properly.
Approximately 33% of pets with cervical intervertebral disk disease relapse within 3 years, requiring additional treatment. For pets with chronic disk disease, surgery may be indicated to prevent future recurrences. (Surgical removal of damaged disks prevents recurrences of these disks from causing future disease; however, other disks could conceivably develop disease at a future time for which additional treatment would be needed.)
To summarize, in general, the results of treating pets with intervertebral disk disease with acupuncture approximate those of surgery. However, surgical removal of the damaged disks prevents the possibility of future episodes of disk disease and the chance of relapse (for those damaged disks) is gone. Surgery is recommended for pets with grade IV disk disease (any pet with paralysis and absence of deep pain) within 24 hours to maximize the chance of cure. However, the prognosis for recovery for these pets is poor even with surgery.
Acupuncture should only be performed on these pets if presented after more than 24 hours or if owner is unable to afford surgery. The chance for recovery following surgery in these pets is very low once 24 hours has elapsed due to the high possibility of permanent neurological damage. If the pet is not in severe pain, acupuncture should be attempted as there is unlikely to be any harm to the pet from acupuncture therapy and a few pets may recover.
Homeopathics and antioxidants can be used in conjunction with conventional therapies as needed. The natural treatments are widely used with variable success, but, with the exception of acupuncture, have not all been thoroughly investigated and proven at this time. Pets with total paralysis are often better treated with surgery depending upon the results of the neurological examination performed at the initial presentation.
As with any condition, the most healthful natural diet will improve the pet’s overall health.
Conventional therapies rely on corticosteroids, muscle relaxants, and surgery when indicated.