Referring a Dog with Back Pain
What we tell veterinarians is that knowing what kind of dog you have, the presenting complaints, and the response to treatment certainly helps determine when you should refer a dog with back pain. We know the typical clinical course that they are supposed to follow...
For example, the small, middle-aged, chondrodystrophic dog like a dachshund, poodle or beagle has a pretty typical course: acute onset of pain, tenderness, reluctance to walk, ataxia and postural reaction deficits. The majority of these dogs will respond within 3-5 days to crate rest, pain medications and anti-inflammatories. It is essential that they are crated for improvement to be noted. Sometimes, it is best to rest these dogs in your clinic for 2-3 days to make sure that they are improving and to ensure strict crate rest. In most cases, the owners are VERY happy that their dog is better, and this really "sells" this treatment to them. They truly understand and accept that your treatment is going to be good for their pup and they can avoid the danger/expense/inconvenience of referral for back surgery with someone like me!
Most dogs with cervical spine IVDD present very similarly, although postural reaction deficits are uncommon in these patients. Treatment is very similar, although if your patient is showing a lot of muscle fasciculations and spasms, a muscle relaxant such as diazepam or methocarbamol is often helpful.
All of these dogs should be rested a minimum of 4 weeks, sometimes up to 6 weeks. The owners should be instructed to have their pet lose weight if overweight, walk the dog with with a harness rather than a collar, and prevent the dog from leaping from the furniture.
So, you ask, how does this help me know when to refer?
Anytime that the situation deviates from the above scenario, you should consider referral. If the dog does not improve in 3-5 days with standard treatment, if the dog is a large, older or you have an aged cat that fails to improve, a referral is in order. (I'll put together an article on cats soon.) Other situations include dogs that are profoundly incapacitated (can't rise, walk or feel their toes), a chondrodystrophic dog that has more than two incidents of pain and paresis in a year or so, a dog with other metabolic or systemic disease that can influence treatment as outlined above, and finally a dog with profoundly asymmetric signs or with great pain associated with the weakness. This may not be a complete list of all possible scenarios, but I think it covers a lot of them.
A word about dogs with sensory deficits: These are dogs that are completely paralyzed and don't have sensation to their toes (deep pain negative). If these dogs are treated with decompressive surgery within 24-48 hours of losing deep pain, they have an excellent (>84%) chance of regaining significant and functional motor ability. Many of them improve back to 100%. Dogs that have lost deep pain for more than 48 hours still have a good (~50%) prognosis of regaining functional motor ability.
If you have a specific question about your cases, please feel free to contact us via email at firstname.lastname@example.org.