In Session II of the Arthritis Summit, Dr. Rebecca Windsor (a veterinary neurologist) discussed back pain and spinal arthritis. This question and exchange was a lead in to the Q&A portion of that session:
Dr. Sheri Berger (Host / Moderator):
Dr. Windsor, we've just talked about spinal arthritis, the pain, and the potential for back or spinal surgery to help these animals. I'm sure a lot of people find that a scary proposition. Can you tell us a little bit more about the conversation that you have with clients and about the successes that we can see in these animals that undergo this type of surgery?
Dr. Rebecca Windsor:
Yes, sure! You know, spinal surgery in humans can be quite scary and debilitating, and I think a major contributing factor to someone's fear is that they (themselves) have gone through surgery or have had a family member or friend that has had back surgery. I do think, however, that our overall success rates are much better in animals, and I think that is because - at least in our in our hospital and our department - we're very selective about the cases we take to surgery. We also make sure we're doing the correct surgical procedure to address that patient's problem, and that it's performed by someone who is skilled and experienced.
The cases that I think are most helped by surgery are those in which you have an area that's really compressed. So, for example, let's say you have a patient with a really compressed nerve root in the lumbosarcal area. You can treat that patient with various medications - all you want - but chances are if you don't relieve the pressure on the nerve then it's going to be difficult to manage it long term. And so, if we are looking at a pretty straightforward procedure to alleviate that compression, it's really hard to argue against proceeding with surgery. You know, if you can go in and remove a part of the joint or remove part of the disc and get that animal out of pain, it's hard to argue against surgery to help the patient.
I've seen many animals that were medically managed - for several months to even years in some cases - and then within a month or two after surgery they're back to normal. That's quite rewarding! On the flip side, though, I do think a lot of animals get taken to surgery who probably shouldn't or don't need it or it's not going to help them in the way that they need. Good examples are the animals that have really chronic compression in the cervical area or the thoracolumbar area, you take the pressure off the nerve, but they also have a lot of scarring in that location. Well, there's not much we can do to help with that, and those patients are not going to have the outcome that owners are wanting or expecting. So I think that, in addition to proper patient selection and procedure performed, it's very important to properly set an owner's expectations.
I also usually tell people that very rarely am I going to rush into a surgery - unless it's a really bad, acute disc herniation. I think the most important thing we can do is to figure out what's happening with the patient. You know, get the full picture and a diagnosis. I think oftentimes people may decline a referral or fail to get to a neurologist because they have the mindset of not pursuing an MRI because they're not going to go for surgery. But oftentimes that's not why we're doing the MRI - we are just trying to get as much information as we can and see the extent of what is or isn't there.
Also, regarding an MRI - let's say surgery is not recommended or even an option (for whatever reason). Determining exactly where the compression is, what's causing the pain, etc. can really help to inform and direct our rehab practitioners in how they can help the patient. The information also helps us in advising what's safe for the animal to do or not do. You know, sometimes we'll see certain things on the MRI and say, for example, that the pet shouldn't jump down like this or should not be allowed to run or twist that way. On the flip side, the MRI may not even look that bad. You know, we may wind up telling an owner that their pet doesn't really have to be restricted in their activity. That's important and helpful information for everyone.
So, I really do advocate for primary care veterinarians - to encourage pet owners to go and see the neurologist - get that MRI if it's recommended - let their clients know that we want to get a full picture to know exactly what's happening. With that information we can best help the pet. That doesn't mean we have to go and proceed with surgery. You know, it may not amount to a surgery recommendation at all, but there's still so much we can do or advise on to help that animal.
Dr. Sheri Berger (Host / Moderator):
Yes, I understand. Even if surgery is not something someone is considering or pursuing, seeing the neurologist, learning their options, and making informed decisions can go a long way in helping the patient. Great perspective and thanks for sharing that, Dr. Windsor!
