In the late 1990s, a classic study1 drew important conclusions about dogs who have “only” paraspinal pain.
Out of 429 dogs diagnosed with thoracolumbar intervertebral disc disease (IVDD), 25 had signs of back pain only. “Back pain only” means they had no proprioceptive deficits and therefore had normal motor function.
A myelogram was performed. It revealed that in 80 percent of these dogs, spinal cord compression was detected, which of course was not suspected based on clinical signs alone.
The authors’ conclusion is very straight forward: “Dogs with thoracolumbar IVDD that have clinical signs of back pain alone, without neurologic deficits, may have substantial compression of the spinal cord.”
The take-home message is simple: If only for liability reasons, you probably should suggest advanced imaging to your client, whether a myelogram, CT or MRI. And you should document this recommendation in the medical record, which of course is also a legal document.
The article referenced may seem old, but we verify its conclusion regularly. Rather than steroids, these patients will benefit from surgery. Sure, we know patients who have improved on steroids (and hopefully strict confinement). But we also know patients who were sent home on steroids, were allowed to run around and became acutely paralyzed.
This is not science fiction. We see it all the time. The dreadful question becomes: Whose fault would it be?