Quiz: Prognosis with med mgmt and surgery for IVDD

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3 replies
  1. Karataiev Pavlo
    Karataiev Pavlo says:

    Hello! What do you think about the information in this paper (https://pubmed.ncbi.nlm.nih.gov/26829270/), where they showed that “a greater delay between onset of paraplegia and referral evaluation was not associated with a poorer prognosis”. I also try to do surgery as quickly as possible, but it seems that patients with delay more than 48 hours have the same prognosis?

    Reply
    • neuropetvet
      neuropetvet says:

      Thanks for bringing that up! I’ve updated the answer above a bit. Historically, prognosis for recovery has been based on the duration of time between loss of nociception and performing surgery. The difficulty of many studies is that it is very difficult to know when the patient truly lost nociception. Perhaps it doesn’t really matter whether nociception is lost. I need to re-read the paper you mentioned to fully refresh my memory, but what I remember is that part of the analysis the authors did was to compare post-op recovery outcomes to (1) overall duration of signs and (2) delay between loss of independent locomotion and initial referral evaluation. As you said, they reported that a similar percentage of dogs with signs longer than 48 hours recovered the ability to walk compared to dogs whose signs were present less than 48 hours. However, I don’t think it was reported, nor could it be accurately determined, when the patient lost nociception. For example, perhaps some/many of the dogs were paraplegic with intact nociception for 40 hours but lost nociception only 8 hours before surgery so their prognosis for recovery might have been better. When I talk to clients, I generally tell them that the prognosis with surgery when nociception has been lost is usually 50-60% at best and goes down with time.

      Reply
    • neuropetvet
      neuropetvet says:

      I will say, however, that the study you mentioned helped me feel better about not doing surgery at night and that there’s little difference between outcome of doing surgery at 11pm at night (when my staff and I are tired after a long day) and waiting until the next morning. If the patient loses nociception overnight, then I wonder how often that nociception would have been lost regardless of whether or not I did surgery the night before.

      Reply

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