A Controlled Clinical Study of Intensive Neurorehabilitation in Post-Surgical Dogs with Severe Acute Intervertebral Disc Extrusion.

Abstract

Simple SummaryThis study explores the potential intensive neurorehabilitation plasticity effects in post-surgical paraplegic dogs with severe acute intervertebral disc extrusion aiming to achieve ambulatory status. The intensive neurorehabilitation protocol translated in 99.4% (167/168) of recovery in deep pain perception-positive dogs and 58.5% (55/94) in deep pain perception-negative dogs. There was 37.3% (22/59) spinal reflex locomotion, obtained within a maximum period of 3 months. Thus, intensive neurorehabilitation may be a useful approach for this population of dogs, avoiding future euthanasia and promoting an estimated time window of 3 months to recover.This retrospective controlled clinical study aimed to verify if intensive neurorehabilitation (INR) could improve ambulation faster than spontaneous recovery or conventional physiotherapy and provide a possible therapeutic approach in post-surgical paraplegic deep pain perception-positive (DPP+) (with absent/decreased flexor reflex) and DPP-negative (DDP−) dogs, with acute intervertebral disc extrusion. A large cohort of T10-L3 Spinal Cord Injury (SCI) dogs (n = 367) were divided into a study group (SG) (n = 262) and a control group (CG) (n = 105). The SG was based on prospective clinical cases, and the CG was created by retrospective medical records. All SG dogs performed an INR protocol by the hospitalization regime based on locomotor training, electrical stimulation, and, for DPP−, a combination with pharmacological management. All were monitored throughout the process, and measuring the outcome for DPP+ was performed by OFS and, for the DPP−, by the new Functional Neurorehabilitation Scale (FNRS-DPP−). In the SG, DPP+ dogs had an ambulation rate of 99.4% (n = 167) and, in DPP−, of 58.5% (n = 55). Moreover, in DPP+, there was a strong statistically significant difference between groups regarding ambulation (p < 0.001). The same significant difference was verified in the DPP– dogs (p = 0.007). Furthermore, a tendency toward a significant statistical difference (p = 0.058) regarding DPP recovery was demonstrated between groups. Of the 59 dogs that did not recover DPP, 22 dogs achieved spinal reflex locomotion (SRL), 37.2% within a maximum of 3 months. The progressive myelomalacia cases were 14.9% (14/94). Therefore, although it is difficult to assess the contribution of INR for recovery, the results suggested that ambulation success may be improved, mainly regarding time.