Abstract
Some dogs do not make a full recovery following medical or surgical management of acute canine intervertebral disc herniation (IVDH), highlighting the limits of currently available treatment options. The multitude of difficulties in treating severe spinal cord injury are well-recognized, and they have spurred intense laboratory research, resulting in a broad range of strategies that might have value in treating spinal cord-injured dogs. These include interventions that aim to directly repair the spinal cord lesion, promote axonal sparing or regeneration, mitigate secondary injury through neuroprotective mechanisms, or facilitate functional compensation. Despite initial promise in experimental models, many of these techniques have failed or shown mild efficacy in clinical trials in humans and dogs, although high quality evidence is lacking for many of these interventions. However, the continued introduction of new options to the veterinary clinic remains important for expanding our understanding of the mechanisms of injury and repair and for development of novel and combined strategies for severely affected dogs. This review outlines adjunctive or emerging therapies that have been proposed as treatment options for dogs with acute IVDH, including discussion of local or lesion-based approaches as well as systemically applied treatments in both acute and subacute-to-chronic settings. These interventions include low-level laser therapy, electromagnetic fields or oscillating electrical fields, adjunctive surgical techniques (myelotomy or durotomy), systemically or locally-applied hypothermia, neuroprotective chemicals, physical rehabilitation, hyperbaric oxygen therapy, electroacupuncture, electrical stimulation of the spinal cord or specific peripheral nerves, nerve grafting strategies, 4-aminopyridine, chondroitinase ABC, and cell transplantation.
Highlights
Current treatment for acute canine intervertebral disc herniation (IVDH) can be divided into medical/conservative or surgical management
While application of a pulsed electromagnetic field (PEMF) device to the site of injury has been most widely studied in pain and wound repair, PEMF therapy has been reported to reduce back and neck pain in people and possibly improve recovery from spinal cord injury (SCI) in an experimental model in cats [9,10,11,12,13]
In a more recent clinical trial of acute paraplegic dogs with absent pain perception due to IVDH, no benefit was demonstrated for Polyethylene glycol (PEG) compared to placebo [36]
Summary
Current treatment for acute canine intervertebral disc herniation (IVDH) can be divided into medical/conservative or surgical management. Neither medical nor surgical management currently aim to repair the damaged intervertebral disc, nor heal the injured spinal cord, and there are limits to the recovery that can be attained. It has been reported that only about one-third of animal studies for any disease considered to have a high likelihood of translation into human medicine progressed to the clinical trial stage and even fewer were associated with any currently available intervention [3, 4] While this should not deter researchers and clinicians from seeking novel treatment options for the injured spinal cord, it does highlight the huge hurdles facing such work and underscores the difficulty of the problem. We have divided treatments in those delivered at or close to the injury site and those delivered systemically
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