Dr. Michael Bauer, Diplomate, American College of Veterinary Surgeons and owner of Colorado Canine Orthopedics @ The Veterinary Specialty Center

Medial patella luxation (MPL) is a common problem, especially in small and toy breed dogs. Poodles are the most common breed affected.               Large breeds and cats infrequently develop MPLs. In my experience, Akitas are the exception to this rule, developing patella luxations almost as often as toy breeds.

As the name medial patella luxation implies, the patella (knee cap), luxates (slips out of position) medially (toward the inward side of the leg) (Fig 1). The problem is believed to be congenital and occurs typically between 6 and 12 months of age. The disorder usually affects both rear legs (possibly to varying degrees).

    Figure 1-  (Left)                         Figure 2

Patella luxations can be categorized from mild to severe and graded from 1-4 respectively. Grade one luxations only luxate under digital pressure.      These patients are usually asymptomatic and usually do not require surgery. In grade 2 luxations the patella spontaneously slips in and out of position. Most dogs with grade 2 luxations experience mild to moderate lameness and often skip with the leg up for several steps when the patella is out. Then when the patella slips back into position the skipping temporarily resolves. Grade 2 MPLs usually require surgical repair. Grade 3 luxations are always out of position but can be reduced by digital pressure. Patients with grade 3 luxations experience mild to severe lameness, skip sometimes and almost always require surgery. Grade 4 luxations are always out and cannot be reduced by digital pressure. Patients with grade 4 luxations usually experience severe lameness and require surgical repair.

The most common clinical signs with MPL include limping and skipping with the affected leg or legs. A popping/clicking sound or feel may be heard or felt by the owner when the pet flexes and extends the rear legs. Clinical signs usually begin around one year of age. Infrequently, some dogs live for years with a MPL without clear clinical signs only to develop lameness in later life. In this scenario many times a cranial cruciate ligament rupture or tear is responsible for the late onset of lameness. In some patients with late onset of signs the cartilage wears through to the underlying bone causing acute pain and lameness.

The diagnosis of MPL is usually made on orthopedic examination although radiography (X-Rays) may also be helpful. The indications for surgery include presence of clinical signs, spontaneous luxation and the grade of luxation as mentioned above. Animals left untreated are prone to develop arthritis and may be predisposed to cranial cruciate tears (also known as ACL tears).

Typically, 5 surgical procedures are used to treat the majority of MPLs. A releasing incision is performed on the medial (inward side) of the joint to allow the patella to move in a lateral (outward) direction. The lateral joint capsule is tightened by a procedure called lateral imbrication. The grove is deepened where the patella normally glides. Several techniques are frequently utilized to accomplish this. Finally, the attachment point of the patella tendon is aligned with the remainder of limb. Either a tibial crest transposition or de-rotational suture can be performed for patellar tendon alignment (Fig 2).

The prognosis for MPL repair is excellent in animals with grades 1-3. At Colorado Canine Orthopedics patients can be comfortably discharged from the hospital the day of surgery. Healing time depends on the age of the patient and procedures employed. In puppies healing usually takes about 1 month. During this convalescent period animals can go on short leash walks, do lots of lap sitting but should not be permitted to jump from furniture or stairs. Following healing the patient can return to a normal, fully active life style.

Scot Swainson, DVM, Diplomate, American College Veterinary Surgeons

The spinal anatomy of dogs is not all that different from humans. Dogs have a spinal cord allowing for communication between the legs and brain, which is encased and protected by a spinal column made up of vertebral bones (cervical, thoracic, and lumbar) (Figure 1). Except for the very first two cervical bones, each vertebral bone is separated by a shock-absorbing intervertebral disc (IVD).

        (Figure 1)                          (Figure 2)

 At the juncture of each vertebral bone, just above the IVD, a small nerve root leaves the spinal cord and spinal column to extend into the body where it exerts it’s affect (Figure 2).

The main differences between D disease, (or IVDD). Dogs, (and for that matter cats), stress their spines a great deal everyday with routine activities. Each time a dog jumps up on the bed, jumps for the ball, or jumps into the back of the SUV, the spine is flexed and then acutely extended, putting increased forces at the low cervical, mid-thoracic, and especially lower lumbar spine. These recurring stresses can result in chronic fatigue and microscopic damage to the IVD. The other major difference between dogs and humans is the genetic predisposition to IVDD. The process is termed chondrodystrophy and is manifested classically in Dachshunds.

Disc herniations can be acute or chronic and result in an entire spectrum of clinical signs from pain only to complete paralysis. Chronic disc herniations result in gradual on-set of signs (Figure 2). The most common locations of chronic disc herniations are low cervical, mid-back (e.g., thoracolumbar, or T-L), and lower lumbar or lumbosacral regions. Dog breeds affected by chronic IVDD include: German Shepherds, Labradors, Golden Retrievers, Rottweilers, and Northern breeds. That being said, just about any dog can be affected by a chronic disc herniation. Usually chronic disc herniations cause pain but not paralysis.

Rapid, acute disc herniations occur most commonly in Dachshunds although other breeds include Cocker Spaniels, Basset Hounds, Corgis, some of the terrier breeds, and mixes thereof are also often affected (Figure 3). In these breeds, IVDs degenerate at a very early age, (even less than a year) and frequently results in more acute and severe disc herniations sometimes even resulting in paralysis.

Ultimately, the key to success in dogs with some form of disc disease is to have them evaluated by a veterinarian surgeon sooner than later. As mentioned above, disc herniation can result in various signs from pain to staggering to paralysis. Acute onset of paralysis or severe staggering is an emergency and these patients may require surgery as soon as possible. Even in the more chronic cases with pain only, early evaluation is key to ensuring the well-being of your pet.

Management of disc disease can be medical or surgical or both. In patients with pain only, medical management including CAGE REST, CAGE REST, CAGE REST plus or minus glucocorticoids (steroids) and analgesics is usually recommended. Patients with recurrent painful episodes may also benefit from surgery. In dogs with paralysis, surgery is unquestionably the treatment of choice. Surgery involves removing the herniated disc from the spinal canal thus removing spinal cord compression. Dogs with sudden onset of paralysis that still have sensation in the toes and dogs with recurrent episodes of pain have an excellent prognosis with surgical treatment. The bottom line is this: if your pet has any of the above mentioned clinical signs please see your veterinarian surgeon or veterinarian neurologist.

Dr. Michael Bauer
Diplomate, American College of Veterinary Surgeons and owner of Colorado Canine Orthopedics @ Veterinary Specialty Center

Anterior cruciate ligament (ALC) tears represent the most common orthopedic problem in small animals. The underlying cause of canine ACL tears remains somewhat unclear. Unlike humans, dogs usually tear their ACLs gradually rather than all at once. The problem is an insidious biomechanical injury rather than acute athletic trauma. Because of this biomechanical wearing, 40% of dogs that tear one side will someday tear the other.

Clinical signs of ACL tears are quite variable. Some dogs become carrying leg lame while others have a slow onset of lameness that varies from day to day. Almost all dogs with ACL problems sit with their affected leg off to the side.

Tentative diagnosis of ACL tears involves clinical examination and radiography (X-rays). The definitive diagnosis should almost always be made using non-invasive arthroscopy. Arthroscopy can be used to confirm the diagnosis, thoroughly inspect the meniscus and other intra-articular structures and debride (clean-up) the ACL and meniscus.

Treatment of ACL tears has always been changing and opinionated. Virtually all veterinary surgeons agree canine ACL tears become debilitating if left untreated. The history of canine ACL repair started long before I became a veterinarian 27 years ago. ACL repairs are classified as either replacement versus biomechanical techniques.

Replacement techniques were the first attempts to repair canine ACL tears. These repairs were modeled after techniques used in humans. The first canine technique advocated using a strip of skin to replace the ligament. This idea evolved into using the patient’s fascia (Under and Over) as well as a portion of the patellar tendon (Over the Top). Fishing line also became a commonly used material for replacement. These techniques became popular during my residency in the early 80s. Another technique introduced in the early 80’s was the Fibular Head Transposition, which changed the orientation of the lateral collateral ligament to mimic the ACL. Most of these techniques have fallen out of favor.

More recently, a special type of suture material, passed through bone tunnels has been described. This new replacement technique is called the tightrope procedure (figure 1). The material is stronger than any other material available and the placement using bone tunnels positions the material in the most ideal orientation. Initial information collected regarding the effectiveness of the technique looks encouraging.

   Figure 1

Biomechanical techniques have become popular over the last 12 years because replacement techniques were not producing results many pet owner and veterinarians were satisfied with. Biomechanical repairs change the sliding motion of the femur on the tibial plateau inherent in canine knees but not so in humans. Consequently, biomechanical techniques are unique to canine orthopedics.

The tibial plateau leveling osteotomy (TPLO) was the first and still is the most accepted technique in this group (figure 2). The TPLO involves making a curved osteotomy in the proximal tibia, rotating and leveling the tibial plateau and fixing the osteotomy in place with a small bone plate.

The tibial tuberosity advancement (TTA) is a newer biomechanical technique that alters the orientation of the patellar tendon (figure 3). In this case a longitudinal osteotomy is performed just behind the tibial tuberosity, the bone is advanced and fixed using a specialized bone plate.

And the winner is????? Despite hundreds of thousands of canine ACL repairs performed, the best technique is still not unanimously agreed upon by veterinary surgeons. Hopefully, clinical research will clear up this ongoing discussion in the near future. In the mean time, veterinary surgeons will recommend the technique that works best in their hands. This is certainly the case with the numerous human ACL repair techniques available.

In the United States the TPLO is by far the most commonly performed ACL repair technique. It is the gold standard that all other techniques are compared to. The doctors at Colorado Canine Orthopedics have preformed well over 10,000 ACL repairs including, Under and Over, Over the Top, Fishing Line, Fibular Head Transposition, TTA, Tightrope, and TPLO. We have performed thousands of replacement techniques, hundreds of TTAs and thousands of TPLOs. Each of our three board certified surgeons performs the procedure they believe offers the best results with the least complications or failures. All three agree the TPLO is, at this point, the superior technique. Occasionally, we perform one of the other techniques in unique situations, but the bottom line is if one of our dogs, or our employees’ dogs or relatives’ dogs or our friend’s dogs tore their ACL the TPLO would be (and has been) the technique of choice. If you would like to discuss the pros and cons of any or all available ACL repairs, please contact us for a consultation at (719)-264-6666.

For more information about the TPLO surgery and other orthopedic procedures please visit www.CanineOrtho.com.

Scot Swainson, DVM, Diplomate, American College Veterinary Surgeons

Hip dysplasia, (abnormal development of the hip joint), is one of the more common causes of rear limb pain and lameness in dogs. A more normal hip is basically a simple ball and a socket [Figure 1]. The socket, also called the acetabulum, forms a sphere, and is located within the pelvis bones. The ball, also called the femoral head, forms a smaller sphere, and is found at the top of the femur (thigh bone). Ideally, the center of the ball sphere should line up with the center of the socket sphere when the ball is placed within the socket. Dogs with hip dysplasia do not have this perfect fit [Figure 2], which results in a “loose” hip where the ball bounces around within the socket, leading to the development of arthritis [Figure 3].

  Figure 1.  Normal Hips - (Left)       Figure 2.  Yound Dog with Loose Hops (Right)     

  Figure 3.  Older Dog with Progressive Arthritis

A common misperception regarding hip dysplasia is that it is mainly a problem in middle age-to-older dogs once the arthritis sets in. Hip dysplasia is actually a disease process that dogs are born with and develop arthritis, pain and lameness from over time. The ideal scenario would be to diagnose those puppies with loose hips at an early age, with the goal of providing early treatment to help decrease the amount of hip arthritis and associated hip discomfort and lameness. Routine x-rays have been used to diagnose arthritic hips as well as certify dog hips for breeding purposes for years. The problem with these x-rays is that they are not as dependable for predicting loose hips in young dogs (4 months to 2 years of age). Thus, a new technique has been developed at the University of Pennsylvania. The technique, PennHIP® radiography, is an x-ray technique whereby the hips are put under tension during the x-ray. This tension allows for identification of those dogs with loose hips, which are more susceptible to the development of arthritis.

PennHIP® radiography has been found to be the best predictor of future hip arthritis development in the young dog. In other words, we can identify those puppies with loose hips before more significant arthritis has developed. PennHIP® radiography can be performed as early as 4 months of age whereas the traditional x-ray technique for hips is not certifiable until 2 years of age.

PennHIP® radiography has stimulated the development of a new treatment option for the young puppy, Juvenile Pubic Symphysiodesis (JPS). JPS involves the fusion of a growth plate within the pelvis. All bones have what are called cartilage growth plates, which are how the bones form their shape and length. Fusion, or stoppage of growth, of a growth plate will alter the shape and development of the affected growth plate and bone.

JPS alters the pelvis development with the ultimate result of the ball and socket fitting much more “tightly,” therefore, decreasing the amount of future hip arthritis. Also, compared to other more traditional surgeries for hip dysplasia, JPS is a much easier technique, is less invasive, less costly, and is a more simple recovery for dogs. JPS should not be thought of as a definite complete cure for hip dysplasia, but can significantly improve hip joint conformation and lessen the long-term affects of hip arthritis.

Today, we now have the tools to better diagnose early, those young dogs with loose hips predisposed to hip arthritis and provide a new, more simplified treatment before the negative issues of hip arthritis have developed.

Dr. Michael Bauer, Diplomate, American College of Veterinary Surgeons
Owner, Colorado Canine Orthopedics @ the Veterinary Specialty Center   

Dogs between six to twelve months of age can develop one of several disorders known as juvenile bone diseases. These conditions occur commonly in large breed dogs. Small and toy breed puppies are less prone to orthopedic problems and similar conditions are rare in cats. 

Most juvenile bone diseases have a genetic predisposition although environmental factors, such as over feeding, have been implicated as well.

Osteochondritis dissecans (OCD)

Osteochondritis dissecans is a disorder involving cartilage and the underlying bone (subchondral bone) of major joints of in young large breed dogs. The interface between the cartilage and bone fails to develop in a normal sequence leading to cell death and weakening between the layers. Normal weight bearing stresses cause tearing and separation of the cartilage from the subchondral bone resulting in a cartilage flap. The shoulder joint is most commonly affected although OCD also occurs in the elbow, knee (stifle) and ankle (hock) joints. Osteochondritis dissecans is often a bilateral condition (affecting both the right and left sides). Moderate to severe lameness is the most common clinical sign. Diagnosis is based on radiography (x-rays) and arthroscopy (fig. 1).

     Figure 1 - Cartilage flap underlying bone

The most common treatment is arthroscopic removal of the flap and prognosis is dependent on the joint involved. Full recovery can be expected for shoulder OCD however the prognosis is less favorable for other joints.

Elbow Dysplasia

Elbow dysplasia is mal-alignment of the elbow joint. Mal-alignment results in rubbing, cartilage erosions and osteoarthritis. Bony protuberances may fail to attach to the primary bone during development and become fragmented. Fragmented medial coronoid process is an example and is considered a subset of elbow dysplasia. Young large breed dogs are most commonly affected. Mild to severe lameness is the most common clinical sign. The condition is often bilateral. Diagnosis is made based on clinical signs, radiography and arthroscopy (fig. 2).

     Figure 2 - Fragmented medial coronoid

CT scans can also be used for diagnosis. Treatment involves arthroscopic removal of any fragments present, and in some cases bone realignment is necessary. Stem cells are also being used as an adjunctive treatment. Prognosis depends on the severity of the mal-alignment. Young German Shepards have a unique elbow problem called ununited anconeal process. Clinical signs and diagnosis are similar to elbow dysplasia. Arthroscopy followed by ulnar osteotomy is the recommended treatment. Prognosis also varies and is dependent of the severity of the problem.

Panosteitis

Panosteitis is an inflammatory disease of unknown cause affecting the bone canal of young dogs (6-10 months). German Shepards are often affected although any large breed dog can develop panosteitis. The most common clinical sign is moderate to severe lameness that may shift from one leg to another. Diagnosis is based on physical examination and radiography. Panosteitis is usually self-resolving within a few weeks to months and aside from anti-inflammatory pain medicine, no treatment is needed.

Hip Dysplasia

Hip dysplasia involves malformation the hip joint resulting in osteoarthritis. Young large breed dogs are most commonly affected although middle aged to older dogs may develop clinical signs as osteoarthritis progresses. Because the disease often affects both hips, clinical signs may be unclear. Lameness, lack of ability to jump into the car or onto the couch, and a bunny hopping gait are common clinical signs. Unlike dogs with ACL tears, dogs with hip dysplasia usually sit in a neat tight manner versus off to the side. Diagnosis is based on radiography. Treatment depends on the severity of the problem. For dogs with ongoing clinical signs, non-cemented total hip replacement offers an excellent treatment for the life of the patient.

Medial Patella Luxation (MPL)

Medial patella luxation is malpositioning of the knee cap (patella) and most commonly affects young small and toy breed dogs. The condition may occur in cats and large breed dogs as well. The most common clinical signs are limping or holding the leg up for a few steps and usually occur at about one year of age. Diagnosis is primarily made by physical examination. Treatment involves realignment of the patella and the prognosis is usually good to excellent.

If you feel your dog might have a juvenile bone disease please contact us at 719-264-6666 for a consultation at Colorado Canine Orthopedics. To learn more about our practice please visit www.CanineOrtho.com.

Michael S. Bauer DVM, Diplomate, American College of Veterinary Surgeons
Colorado Canine Orthopedics at the Veterinary Specialty Center

What is hip dysplasia?
Hip dysplasia is a malformation of the hip joint. In most cases, the ball and socket do not fit together correctly. The ball can be mal-shaped, the socket can be too shallow and the ball can be poorly “seated” within the socket, or all of the above.

Over time, the hip becomes arthritic because of these anatomical abnormalities. These secondary arthritic changes (dogs and cats almost never develop arthritis without an underlying anatomical reason) can develop quickly; puppies with severe hip dysplasia can develop severe arthritis before their first birthday.

What are the causes of hip dysplasia?
The primary cause of hip dysplasia is genetic. Parents with hip dysplasia are more likely to yield puppies with hip dysplasia, although breeding normal parents does not ensure the puppies will be free of hip dysplasia. Overfeeding puppies can also result in hip dysplasia. And finally, trauma can cause hip malformation and secondary arthritis which looks similar to hip dysplasia.

What breeds get hip dysplasia?
Any dog or cat can develop hip dysplasia. However, hip dysplasia is most common in large to giant breed dogs. Saint Bernards, rottweilers, German shepherds and Labrador retrievers are a few examples.

What are the symptoms of hip dysplasia?
Dogs with hip dysplasia can exhibit a variety of clinical signs. Bunny hopping, reluctance to go for long walks or play or jump into the car, standing or walking with the feet close together, and slowing down in general, are common clinical signs. These signs usually come on gradually. Dogs with acute, clear-cut lamenesses usually have a different problem, such as ACL tears. Many dogs with hip dysplasia coincidentally also develop ACL tears that can go undiagnosed for long periods. The best way to differentiate between the two is to observe the sit pattern. Dogs with bad hips can sit perfectly. Dogs with bad knees (ACL tears) have difficultly sitting, are reluctant to sit on command and sit to the side or all the way back on their tail bones, somewhat resembling a bear.

   Arthritic Hips                                                                   Good Hips

What can be done to confirm the diagnosis of hip dysplasia?
Palpation of the hips may aid in the diagnosis of hip dysplasia. However, radiographs (X-rays) are usually needed to confirm the diagnosis. If the radiographs do not support the diagnosis of hip dysplasia, an ACL tear should be strongly considered.

What are the treatment options for hip dysplasia?
Four general options are available to treat hip dysplasia. The first option is non-surgical management. Many dogs with mild to moderate hip dysplasia can live with the problem fairly well. Weight management and moderate exercise is usually appropriate. Some need some form of added pain management. Non-steroidal anti-inflammatory drugs, such as Rimadyl or even aspirin may be needed either daily or intermittently depending on the severity of the problem. Glucosamine and other holistic products may be helpful as well (these options should be discussed with your family veterinarian). Acupuncture is also effective in pain relief. Stem cell therapy is the latest treatment for hip dysplasia, which shows promising results.

Lastly, if the clinical signs are severe, surgical intervention may be needed. Three surgical options exist: femoral head ostectomy (FHO), triple pelvic osteotomy (TPO), and total hip replacement (THR).

Femoral head ostectomy (FHO) is best suited for cats and small dogs (5-30 pounds). FHO involves removal of the ball from the ball and socket joint. Scar tissue forms between the bone and forms a “false joint”. The primary advantage of the FHO is lower cost, since no implants are needed.

Triple Pelvic Osteotomy (TPO) involves making three cuts in the pelvis and tilting or rotating the socket to bring the ball and socket into a more normal position. A specialized bone plate is applied to hold the bone in position during healing. TPO is best suited for young dogs prior to the development of arthritis (ideally under nine months of age and certainly under one year of age). Dogs that undergo TPO at our hospital are discharged the day of surgery, use the operated leg that evening and are doing very well within 1-2 weeks.

Total hip replacement (THR) is the ideal treatment for dogs with hip dysplasia. In about 95% of dogs, the results are excellent. From running, hiking, biking or horseback riding companions, to back yard dogs that love to chase a tennis ball, THR affords an active lifestyle.

Two general types of canine THRs are available, cemented and non-cemented. The new state of the art non-cemented THR (also known as the Kyon or Zurich hip, developed in Switzerland in 1996) is superior to the older cemented implants. Non-cemented THR can also be performed on dogs as young as six months of age. Over the past year we have performed numerous TPOs on one side and THRs on the other. And although TPOs do well, THRs are better. Dogs that undergo THR at our hospital are discharged the day of surgery, use the operated leg that evening, are doing great within 1-2 weeks and are usually perfect by 4-6 weeks.

  Total Hip Replacement

What is the prognosis for dogs with hip dysplasia?
The prognosis for dogs with hip dysplasia is dependent on the severity of the problem and the treatment employed. Many dogs can live with hip dysplasia using medical treatments to control pain. In cases where the dog’s (and owner’s) life style is impaired, surgical options are available. Ninety-five percent of dogs who undergo total hip replacement have perfect hips for life.

To learn more about our doctors and services visit us at www.CanineOrtho.com.

Arthroscopy: ‘We’ll Show You Around the Joint’

Dr. Michael Bauer, Diplomate, American College of Veterinary Surgeons
Owner, Colorado Canine Orthopedics @ the Veterinary Specialty Center   

Most of us dog lovers/owners have heard about Anterior Cruciate Ligament (ACL) tears, Elbow Dysplasia and Osteochondritis Dissecans (OCD) affecting the elbow, shoulder, stifle and hock joints. What do all of these problems have in common? They are frequently encountered canine orthopedic problems, they all involve joints and all patients with these common problems can benefit from the diagnostic and therapeutic advancements in veterinary arthroscopy.

 (Elbow Joint - Severe Cartilage Erosion)            

  (Normal Elbow Joint)

What exactly is arthroscopy you ask? Arthroscopy is a surgical technique used to visualize, diagnose and treat intra-articular (inside a joint) problems. The word comes from two Greek words, "arthro" (joint) and "skopein" (to look). The term literally means, "to look within the joint." In an arthroscopic procedure, a small nick is made in the skin and a half pencil-sized instrument that contains a small lens and lighting system to magnify and illuminate the structures is inserted into the joint. Light is transmitted through fiber optics to the end of the arthroscope and a miniature television camera connected to a monitor enables the surgeon to see the interior of the joint through a very small incision rather than an open surgical approach.

Arthroscopy has revolutionized the way we diagnose and treat many joint injuries and disorders. At Colorado Canine Orthopedics, we have been performing arthroscopic procedures for about a decade.

Over the past 10 years, technological advancements in arthroscopic equipment have resulted in a clearer, crisper and brighter picture. Accurate color reproduction and greater depth of field has enhanced the surgeon’s ability to view intra-articular structures accurately. Scopes and cameras have become more compact, more ergonomic and easier to handle. Newer technology has also allowed intraoperative still and video photography. At Colorado Canine Orthopedics we archive an intra-articular video of all patients undergoing an arthroscopic procedure. If a patient ever has an additional problem within the joint, we have an accurate video record for comparison.

In most cases arthroscopy is used as a diagnostic tool as well as a treatment modality. The most common uses in canine patients involve juvenile bone diseases and ligament injuries in the stifle (knee) and glenohumeral (shoulder) joints. Arthroscopy is minimally invasive and allows for more thorough as well as magnified inspection of the joint. Diagnoses can be made that would otherwise be missed by the naked eye, open arthrotomy. As an example, we can diagnose early partial ACL tears that precede the development of osteoarthritis. These patients can experience moderate to severe lameness with only a small partial tear that was all but impossible to identify prior to advancements in arthroscopic equipment and skills. In fact, arthroscopy is so accurate, expensive diagnostic imaging techniques such as MRI can be avoided in some instances.

Once a diagnosis is made many conditions can be treated arthroscopicly. By avoiding open surgery, post-operative discomfort is minimized, recovery is significantly quicker and hospitalization time is shorter. While arthroscopy is not inexpensive, quicker recovery, shorter hospitalization time and avoidance of redundant diagnostic imaging techniques may actually reduce overall cost.

The surgeons at Colorado Canine Orthopedics have performed thousands of arthroscopic procedures. If your pet has a joint disorder such as an ACL tear, arthroscopy should play an important role in the diagnosis and treatment of the problem. With today’s technology and available veterinary specialists almost no canine joint should undergo an open exploration. Examples of video and still arthroscopic images can be found on our website at www.CanineOrtho.com.

Dr. Todd Riecks, Diplomate, American College of Veterinary Surgeons,  Colorado Canine Orthopedics @ the Veterinary Specialty Center

Intervertebral disc disease (IVDD) is most common in canines. By far, the most common breed affected is the Dachshund, with other high risk breeds including the Beagle, Pekingese, Shih Tzu, and Lhasa apso. Clinical signs include spine-associated pain, ataxia (“drunken-sailor walk”), and paresis (weakness) or plegia (paralysis). Persistent trembling, stiff walking, hunched back or stiff neck, anorexia, or random vocalization can be signs of spinal pain. Walking on the tops of paws (knuckling), tripping/falling/crossing over of limbs, dragging of one or both hind limbs, and/or holding a limb up at a time of rest can indicate spinal associated weakness. Signs can be acute/sudden in onset or insidious with progressive weakness over time.

There is an intervertebral disc (“between” vertebra) at every vertebral space in the canine spine, save the cervical vertebral space at cervical vertebra one and cervical vertebra two (C1-C2). The discs are positioned below the spinal canal and facilitate shock absorption and fluid movement of the vertebral spine. Their basic anatomy is similar to a “jelly-donut” with a dense fibrous outer layer or annulus (donut) and a gelatinous center or nucleus (jelly filling). The outer annulus has an intimate association with its vertebral bodies on either side providing spinal column stability. These discs can degenerate over time, loosing their water content and thus their shock absorbing capabilities. In the predisposed breeds, this happens at a very early age (8 months – 2 years of age) with 75% of intervertebral discs undergoing some degree of degeneration by year 1.

   Disc Degeneration

Once disc degeneration occurs, they are predisposed to slowly “bulging” due to a combination of a weakened annulus and hardening nucleus (Figure 1A) or acutely herniating with a sudden rupture of the annulus and projection of the nucleus into the spinal canal (Figure 1B). Either way, clinical signs as described above are a result of the ongoing compressive force on the spinal cord (a mass occupying space in the spinal canal) and/or the percussive force to the spinal cord that occurs with acute herniation.

Treatment can be medical or surgical depending on the severity of the presentation and clinical history of your dog. The key to medical therapy involves 3-5 weeks of rest with judicious use of antiinflammatories and pain medications. Surgical intervention involves removal of the disc within the spinal canal that is causing spinal cord compression. Surgical decompression requires a high level of expertise and specialized surgical equipment. Which decision is right for your dog should be explained to you by your family veterinarian and a consultation with a surgical specialist. Of all possible presentations of severity ranging from pain only to paralysis representing 80% of dogs with clinical signs attributed to IVDD, 85-90% have a chance for full recovery. Owners must be aware that spinal cord healing is prolonged, with an average recovery time of 6 weeks even with surgical correction. Dachshunds as a breed have a 25% chance of having another herniated disc in their life time while all other breeds have a 10% risk of recurrence.

How can we as owners prevent or slow disc degeneration? Obese dogs are logically putting more strain on all joints including vertebral. Keep your dog active and at their ideal weight and the risks are reduced.

For more information about orthopedic conditions and treatment visit http://www.CanineOrtho.com