Thoracolumbar Disc Disease
Ulrike Wurth, BVSc, Dip Acup., IVAS Certified
Victoria, Australia

One of the earliest uses of acupuncture by Western medical practitioners was for the treatment of chronic back or neck pain, probably because Western Medicine had little to offer other than analgesics, or surgery. In many cases, although the patient was in a lot of pain, there were no lesions visible on radiographs. This is also the case with many of our veterinary patients.

PAIN

In Traditional Chinese Medicine, pain is the accumulation of Qi and Blood in the meridians. The Qi or Blood becomes excessive in a particular area either because the flow is blocked, or due to a deficiency of Qi, which no longer can move the Blood.

 Qi and Blood can be blocked by :

 trauma

 blood clots

 external pathogenic factors Wind, Cold and Damp

 Qi can become deficient by:

 prolonged illness or internal weakness

 scars

Acute Pain: due to excess Qi in the painful area. This is a sharp pain that is worse with pressure and exercise.

Chronic: due to deficient Qi. The body is weak and has insufficient strength to move the Qi. This is a dull pain that improves with pressure and exercise.

It is easier to treat an acute rather than a chronic disease, because it is easier to move Qi, than create it. Acute athletic type injuries, e.g., in the racehorse or greyhound, respond quickly to acupuncture treatment. These animals are fit and healthy and have plenty of Qi. In chronic cases, e.g., an old dog with arthritis, the treatment is longer and aimed at increasing the Qi as well as moving it.

THORACOLUMBAR DISC DISEASE

Thoracolumbar disc disease is a relatively common disorder in the dog. Unless there is major trauma, intervertebral disc disease is generally secondary to a degeneration of the disc. Pathology is due to combined vascular and mechanical effects. The severity of the pathology and symptoms caused by protrusion or extrusion of an intervertebral disc depends on three factors:

 the velocity of herniation

 the degree of herniation

 the duration of the compressive force on the spinal cord.

Effects of Disc Extrusion --Hansen Type 1

 haemorrhage, oedema and necrosis of the white and grey matter of the spinal cord.

 rupture of vertebral venous sinuses and haemorrhage into the epidural space.

 tissue oedema occurs within 5 minutes of trauma and lasts 20 days.

 within 30 minutes microscopic haemorrhages occur in the central grey matter of the spinal cord, followed by coagulative necrosis.

 vasospasm, vascular tears, thrombus formation and periaxonal swelling occur in the adjacent white matter. Because the dura mater is non elastic and the cord cannot expand, any swelling of the cord will further decrease the circulation to that area.

 progressive haemorrhagic myelomalacia can occur within24 hours without any additional mechanical compression.

 disc fragments and extra dural haemorrhage also cause spinal cord compression and decreases the circulation in the spinal artery and venous plexus on the floor of the spinal canal.

Effects of Disc Protrusion--Hansen Type 2

 a gradual spinal cord compression resulting in white matter changes such as demyelination, focal malacia, vacuolization and loss of axons.

These dogs are conventionally categorised into five types depending on the severity of the clinical signs.

Type

Symptoms

Prognosis

1

Spinal hyperaesthesia without neurological deficits

Good

2

Hindleg paresis +/-pain ambulatory

Good

3

Hindleg paresis, non ambulatory

Fair to Good

4

Hindleg paralysis with deep pain

Poor to Fair

5

Hindleg paralysis with loss of deep pain sensation.

Grave

TREATMENT

Because the actual tissue damage following trauma to the spinal cord occurs within the first 24 hours, any treatment to prevent tissue damage should be instigated during this time. After 24 hours, the treatment can only focus on the regeneration of the traumatised tissues. Most dogs have already had the problem for more than 24 hours by the time they are presented to the clinic.

Conservative medical treatment involves the use of antiinflammatory medical therapy, as well as strict cage rest preferably under veterinary supervision. Often the neurological dysfunction of the animal will get worse, if exercise is not restricted. Corticosteroids are still the most commonly used drugs for treatment of intervertebral disc disease.

ACUPUNCTURE

Clinical observation indicates that acupuncture rapidly relieves the pain and muscle spasm, stimulates the healing process and reduces the healing time.

Experimentally acupuncture has been shown to regulate the blood pressure within blood vessels and relieve spasms in lymph vessels, thereby improving the lymph circulation, and lessening the effusion and swelling that accompanies inflammation. During the inflammatory process, acupuncture has been shown to reduce the time needed for the cells to stop effusion, reduce spasm of lymph vessels and reduce capillary permeability. This can be particularly beneficial where there is haemorrhagic inflammation.

Acupuncture has also been shown to increase the rate of healing by increasing phagocytosis as well as affecting the pituitary adrenal cortex system which increases the body's resistance to disease. Acupuncture increases the excitability of nerves. This increase continues for several minutes after the needle stimulus and seems to be cumulative.

Points Used:-BL 60, BL 40, GB 34, GB 30, BL 23, plus the Bladder point above and below the lesion.

This combination of points uses the treatment principle of local and distal points. The points are listed in the order they are used. Needling the distal points first, relieves the muscle spasms of the back sufficiently to be able to needle the points along the back without causing the animal additional pain.

Acupuncture points can be stimulated using dry needling, Laser, and point injections. Dry needling is the most common technique. Point injection using saline, lignocaine, Vitamin B complex can be used. Electro acupuncture is contraindicated in acute spinal injury. It has been shown to release dynorphin at the spinal level. Dynorphin has been implicated as one of the hormones released with spinal cord trauma.

After the first treatment, it is important to hospitalise the dog with complete cage rest. The importance of this rest immediately after acupuncture was found to make a significant difference to the recovery time. The treatment is repeated within 24 hours. The dog is then treated on an outpatient basis according to the clinical symptoms, usually in 3-4 days, then weekly until recovery.

It has been observed by many acupuncture practitioners that dogs previously treated with corticosteroids have a slower recovery time. This has not been measured, but clinical observation would suggest it may double the expected recovery time.

CERVICAL DISC DISEASE

Only 16% of all intervertebral disc lesions occur in the cervical region. The primary presenting sign is a recurring, acutely painful neck. Treatment includes, conservative medical therapy, disc fenestration and acupuncture.

Type

Symptoms

Prognosis

1

Neck pain (includes front leg pain radiation)

Good

2

Neck pain + front leg and hind leg paresis + loss of proprioception

Good

3

Neck pain + front and hindleg paralysis

Poor

ACUPUNCTURE TREATMENT

The points used are: GB 34, SI 3, LI 11, GB 20, TH 15, GB 21 and any other painful points in the neck.

Acupuncture has been used successfully to treat intervertebral disc disease. It relieves pain, muscle spasm, stimulates healing, increases the excitability of nerves and stimulates nerve regeneration. It can be used for acute and chronic cases.

REFERENCES

1.  Acupuncture -A Comprehensive Text. Shanghai College of Traditional Chinese Medicine. 1983.

2.  Acupuncture in Animals, Proceedings No 167 Post Graduate Committee in Veterinary Science 1991.

3.  Bracken M.B., Shepard M.J., Collins W. F. et al. Methylprednisolone or Naloxone treatment after acute spinal cord injury : One year follow up data. J. Neurosurgery 76: 23 -31 1992.

4.  Deutschman C.S. Konstantinides F. N. Raup S. and Cerra F.B.: Physiological and metabolic response to isolated closed head injury -The effects of steroids on metabolism, potentiation of protein wasting and abnormalities of substrate utilization. Journal of Neurosurgery 66 1987.

5.  Ettinger S. J. and Feldman E.C.: Textbook of Veterinary Internal Medicine. Diseases of the Dog and Cat. 1995.

6.  Hall E.D. : The neuroprotective pharmacology of Methylprednisolone.J. Neurosurgery 76 13-22 1992.

7.  Janssens L.A.A.: Experimental spinal cord trauma in the rat -PhD Thesis 1990.

8.  Janssens L.A.A.: Acupuncture treatments for canine thoracolumbar disc protrusions -A Review of 78 Cases. VM/SAC 78 1584 1983.

9.  Janssens L.A.A.: The treatment of canine cervical disc disease by means of acupuncture, a review of 32 cases. J. Small An. Pract. 26 203, 1985.

10. McDonogh J.: The fenestration of intervertebral discs for thoracolumbar disc disease in the dog. Master of Veterinary Studies Dissertation. University of Melbourne 1990.

11. Salopsly R. M. Pulsinelli W. A.: Glucocorticoids potentiate ischaemic injury to neurones: Therapeutic Implications. Science 229 1397-1400 1985.

12. Still J.: Acupuncture treatment of thoracolumbar disc disease, a study of 35 cases. Compendium of Animal Practice, 2:19 January 1988.

13. Still J.: Analgesic effects of acupuncture on thoracolumbar disc disease in dogs. Small Anim. Pract. 30 298. 1989

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Ulrike Wurth, BVSc, Dip Acup., IVAS Certified
Victoria, Australia


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