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Spondylosis and other possibilities
Spondylosis deformans or spinal arthritis and pain control
Spondylosis
Discospondylitis
Is it Spondylosis?
Spondylosis causes
Spondylosis
Spondylosis or other possibilities
also see Arthritis
also see Lameness
also see Neurological Problems
also see Orthopedic Problems
also see Spinal Disc
Spondylosis and other possibilities in German Sherpherd mix
Question: Dear Dr. Mike,
First let me thank
you for the time to answer my question.
Recently we took our
8yr. old german shep. mix to the vet to
have 2 fatty tumors removed.
Right before that we noticed that she had some tenderness in her tail
where to connects to the body. So while she was under for the stitches
removal, from the surgery, we asked the vet to look into the tail and
get some
x-rays of the area to see what was going on. We advised him that suddenly
at
times and a whole day she wouldn't sit, she was in so much pain.
Well the x-rays were done
and he informed us that she had
terrible arthritis in that area. I also saw the x-rays. The calcification
had
formed arches above and below each tail bone until about 3-4 bones
down from
the body.
Shocked by this I asked him what caused it, and how do we treat this
condition. Well he said it was a trauma of sorts some time ago
even
as a puppy, at the tail area (pulling, falling). Well that is a possibility
since we got her from the pound at 7 months. She has fallen as well,
jumped
off deck and fell in the area, but we didn't notice any problem then.
She
also has a habit of chasing the tail, since a pup. She sits on the
floor
putting all balance and weight on that area and spinning around until
she
caught the point. She would do this for at least 20 mins. a day as
entertainment,
it was standard procedure after or during outside play or fetching.
My question come from
his recommendations for treatment.
First he has prescribed 50 mg. of Rimadyl 2x Day.
If the medication seems to have no effect the next option would be
Tail Amputation.
Well, I am not sure of that drastic measure. She seems to have more
discomfort and pain when it rains or is humid out and on those days,
the medication seem to have no effect, other days she is fine.
I do not think the medication is helping. Before she was taking it
she
was the same. Bad when it rained and fine other days.
I want a second opinion before considering amputation, and I do not
believe that it will help the area that is closest to the body. she
will still
have arthritis in that area and trouble sitting. I am and have been
in
search of a specialist that deals with this kind of arthritis in the
tail but
have gotten nowhere in 2 weeks.
Have you ever heard of this problem before and do you know of any
treatment, surgery, and/or specialists in the NY area that would know
of this?
As of now I am considering taking her to the University of Pennsylvania
Vet
Hospital to seek treatment.
Another question is about these Vet referrals, I have been asking
around and you need a referral to see any other vet or specialist.
Is this now
standard procedure?
Again thank you for time and answers.
Tammy & Bela
Answer: Tammy-
From your description it sounds like the X-rays are showing a
condition referred to as spondylosis. It is not possible to be certain
of this
without seeing the X-rays, but it is very common. This is a normal
aging change in many dogs. It is highly unusual for it to cause significant
pain or disability. The amount of visible calcium deposition can be
startling even when there is no correlation at all with pain.
This doesn't necessarily mean that your vet's current treatment plan
is
a bad one. It seems appropriate to try to determine if non-steroidal
anti-inflammatory medications such as carprofen (Rimadyl Rx) will work
to control the pain and discomfort. Since this doesn't appear to be
working, though, you probably will need to consider something else.
There are several possible causes for the signs that you are
seeing. German shepherds sometime suffer from spinal disc disease
and
they can have lumbosacral instability that may lead to the clinical
signs
you are seeing. If these conditions are present, MRI examination is
the
best diagnostic test but a CT scan or myelogram may also offer the
ability
to make the diagnosis. It is important in a German shepherd to carefully
examine the rectal area for perianal fistulas. This is a painful
condition that makes dogs very uncomfortable and can make them reluctant
to sit
down. This condition is often inflammatory enough to be pretty obvious
but in
some dogs it isn't noticeable unless someone is specifically looking
for it. An older treatment for this condition is tail amputation (and
it
may still be done in some cases) but there is a pretty good medical
treatment now. Anal sac disease can cause discomfort when sitting and
sudden pain
in the tail area, as well. Since she put a lot of pressure on her tail
as
a pup, there is probably some chance of a painful tail injury and
sometimes tumors form around the tail gland but a tumor should be a
visible
problem.
I do think that it would definitely be best to get a second opinion
from a veterinary specialist before considering tail amputation. It
is a
little hard to tell you where to start, but I think that I would request
that
the X-rays be reviewed by a board certified radiologist. If the radiologist
feels that there is a visible cause for the problem then you would
know
whether to ask for referral to a veterinary neurologist or veterinary
orthopedic surgeon for the spinal problem. If there is nothing visible
on the X-rays and you have any suspicion of a rectal problem, an internal
medicine specialist might be a better choice. If there is nothing
visible on the X-rays and no sign of rectal problems it would be best
to go to
the vet school because they will have all three specialists -- and
obviously this isn't a bad choice for any of the other problems, either.
In most cases veterinary specialists do require a referral from a
patient's veterinarian prior to seeing a patient. Not all require this,
though.
If your vet won't refer you then find a vet who will. Most vets have
no
problems with referring to a specialist, although they often prefer
one
specialist over another and it is usually OK to follow the vet's
recommendation on the specialist.
Good luck with this.
Mike Richards, DVM9/12/2001
Spondylosis deformans or 'spinal arthritis', pain and prednesone - Pom
Question: Dear Dr. Richards,
Princess is starting off at 0.5 ml. of a 5 mg/ml solution of prednisone
at
2x per day for 3 days, then 1 dose per day for the next 3 days and
every
other day thereafter. Please explain what the purpose is of the
tapered
dosages. Someone told me that this is being done for the purpose
of
allowing the body to continue making its own predisone?
How can we know if Princess is experiencing pain from the disc?
When she
was examined by the vet a few days earlier, the vet said she could
not
elicit any reaction of pain in the suspected areas. X-rays were
taken
earlier last month and the vet who examined her then showed us her
spine is
a little humped (as in old lady hump) and showed that the lower spinal
area
shows signs of developing arthritis. I am just wondering
if her inability
to get up on her own last week could have been due more to the arthritis
than an actual disc problem. But I think this probably requires
the work
of a vet. back specialist to make the final determination?
Just a few
minutes earlier she was making a nest from a pile of old clothes when
I
heard a thump. I saw her sitting on her butt. She then
picked herself up
and walked a few yards when it seems her hind legs gave way momentarily.
Incidences such as these concern us greatly.
All I can say and sense at this point is that there are times
when
Princess shows some energy, although the expression on her face gives
the
impression that she is not totally happy or even tired. On the
other side
there are also times when she does appear to be happy and energetic,
almost
like her real self.
Sincerely, Tony
Tony-
It is much more likely that a dog with signs of spinal problems has
a disc
disorder than that visible excess bone along the vertebrae, spondylosis
deformans --- often referred to as 'spinal arthritis', is causing the
pain.
In a couple of pretty large studies of dogs there was a high incidence
of
visible spondylosis deformans on X-rays and no correlation at all with
lameness or pain.
It is very hard to determine if pets are in pain since they are often
pretty good at hiding it or are just willing to accept it and function
anyway. For this reason, if a problem is usually painful in humans
it is
best to assume that it is painful in pets and just treat accordingly.
I can
attest to the pain associated with disc herniation and am very quick
to
treat patients with pain medications due to this personal experience.
Prednisone is a corticosteroid. The body makes its own corticosteroids
and
these are essential to the body (all mammal bodies, as far as
I
know). These hormones are regulated by the brain, which stimulates
production when levels are too low and inhibits it when levels are
too
high. The dosage of corticosteroids used as anti-inflammatory
medications
is high enough to turn off the body's own production of corticosteroids.
If
this situation goes on long enough, the body won't be able to respond
to a
need for cortisones when one arises. Early in the use of cortisone
this
need was not recognized and some patients died when corticosteroids
were
withdrawn abruptly. The risk of this is minimized by using the medications
on an every other day basis. In addition, there is less immune suppression
and a general lowering of other side effects, such as increased drinking
and urination. For all of these reasons it is a good idea to use
corticosteroids on an alternate day basis whenever possible.
Mike Richards, DVM
2/22/2001
Question: My ten-year-old dog has been diagnosed with calcium deposits on her spine. This was discovered with x-rays when she couldn't walk. A cortisone shot and follow-up medication helped with pain relief and she now seems back to normal. However, I would think that the calcium deposits continue to cause some pain on a daily basis.
Is it a good idea to give her doggy aspirin each day? Or is there some
other type of treatment to increase her
comfort level? We walk 1.25 miles each day and sometimes she lags behind.
Should we cut short her walk or is
the exercise good for her back? If only she could talk!
Anne
Answer: Anne-
Spondylosis is the term used to describe the usual cause of accumulation
of new bone (calcium
deposits) around the spinal vertebrae. Usually, this condition does
not cause discernible pain or
disability. However, there are dogs that do seem to experience one
or the other problem as a result
of this condition. There is no clear answer to the question about whether
to keep up with exercise or
not. My personal opinion is that it is better to continue with moderate
exercise, though. If aspirin
seems to help, it seems reasonable to continue to use it, to me. If
it stops working there are more
potent pain relievers, such as carprofen (Rimadyl Rx), etodolac (Etogesic
Rx) or
hydrocodone/acetaminophen combinations. It is usually possible to make
older patients with minor to
moderate arthritis problems comfortable with some combination of medications.
Mike Richards, DVM
1/4/2001
Q: I have a question about my pit bull. He is 11 years old and is in perfect health except for slight hip dysplasia and mild spondylosis. About 3 weeks ago he fell in the water while getting out of our boat and when he got out of the water, he was staggering all over the place. He seems to have lost some control of his rear legs. We have been to 4 or 5 different vets and yesterday we went to LSU in Baton Rouge with him. They took x-rays and they showed a cloudy area in one of his vertebrae. The doctor did not want to do surgery on him because he is still walking and seems to get around okay with just a little stagger in his walk. She seemed to think it is an infection in his spine and started him on 750mg of Keflex a day and told me to wait a week and see if he improves. He is also on 4 75mg Rimadyl a day which keeps the pain down. He has normal urine and bowel movement. She also did not want to do a myelogram without going straight into surgery for risk of spreading the infection. Me and my wife are sitting here going crazy while we are waiting to see if the Keflex is going to work.
A: Richard-I hope that your pit bull is improving or healed by now. The description you give seems to match discospondylitis and the treatment is standard for that. It is tough to wait out problems like this but that is the best course of action in most cases. I truly hope your patience has been rewarded.
Mike Richards, DVM
Q: The sister to my Doberman began roaching her back when being "set up" (ie posed) at dog shows. She had a film done which revealed spondylosis. I am not positive which vertebrae it involves but I would assume the thoracic because of the area in her spine where the lump on her back is visible. My bitch had a slight bump in her thoracic area that I noted on occasion when she was about 14 weeks old. This resolved. About six months ago she leaped in the air while playing and severely twisted her back while in the air and then landed on her side. She did not move for several minutes after and then got up and was walking with a limp. She seemed fine afterwards so against my better judgment she did not go to the vet. All seemed fine until about 2 months ago when I noticed the lump on her spine again but this time it is more evident. I didn't put two and two together and link it with the fall until I found out what was wrong with her sister. She will be seeing an orthopedic surgeon in several weeks. My question is whether there is a hereditary predisposition to spondylosis or is this usually caused by trauma? What are the treatment options and will this condition worsen over time. P.S. The limp had resolved shortly after she came into the house .Thank You!
A: Spondylosis is very very common in dogs. It rarely causes clinically apparent disease and is most often found by accident when looking for something else. Whenever a diagnosis of pain or disability caused by spondylosis is suspected it is a good idea to be really sure that there is not another cause of the observed problem. There is a very good chance that is the case.
Having your dog examined by the orthopedic specialist is a very good idea. I think it is likely that spondylosis is not the problem but whenever this is suspected it is a good idea to get an opinion from a specialist.
Mike Richards, DVM
Q: Is spondylosis usually caused by trauma or is there a hereditary predisposition for it?. Is treatment medical, surgical or both?. Has Cosequin proved helpful? P.S. - I am not referring to CVI Thankyou !
A: Spondylosis is probably caused partially by some hereditary predisposition and by the wear and tear of life (or trauma if you prefer). It rarely causes clinical symptoms and most of the time does not require treatment at all.
Mike Richards, DVM
Q: My dog has Spondylosis and her x-rays show progressive changes in her spine. She has been on daily Ascripton for more than two years and Banamine when signs of pain occur. Recently she has been diagnosed with a condition which causes abnormal elimination - urine gets trapped in her fur and irritates the surrounding skin. My vet says this change in her anatomy is probably a result of the remodeling of her spine. What other changes can I expect? She is 12 years old and gets regular, moderate exercise and is not overweight. Will acupuncture help? Does it relieve pain or can it stop the progression of this disease? My veterinarian recommended waiting until pain becomes chronic. What about Coqasin? Are there any risks or side effects? My vet is reluctant to prescribe it. I really appreciate any information you can give me regarding this. Thank you.
A: I do not know if acupuncture would help with your pet's condition but there has been a lot of support for it and I don't see how it can hurt. I think it would be worthwhile to consider making a trip to one of the vet schools if that is an option for you. Getting a second opinion from the neurologist or orthopedic surgeons there may help. It would not be possible to tell you what further changes may occur without really knowing what the problem is and I wasn't able to be sure from your posting .
Mike Richards, DVM
Spondylosis or other possibilities
Q: Dr. Mike, I saw the one question regarding spondylosis, but would like to know more about the long term affects, and the best way to accomodate my dog, as far as not over doing the exercise, etc. He has been on Rimadyl for about 10 days now and I see no improvement. He limps all the time and I am worried about him completely losing the use of his back legs. Any recommended reading on this disorder? Thanx, L.
A: I am never sure how clear I have been when discussing spondylosis but just to be sure - I would never accept a diagnosis of spondylosis as the cause of lameness in one of my dogs without a lot of additional proof. This condition occurs so commonly with absolutely no clinical signs that it is hard for me to believe that it causes problems in many dogs.
There are a number of other problems that do lead to weakness in the rear legs. It is worrisome that carprofen (Rimadyl Rx) has shown no beneficial effect. We have not been using Rimadyl long enough to get a really good idea of when it will and will not work but I am always concerned that I have missed a problem that isn't arthritic in nature when it doesn't work. Examples would be degenerative myelopathy, spinal cord tumors and ruptured cruciate ligaments (partially arthritic in its effect).
Please let your vet know that Rimadyl did not help and discuss other possible problems with him or her. The recommendations for exercise and medications are not the same for all conditions so it is important to be absolutely certain what is going on if at all possible.
Mike Richards, DVM
Last edited 08/30/02
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