Surgical Treatment for Intervertebral Disk Disease: A Reappraisal

Presentation Description / Summary: Since the time that surgical therapies were developed these treatments have been universally applied to dogs with a variety of spinal conditions. Most notably, decompressive-type surgical procedures have become standard of practice for surgical treatment of intervertebral disk disease. Unfortunately, after almost 70 years of application, it remains scientifically unclear and even debatable as to the spectrum of associated benefits relative to costs (financial and patient risk). This includes pre-surgically determining which patients will likely benefit from surgery versus non-surgical treatments and at what level of morbidity. Additionally, the assortment of technical standards of performance makes comparison of outcomes between individual surgeons problematic. Finally, there is no agreement upon surgical goals or specific medical outcomes. Because of 1) the ubiquity of surgical procedures performed annually and 2) the associated individual opinion/bias relative to surgical standards and outcomes, standard blinded randomized clinical trials are difficult to ethically justify even though this type of evidence would afford the true benefits compared to non-surgical therapies. This presentation will summarize and discuss/debate the known literature relative to this subject via a systematic review format with the goal of providing recommendations for future clinical decision-making algorithms relative to animals with intervertebral disk disease.

Learner Outcomes: Following this discussion, the clinician should be able to: 1) Articulate the aspects of spinal surgery where there is technical debate 2) Identify clinical outcome standards from historical scientific studies 3) Develop standards of performance to assess surgical outcomes