Clinical grading scale - references

This page contains additional detail and references to source papers on the clinical grading scale for IVDD in Dachshunds..

 

Your vet will assess your dog to determine the severity of the disease process. Dogs can be graded, with mildest cases being a grade 1, and worst-affected cases being a grade 5 (N.B. some clinics worldwide use a different or reversed grading scheme). The clinical grade helps in deciding which treatment is most suitable. Tracking your dog’s grade over time can also help your vet to work out whether your dog is getting better or worse. 

 

At grades 1 and 2, conservative (non-surgical) treatment is often a sensible first choice, though surgery may be indicated if the dog does not improve. At grades 3-5, surgical treatment gives a better chance of a successful outcome. 

 

IVDD diagnosis & prognosis:

Clinical grade

Findings on veterinary examination

Description

Prognosis with non-surgical treatment

 

Prognosis with surgical treatment

1

Normal gait

 

Paraspinal hyperaesthesia

Walking normally. Painful around affected area of spine.

70-100% dogs recover (i.e. pain resolves) 1,2,3,4

About 95% dogs recover to be more comfortable than before the op.

2

Ambulatory paraparesis

 

Paraspinal hyperaesthesia

Walking but weak and wobbly.

 

Painful around affected area of spine.

55-100% will walk fairly normally again.1,2,3,4

About 95% dogs recover to walk better than they did before the op. 5

3

Non-ambulatory paraparesis

 

Paraspinal hyperaesthesia

Unable to walk or stand unassisted.

 

Painful around affected area of spine.

55-80% dogs will walk fairly normally again.1,3,4

80-90% dogs will walk fairly normally again.5,6,7,8,9

 

Recovery times vary. Dogs typically walk within 1-3 weeks, though some take 2 months or more. 5,6,7,8

4

Paraplegia

 

Paraspinal hyperaesthesia.

+/-Urinary incontinence

No deliberate or voluntary movement of affected limbs.

 

Painful around affected area of spine.

+/- Loss of bladder control.

40-80% dogs will walk fairly normally again. 1,3,4,10

5

Paraplegia

 

Absent deep nociception in affected limbs

 

Paraspinal hyperaesthesia

 

+/- Urinary incontinence.

 

Loss of deep pain sensation in toes of affected limbs.

 

No deliberate or voluntary movement of affected limbs.

 

Painful around affected area of spine.

 

+/- Loss of bladder control.

Only up to about 30% of these dogs walk again without surgery.1,3,4

 

 

About 50-60% will walk fairly normally again.8,9,11,12,13

 

Recovery can take up to 9 months or more, though most “successful” dogs walk within 6-12 weeks.8,9,11,13

 

Delaying surgery >48 hours does not affect outcome8,13  (though of course these dogs are painful and need immediate care).

 

 

 

 

  1. Levine, J. M., Levine, G. J., Johnson, S. I., Kerwin, S. C., Hettlich, B. F., & Fosgate, G. T. (2007). Evaluation of the success of medical management for presumptive thoracolumbar intervertebral disk herniation in dogs. Veterinary surgery, 36(5), 482-491. A retrospective questionnaire-based study looking at non-surgical management. Out of 122 grade 1 dogs, 84 recovered (69%). Out of 63 grade 2 dogs, 35 recovered (56%). Out of 23 grade 3 dogs, 13 recovered (57%). Out of 12 grade 4 dogs, 6 recovered (50%). Out of 3 grade 5 dogs, none recovered.
     

  2. Mann, F. A., Wagner‐Mann, C. C., Dunphy, E. D., Ruben, D. S., Rochat, M. C., & Bartels, K. E. (2007). Recurrence rate of presumed thoracolumbar intervertebral disc disease in ambulatory dogs with spinal hyperpathia treated with anti‐inflammatory drugs: 78 cases (1997–2000). Journal of Veterinary Emergency and Critical Care, 17(1), 53-60. Out of 77 grade 1-2 dogs, 100% recovered, but around 50% then experienced a relapse.
     

  3. Davies, J. V., & Sharp, N. J. H. (1983). A comparison of conservative treatment and fenestration for thoracolumbar intervertebral disc disease in the dog. Journal of Small Animal Practice, 24(12), 721-729. Out of 8 grade 1 dogs managed non-surgically, 100% recovered. Out of 38 grade 2 dogs managed non-surgically, 84% recovered. Out of 10 grade 3 dogs managed non-surgically, 100% recovered. Out of 6 grade 4 dogs managed non-surgically, 3 recovered (50%). Out of 14 grade 5 dogs managed non-surgically, 1 recovered (7%).
     

  4. Hayashi, A. M., Matera, J. M., & de Campos Fonseca, A. C. B. (2007). Evaluation of electroacupuncture treatment for thoracolumbar intervertebral disk disease in dogs. Journal of the American Veterinary Medical Association, 231(6), 913-918. 16 out of 19 (84%) grade 3 and 4 dogs were able to walk within 3 weeks without surgery (Hayashi et al 2012). Some of these dogs had received electroacupuncture.
     

  5. Aikawa, T., Fujita, H., Kanazono, S., Shibata, M., & Yoshigae, Y. (2012). Long-term neurologic outcome of hemilaminectomy and disk fenestration for treatment of dogs with thoracolumbar intervertebral disk herniation: 831 cases (2000–2007). Journal of the American Veterinary Medical Association, 241(12), 1617-1626. In 279 grade 1-2 dogs, 96.8% had a good long term outcome, but there was a non-ambulatory period after surgery in many dogs, with only 86.7% dogs walking within 14 days, and 3% of “successful” cases not walking until 2 months post-op. There was a 95% good outcome in 180 grade 3 dogs. 81.9% of dogs walked within 2 wks. 2.3% of dogs took >61 days to walk again. Mean time to walking was 7.7 days (Aikawa et al 2012). Outcome was 98% successful in 161 grade 4 dogs. Approx 70% walked within 14 days, and about 8% dogs took >61days to walk again. Mean time to walking was around 11 days. 52% of 211 grade 5 dogs recovered ambulation. 36% of successful cases could walk within 14 days. 26% walked within 15-30 days, 18% walked at between 31-60 days. 11% walked at between 2-6 months. 3% walked at between 6-12 months. The remaining few dogs were lost to follow-up. Mean time to ambulation was 21 days.
     

  6. Davis, G. J., & Brown, D. C. (2002). Prognostic indicators for time to ambulation after surgical decompression in nonambulatory dogs with acute thoracolumbar disk extrusions: 112 cases. Veterinary surgery, 31(6), 513-518. Out of 112 grade 3 and 4 dogs, 96% were able to walk within 3 months of surgery. Mean time to ambulation was 12.9 days (range 1-55 days) and surgical decompression was performed within 6 days of onset of non-ambulatory status.
     
  7. Ferreira, A. J. A., Correia, J. H. D., & Jaggy, A. (2002). Thoracolumbar disc disease in 71 paraplegic dogs: influence of rate of onset and duration of clinical signs on treatment results. Journal of small animal practice, 43(4), 158-163. Out of 71 grade 3 and 4 dogs, 86% regained the ability to walk. Mean time to ambulation was 10.8 days (range 1-60 days). NB: 17% of the 71 dogs regained the ability to walk but were left with ongoing paraparesis and/or pain.
     

  8. Ito, D., Matsunaga, S., Jeffery, N. D., Sasaki, N., Nishimura, R., Mochizuki, M., ... & Ogawa, H. (2005). Prognostic value of magnetic resonance imaging in dogs with paraplegia caused by thoracolumbar intervertebral disk extrusion: 77 cases (2000–2003). Journal of the American Veterinary Medical Association, 227(9), 1454-1460 Out of 48 grade 3 and 4 dogs, 92% regained the ability to walk. Surgery was performed at up to 30 days after onset of clinical signs and, within this group, time to surgery did not affect outcome. Mean time to ambulation with only slight ataxia was 45 days (range 7 to 180 days).
     

  9. Kazakos, G., Polizopoulou, Z. S., Patsikas, M. N., Tsimopoulos, G., Roubies, N., & Dessiris, A. (2005). Duration and severity of clinical signs as prognostic indicators in 30 dogs with thoracolumbar disk disease after surgical decompression. Transboundary and Emerging Diseases, 52(3), 147-152. 6/6 grade 3 dogs all did well after surgery. 8/11 (73%) grade 4 dogs had a “fair to good” outcome, ie. they could walk. Out of 8 grade 5 dogs, 4 regained the ability to walk after surgery (Kazakos et al 2005). Walking took 15 days -2 months.

    10. Joaquim, J. G., Luna, S. P., Brondani, J. T., Torelli, S. R., Rahal, S. C., & de Paula Freitas, F. (2010). Comparison of decompressive surgery, electroacupuncture, and decompressive surgery followed by electroacupuncture for the treatment of dogs with intervertebral disk disease with long-standing severe neurologic deficits. Journal of the American Veterinary Medical Association, 236(11), 1225-1229. The study looked at 19 severely-affected dogs treated with conservative management including electroacupuncture (these were 9 grade 4 dogs and 10 grade 5 dogs). 15/19 (79%) improved to grade 1-2 within 6 months. 
     

  10. Jeffery, N. D., Barker, A. K., Hu, H. Z., Alcott, C. J., Kraus, K. H., Scanlin, E. M., ... & Levine, J. M. (2016). Factors associated with recovery from paraplegia in dogs with loss of pain perception in the pelvic limbs following intervertebral disk herniation. Journal of the American Veterinary Medical Association, 248(4), 386-394. Out of 78 grade 5 dogs managed with surgery, 58% had a successful outcome (walking within 3 months)). Dogs were not followed up beyond 3 months post-op. For recovered dogs, median time to ambulation was 27 days. Mean time and range not stated. Dogs in this study were first assessed at the referral centre at up to 48.1hours after loss of ambulation. Clinical signs started up to 4.9 days before treatment.
     

  11. Laitinen, O. M., & Puerto, D. A. (2005). Surgical decompression in dogs with thoracolumbar intervertebral disc disease and loss of deep pain perception: a retrospective study of 46 cases. Acta veterinaria scandinavica, 46(2), 79. Out of 46 grade 5 dogs, 41.3% recovered following surgery (Laitinen & Puerto 2005). Variable follow-up period (0-52weeks) and time to ambulation is not stated.
     

  12. Scott, H. W., & McKee, W. M. (1999). Laminectomy for 34 dogs with thoracolumbar intervertebral disc disease and loss of deep pain perception. Journal of small animal practice, 40(9), 417-422. Out of 34 grade 5 dogs, 62% recovered after surgery (Scott & McKee 1999). Dogs in this study had lost deep pain 0-72 hours before surgery. Time to recovery varied from 1 to 11 weeks.

 

We are grateful to Marianne Dorn BVM&S PGCert SART MRCVS for providing the content of this page (Sept. 2017). Marianne's Canine Rehabilitation website is here and you can download her Dachshund crate recovery guide here.

 

 

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