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Integrative Treatment of Spinal Dysfunction

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How acupuncture, homeopathy and other therapies can help in the treatment of intervertebral disc disease (IVDD) and spondylosis in pets.

I have seen it time and again: a client brings in a sweet beloved pet that cannot use his hind legs. Depending on which segment of the spinal cord is affected, the animal may also be unable to urinate or defecate with control. The client is understandably upset but still holding out hope that something can be done about her pet’s spinal dysfunction, which may signify IVDD, spondylosis, or other conditions.

Many pet owners today are asking for an integrative approach to treating spinal dysfunction, in addition to conventional pain management, after learning about successful outcomes through word of mouth, the Internet and social media. It seems the high cost of surgery, plus the time and pain involved in what is called conservative therapy (total cage rest, pain medications, anti-inflammatories) is leading owners to look for alternatives. Even some conventional experts are questioning conservative therapy. In a recent textbook, Curtis Dewey, DVM, MS, states that one study found “no association between duration of cage confinement and success of medical therapy”.1

In my integrative practice, I treat many species with neurological conditions, including intervertebral disc disease (IVDD) and spondylosis deformans. In my experience, localization of the spinal lesion can best be done by combining conventional exam and diagnostics, and holistic techniques.

CONDUCTING THE PHYSICAL EXAM

The integrative veterinarian may be presented with anything from lameness, organ dysfunction, proprioceptive loss and ataxia, to paresis and paralysis. The first step in diagnosing the condition is a physical exam. This typically means repeating the tests made by any conventional veterinarian with the goal of locating the lesion and delineating the cause.

Conventional

Most of the time, pain will impede many normal responses, and muscle stenting and compensatory changes in joint movement are also present, so while examining the dog, avoid anything but gentle palpation in the area. Evaluate the nervous system from head to toe:

  • Check for cranial nerve deficits.
  • Palpate to test for painful areas along the vertebrae. Are they lumbar, thoracic or cervical?
  • Determine if the lesion is Upper Motor Neuron or Lower Motor Neuron. Are the leg reflexes hyper- or hypo-reflexive? Is there a panniculus response?
  • Test the integrity of the proprioceptive pathway. Does the brain respond to the foot being turned over?2

Acupuncture

The TCVM practitioner interviews the client, observes the patient, takes the history and evaluates the tongue and pulse as part of the exam to determine:

  • Preferences to hot or cold
  • Pain behaviors – is the animal in pain or is there weakness without pain?
  • Wet or dry presentation
  • Which acupoints are sensitive and what portion of the nervous system are we trying to modulate by stimulating the nerves and the local humoral response?

From these points, the practitioner can differentiate between spondylosis and IVDD to select the most appropriate treatment. IVDD will generally present with a stagnation pattern of pain (in muscles or joints, and/or stiffness in the joints), and also present with the Bi syndrome. (Table 1)

Spondylosis is more chronic and slow to progress since it can develop as generalized Bi syndrome over a long period, reflecting spinal instability. Most commonly, the patient presents with ataxia but he/she may present acutely, showing weakness without pain due to loss of neurological function. This pattern is the Wei syndrome. (Table 2)

Table 1 – Bi Syndrome Pattern3

Bi syndrome patterns

Tongue

Pulse

Clinical findings/grade of deficit

Wind-Cold-Damp invasion with external Qi/Blood stagnation

Purple

Superficial, strong, slow, wiry

Grade 1 acute neck or back pain. No paresis or paralysis.

Kidney Yin deficiency with external Qi Blood stagnation

Reddish purple, dry

Deep, weak, worse on left, rapid, thready or wiry

Grade 1 acute neck or back pain. No paresis or paralysis. Panting, cool-seeking, warm ears, back, feet, dry skin.

Kidney Yang deficiency with external Qi Blood stagnation

 

Purple

Deep, weak, worse on right or wiry

Grade 1 acute neck or back pain. No paresis or paralysis. Heat-seeking, cold ears, back, feet.

Spinal cord Qi/Blood stagnation with Kidney Qi deficiency

 

Pale purple, wet

Deep, weak, worse on right or wiry

Grades 2-5 deficits acute or chronic. Paresis or paralysis (+/=) neck or back pain.

Spinal cord Qi/Blood stagnation with Kidney Yang deficiency

 

Pale purple, wet

Deep, weak (weaker on right), slow, may be wiry

Grades 2-5 deficits acute or chronic. Paresis or paralysis (=/+) neck or back pain. Heat-seeking, cold ears, back, feet.

Spinal cord Qi/Blood stagnation with Kidney Yin and Qi deficiencies

 

Pale or red, purple, wet or dry, cracked, chronic

Deep, weak, may be on both sides, rapid, thready, may be wiry

Grades 2-5 deficits acute or chronic. Paresis or paralysis (=/+) neck or back pain. Panting, cool-seeking, warm ears, back, feet, dry skin

Spinal cord Qi/Blood with Kidney Yin and Yang deficiencies

 

Pale, red or purple, wet or dry

Deep, weak pulses on both sides, may be rapid or slow or wiry

Grades 2-5 deficits acute or chronic. Paresis or paralysis (=/+) neck or back pain. Seeks heat or cold, may or may not pant, warm or cold ears, back, feet. May be warm in front and cold in back.

 

Table 2 – Wei Syndrome Pattern4

Wei syndrome patterns

Tongue

Pulse

Critical signs

Damp Heat

Greasy, moist

Rapid, slippery

Obesity, chronic skin problems, edema, weakness in back legs, no paralysis.

Spleen Qi deficiency

Pale, swollen

Deep, weak

Weak limbs, flaccid loose stools, weakness in rear legs.

Kidney Qi and/or Yang deficiency

Pale, moist

Very deep, weak

Weak and cold lumbus and hind end, difficulty rising. Weakness to immobile rear legs.

Qi and Yin dual deficiency

Pale or red and dry

Weak, thin

Emaciation, weak hind end, dry skin, false heat, cool-seeking, weakness to immobile rear legs.

 

Differentiating Bi and Wei syndromes facilitates choosing the correct acupuncture points, Chinese herbal formulas, Tui Na massage plans, and food therapy for each animal.

Homeopathy

The homeopathic veterinarian looks for idiosyncratic reactions that indicate the best remedy. Signs to consider:

  • A fear of being touched
  • Temperature of the paws
  • Condition of the hair coat
  • Vaccination history
  • Reaction to stimuli
  • Past medical history.5

DIAGNOSTICS

After localizing the lesion area with a physical examination, the integrative veterinarian moves to the next phase of diagnostics, which is radiography. The newer digitized radiographs allow us to see late stage inflammatory changes, but not always all the pathology. If Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) is going to be pursued, generally, surgery will be planned.  

TREATING IVDD AND SPONDYLOSIS

Following case intake, physical exam and diagnostics, a treatment plan is formulated using the appropriate modalities. Different approaches are needed for IVDD and spondylosis.

Treatment options for IVDD

Before discussing treatment options, let’s review IVDD pathology. Spinal vertebrae surround the spinal cord. Between the vertebrae sit eight joints, including an intervertebral joint, which contains the nucleus pulposus. This acts like a malleable ball bearing to equalize stress on the disc. With IVDD, calcification of the nucleus pulposus occurs (this can happen as young as three years of age). Quadrupeds have shear force along the spinal canal versus compressive force in the human species. Enough shear force can cause the nucleus pulposus to rupture up through the layers of annulus fibrosus lamina and into or around the spinal canal. Type I Hanson’s IVDD occurs acutely, most commonly in short-legged long-bodied dogs. Type II is more degenerative than explosive, often occurring in older dogs and larger breeds. 

The conventional veterinarian will suggest surgery, anti-inflammatories and cage rest for IVDD. However, in his book, A Practical Guide to Canine & Feline Neurology, Dr. Dewey says that in studies, the “glucocorticoid therapy in treating spinal injury is questionable at best, with no beneficial effect”, although NSAIDs in the acute phase have been shown to have an anti-inflammatory effect.6

On the other hand, the integrative veterinarian has many tools available to treat IVDD. Dr. Narda Robinson of Colorado State University states the following in her request for a re-evaluation of the Standard of Care for IVDD:

“The old mindset that nothing can cure a dog but surgery and strict cage confinement (with minimal to no analgesia) remains widely held in some circles, even academia…. Acupuncture reduces the extent of damage by helping keep neurons and oligodendrocytes alive. In comparison, what does cage confinement without physical medicine do to a dog with disk disease and back pain? It risks further degrading the disks, increasing muscle tension, and inducing long-term maladaptive gait patterns.”7

Other experts agree with Dr. Robinson. Joaquim et al show that acupuncture has been demonstrated to aid in recovery from IVDD.8 

Acupuncture point selection is based on a pattern diagnosis to improve and modulate the nervous system. In addition, TCVM practitioners include Chinese herbal medical formulations for anti-inflammatory and healing effects, as well as Tui-Na massage. A prescription of physical rehabilitation passive exercise during exercise restriction can improve proprioception, motor pattern generators and reduce pain.

Spinal manipulation and stretching

Careful consideration is needed before using adjustments on a dog with IVDD. Is there movement in the intervertebral area, or is it too dangerous to gauge movement in the event of a possible nucleus pulposus rupture? We can use spinal manipulations to add movement to other joints around the area, and use stretching to relax spasmodic muscles.9

HOW INTEGRATIVE APPROACHES IMPROVE OUTCOMES

Outcomes with a conventional-only approach are often limited. At the least, a patient may experience loss of muscle mass. At the worst, a paralyzed patient can die from the inability of his organs to function due to poor innervation of the sympathetic and parasympathetic nervous systems. An integrative treatment plan (with consultation from experts, if needed) can improve the return to function and keep the neurological status of the patient healthier.

Homeopathy

When the homeopathic medicine matching the individual dog is administered, the vital force begins a self-healing. First the dog will have improved mentation, appetite and energy. Then, even with total paralysis, he will begin to show a return of normal neurological function. Several weeks may be needed if treatment is begun shortly after diagnosis; several months if paralysis has not responded to surgery and drugs. Hypericum and Nux vomica are frequently indicated remedies. One eight-year-old Dachshund presented with a flaccid tail, stool falling out, urine retention and no deep pain. Five doses of Hypericum 12c over a two-week period were needed for full recovery.5

TREATMENT AND PREVENTION OF SPONDYLOSIS

What about the pathology of spondylosis? The ligaments of the spine allow it to move within an acceptable range of motion. One of these ligaments – the ventral longitudinal ligament (VLL) – runs beneath the spinal cord and prevents hyperextension of the spine. The VLL can become stretched and unable to support the vertebral joints and spinal cord if the intervertebral joints move too far in any direction and/or the abdominal muscles are consistently weak. This chronic instability of the joints leads to inflammation and, finally, calcification of the ligament. Calcification causes a decrease in nerve health due to:

  1. Fewer nutrients, resulting from impeded blood flow;
  2. Decreased firing from lack of movement, which is the body’s attempt to keep the spine from moving abnormally (from compromised muscle support, arthritis in the joints and ligaments, and tendons becoming stressed and then fibrotic). Early fibrotic changes will appear on the radiograph as rounding, due to loss of calcification of the bone at those attachments.

The conventional approach of using anti-inflammatories and joint modifiers (glucosamine, chondroitin, milk proteins, hyaluronic acid) may not be enough to avoid spondylosis.

Occasionally, surgery can fail and owners will seek other options. These cases are by far the more difficult to treat due to the loss of muscle tissue from the surgery and the time lag from recommendations that delay follow-up care with the integrative practitioner.

On the other hand, an integrative veterinarian has a number of techniques available to help reverse or stabilize the changes in the ligament that lead to this condition.10 Sometimes, even the entire mass of accumulated calcium can be dissolved.5 Since inflammation triggers the production of calcium deposits, multiple modalities can both prevent and possibly resolve spondylosis, by ensuring movement and healthy blood flow to intrinsic muscles, tendons and ligaments. Remember, when the joints move freely, the nerves can fi re adequately. Proper ROM also keeps the intrinsic and paravertebral muscles healthy so they in turn can maintain postural input to the sympathetic and parasympathetic nervous systems. Successful approaches include:

  1. Regular animal chiropractic work
  2. Spinal manipulation and adjustments
  3. Stretching, balancing and flexion/extension exercises
  4. TCVM – Chinese herbs, acupuncture and Tui-na
  5. Homeopathy – individualized selection of remedies.

In conclusion, integrative care – joint modification therapeutics, Chinese herbal formulas, and homeopathic remedies, combined with conventional medications in the acute phase – can improve the outcome of IVDD and spondylosis. Many more spinal conditions can also be treated with these integrative modalities. At our clinic, we also use laser therapy, an underwater treadmill, and PEMf therapy with TCVM modalities. By using these integrative modalities, successful return to function without surgery, or post-surgical rehabilitation for muscle, neurological and gait deficiencies, is often achieved

CASE REPORTS

Daisy is a 12-year-old FS Border Collie who moved slowly and loved to lie under the car. On New Year’s Eve, her owner did not know she was there, and she sustained fractures in the skull, mandible and foot; a large de-gloving area; and a painful back.  With chiropractic adjustments, Chinese herbal formulations, laser, and great nursing care, she became pain-free and even more mobile than she was prior to the accident, once her wounds were completely healed.

Captain is a ten-year-old Jack Russell terrier who presented in extreme pain due to IVDD. Five years ago, his referral veterinarian gave a poor prognosis after incorrectly diagnosing him with Granulomatous Meningeal Encephalitis (GME). Peripheral nociception (part of the pain response sensation) and LMN disease affected his CNS, causing disorientation. Acupuncture, laser, chiropractic and Chinese herbal formulations alone have been able to keep his mentation and spinal nerves healthy, in spite of two more episodes of IVDD.

Over the years, Captain’s owners have been willing to treat him only two times at each episode. On the referring veterinarian’s insistence, they stopped all Chinese herbal formulations for Bi syndrome, except the formulation for neck pain. As a veterinarian, I treat what I have at the moment. Each time, “moving the stagnation” and treatment has him back acting as Jack Russells do. Owner compliance with rehabilitation, acupuncture, laser and Chinese herbal formulations are a challenge, as this real case demonstrates.


References

1Eschbach, Dennis. “Thoracolumbar Pathology: Based on notes by Sharon Willoughby”, Basic Chiropractic Course, 2007.  P.371-37.

2Dewey, Curtis W. “Chapter 10: Myelopathies:  Disorders of the Spinal Cord”, A Practical Guide to Canine & Feline Neurology, 2008, p. 332.

3Chrisman, Cheryl L. “Spinal Cord Disorders”, Traditional Chinese Veterinary Medicine for Neurological Diseases, 2011. 13th Annual TCVM Convention, pp. 225-266.

4Ferguson, Bruce and Boggie, Linda. “How I Treat Wei Syndrome”, Traditional Chinese Veterinary Medicine for Neurological Diseases, 2011. 13th Annual TCVM Convention, pp. 455-465.

5Personal communication with Drs. Pantzer and Chambreau.

6Jurek, Christine. “The Role of Physical Manipulation (Chiropractic) in Canine Rehabilitation”, Canine Sports Medicine and Rehabilitation, 2013. p. 431.

7Joaquim JG, Luna SP, Brondani JT, et al. “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 defi cits”. J Am Vet Med Assoc, 2010.  pp. 1225-1229.

8Robinson, Narda. “An Emerging Standard of Care for Thoracolumbar Intervertebral Disk Disease in Dogs”, CuraCore, curacore.org, Sept. 12, 2015.

9Dewey, Curtis W. “Chaper 3:  Performing the Neurologic Examination”, A Practical Guide to Canine & Feline Neurology, 2008, pp. 53-74.

10Dewey, Curtis W. “Chapter 10: Myelopathies:  Disorders of the Spinal Cord”, A Practical Guide to Canine & Feline Neurology, 2008, p. 332.

Dr. Margie Garrett graduated from Purdue University School of Veterinary Medicine in 1992. She attended the Chi Institute to study acupuncture and Traditional Chinese Veterinary Medicine, herbal therapy, and Tui-na massage. She is certified in animal chiropractic, and is attending the University of Tennessee program for animal rehabilitation. Dr. Garrett practices homotoxicology and is familiar with homeopathy, Bach and other flower remedies, and aromatherapy. She is an active member in the AVMA, AHVMA, AAVA, IVAS, AATCVM, IVCA and SWIVMA.