During the first week of injury to the spinal cord there are actions that can be taken to mitigate many of the negative repercussions of spinal cord compression. The Glial Scar is our enemy and the purpose of these actions is to prevent further damage, and to combat the cascade of inflammatory and destructive forces acting on the spinal cord.
- Prevent Movement for two weeks. This means crate or cage rest supplemented with pain control. These recommendations are standard except for the two weeks of cage rest recommendation. Most recommendations are for 6 weeks or more of confinement. This is not necessary as the inflammatory stage has passed by now and the disc will not continue to erupt as was feared before. In addition, lack of encouraged movement greatly inhibits nerve healing during this stage. Retrospective studies do not show any benefit or increased healing or return to function from longer periods of cage rest.
- Use Ice packs during first 24 to 72 hours to reduce inflammation. Cold therapy can be applied using ice and gel packs which can be purchased commercially. The application of a cold pack over this area may prevent significant swelling in the spinal canal thereby reducing the amount of spinal cord damage from this event. Homemade ice packs (alcohol, water, ice, slush bags made with zip-lock bags containing crushed Ice and rubbing alcohol) are more effective than gel packs or gel beads purchased commercially. Apply this over a wet or dry towel between the skin and the cold pack. Apply for 15 minutes every 6 hours.
- Minocycline administration is highly neuro-protective, it has nerve anti-inflammatory effects and has been proven to promote better outcomes in spinal cord injury than animals without minocycline. Minocycline is an antibiotic, that is inexpensive and is used in humans for acne control. Veterinarians that treat heartworms commonly will be familiar with its enhancement of the effects of heartworm treatment. Minocycline is in the tetracycline family of antibiotics and is safe.
- DMSO is a common solvent that is used as a carrying agent for many medications. It has been used for decades as an anti-inflammatory medication particularly in horse therapy. DMSO has recently been studied in spinal cord injuries and found to be very effective in promoting healing and restoration to function when given during the peracute and acute course of spinal cord injury. DMSO is a free radical scavenger, it suppresses inflammation, reduces harmful Ca+ influx and reduces glutamate excitotoxicity. Sub-cutaneous injections for the first three days. Two times a day for three days was effective. DMSO is readily available and penetrates intact skin and while the research used injections, it is probably effective as a topical application over the part of the back or neck that is affected. Twice a day, use gloves so it does not penetrate your skin and get ready for the garlic breath and odor that it creates.
- Do Not give Cortisone. The administration of cortizone, prednisolone, dexamethasone, methylprednisone, all grouped under the heading of “Steroids” is commonly recommended. These medications are all powerful inhibitors of inflammation but are not indicated in spinal cord injury. Most human trauma centers are no longer giving these drugs. A large study in dogs confirmed that there is no benefit to the administration of these medications and many veterinary schools have stopped their use. I expect this will be slow to change in veterinary medical practice.
- Non-Steroidal Anti-inflammatory Medications (NSAIDS) are however associated with improved outcomes of spinal cord injury. The administration of these medications to control pain is well documented but they also modulate the formation of the glial scar and promote healing after the compression event. NSAIDS should be given with an intestinal protective agent such as pepcid to reduce ulcers.
- Polyethyelene Glycol (PEG) has received attention for its ability to fuse membranes and extend the life of neurons and has improved outcome in experimental models of spinal cord injury. It also has been evaluated in a clinical trial in dogs with the most severe grade of injury caused by IVDD. The outcome of dogs in this trial was favorable when compared with historical controls yet PEG did not result in better results when compared to pets treated with surgery alone.
The Peracute and Acute treatment of IVDD should involve decompressive surgery and the administration of medications that control pain and inhibit the formation of the glial scar. We recommend the use of NSAIDS, Minocycline and DMSO, along with early use of controlled physical therapy.
