Top Tip 10 - IVDD and neurologic injury – Should I reach for the steroids?

Use of corticosteroids in dogs with IVDD or neurologic injury

Dr Melati Laksito - Residency Trained Surgeon

There are a number of arguments both for and against using corticosteroids in patients with intervertebral disc disease and neurologic injury. Here’s a quick glance at the potential pros and cons of corticosteroid use in your patients.

The rationale for using corticosteroids includes improved local blood flow, free radical scavenging, and reduction of inflammation. In the nervous system, certain corticosteroids, for example methylprednisolone and dexamethasone, protect the cell membranes from lipid peroxidation by fitting into the fatty acid portion of the cell membrane.

Many clinicians administer corticosteroids to patients with intervertebral disc disease (IVDD), both those being managed medically and surgically. The use of corticosteroids in IVDD cases has been controversial, but the current clinical and pharmacological evidence in humans and dogs suggests that there is little to no benefit to corticosteroid administration in cases of IVDD that have resulted in neurologic deficits. A 2008 study examining adverse outcomes of preoperative dexamethasone administration in dogs with surgically managed IVDD showed that dexamethasone increased the risk of adverse effects compared with other corticosteroids or the control group (no corticosteroids), and there was no difference in outcomes. Thus, dexamethasone is not recommended in the management of surgical IVDD. Corticosteroids will not correct a disk herniation, are unlikely to reduce spinal cord swelling, and will likely be associated with side effects that may complicate patient management and wellbeing.

The use of corticosteroids in spinal cord trauma is controversial. In both clinical and experimental trials in humans, the wrong dose or incorrect timing of doses can result in worsening of clinical outcome. High doses of dexamethasone in dogs with acute spinal cord trauma have been be associated with an increased incidence of fatal colonic perforation and other gastrointestinal side effects.

In humans, high-dose methylprednisolone sodium succinate (MPSS) has been shown to have a potential benefit in humans with spinal cord injury, however the significance of this improvement is currently under debate. Some experimental studies of IVDD in small animals have suggested that administration of soluble corticosteroids may provide some benefit if administered within eight hours of the trauma. Other experimental studies in dogs or rats have failed to demonstrate any benefit of MPSS with compressive cord lesions. Importantly, no experimental benefits have translated into clinical benefits. There are no prospective blinded or controlled studies examining the effects of MPSS on clinical outcomes with IVDD in dogs. At best, high dose MPSS therapy in small animals should be considered an experimental treatment of unproven benefit. At worst, it may have deleterious effects both on neural tissue and other organ systems.

Safer options for analgesia in surgical and non-surgical IVDD cases include non-steroidal anti-inflammatory drugs, opioids or tramadol, and gabapentin. Activity restriction is important after the initial injury and after surgery, to minimise the risk of further disc extrusion and worsening of neurologic function.

This article is contributed by Dr Melati Laksito, SARC’s residency trained surgeon. If you have a query about a surgical case you have under management or would like some general information about this or any other surgical topic, please do not hesitate to contact SARC on (03) 9532 5261.

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