Vol. 19, No.
2 February 1997
Continuing Education Article
FOCAL POINT
★Careful attention to postoperative
management techniques in dogs
that have undergone spinal
surgery will improve surgical
success rates and client
satisfaction.
KEY FACTS
■ Untreated pain can lead to
unfavorable physiologic and
psychologic responses that can
delay normal healing.
■ Failure to maintain adequate
voiding of urine can lead to
cystitis, bladder atony, and
pyelonephritis.
■ Pharmacologic agents can
assist in overall bladder
management but do not restore
normal bladder function.
■ Physical therapy should begin
as soon after surgery as the
patient’s clinical condition
allows.
Postoperative
Management of the
Canine Spinal Surgery
Patient—Part I
Texas A&M University
Richard M. Jerram, BVSc, MRCVS
Robert C. Hart, DVM
Kurt S. Schulz, DVM, MS
T he two broad areas of vertebral surgery are (1) spinal cord decompres-
sion (or exploratory surgery) for treatment of intervertebral disk dis-
ease, neoplasia, and lumbosacral disease and (2) vertebral stabilization
for treatment of atlantoaxial subluxation, cervical vertebral instability (wobbler
syndrome), lumbosacral disease, and spinal fracture/luxation. 1 Although
surgery is only one component in a comprehensive management plan for dogs
with spinal neurologic disease, the scientific literature has focused on the surgi-
cal procedure—leaving postsurgical management in need of further attention.
Postsurgical management is a critical determinant of the success rate of
spinal surgery. It is often difficult to accurately predict the outcome of animals
after spinal surgery. Some completely recover, whereas others remain perma-
nently paralyzed.
Because each animal that will go undergo spinal surgery presents with a dif-
ferent level of neurologic compromise, it is essential to develop a plan that is
tailored to meet the specific surgical, therapeutic, and nursing care needs of
that animal. Client education must begin immediately after the decision to
proceed with surgery because clients need to be aware of the time and effort re-
quired in the postsurgical period.
This two-part article focuses on helping veterinarians better understand the
key issues, required treatments, and some of the potential complications associ-
ated with the postoperative management of dogs that have undergone spinal
surgery. Six primary areas of concern will be reviewed. Part I discusses pain
management, bladder management, and physical therapy. Part II will address
gastrointestinal complications, such as fecal incontinence and steroid-induced
colitis; wound complications, such as discharge, seroma and infection; and re-
Small Animal The Compendium February 1997

cumbency management, same stimulus applied to an

with special attention to animal should also be con-
bedding, bathing, nutrition, sidered painful. Treatment
and walking aids for pa- based on this anthropomor-
tients whose recovery period phic view of pain should
is prolonged. not be considered inappro-
The postsurgical needs of priate6,7 (Figure 1).
animals with spinal cord The clinical signs and
disease can be time-consum- physiologic effects of pain
ing and frustrating. The re- seen in dogs after spinal
wards, however, of im- surgery are given in the box.
proved neurologic function All of these signs are not
and client satisfaction can present in every patient, but
be significant. a subjective diagnosis of
Figure 1—A dachshund in its cage after spinal surgery. It is pain can be made if several
PAIN MANAGEMENT often difficult to determine whether a dog is experiencing of these signs occur concur-
“Pain is an unpleasant sen- pain after surgery because signs of pain are varied and non- rently.6–12
sory and emotional experi- specific. Because animals may not
ence associated with actual vocalize until pain is severe,
or potential tissue damage.”2 Surgical events, such as vocalization is not a sensitive indicator of pain.6–12 Also,
pain, hemorrhage, tissue damage, hypothermia, and many animals vocalize in the dysphoric phase of nor-
hypoxia, initiate stress responses. These responses can mal anesthetic recovery, thus making vocalization even
be metabolic, inflammatory, neural, or endocrine and more difficult to interpret.12
3,4
result in physiologic changes in the body. Pain can
lead to hypoxia, hypercalcemia, lung atelectasis, and Analgesic Agents Clinical and
pneumonia. Analgesics should be a stan-
Physiologic Signs
Compensatory responses to the demands of damaged dard component (unless con-
tissue include an increase in the release of cortisol, cate- traindicated because of under- of Paina
cholamines, renin, and inflammatory mediators.5 If lying cardiovascular or respira-
■ Depression
these unfavorable physiologic changes become extreme, tory disease) of the anesthetic
a delay in normal healing may occur. These changes are premedications given to dogs ■ Reluctance to move
of particular importance in animals that have under- undergoing spinal surgery. ■ Timidity
gone neurosurgery. Recovery is often prolonged as a re- Opioids, nonsteroidal antiin- ■ Inappetence
sult of neurologic dysfunction, and unnecessary imped- flammatory drugs (NSAIDs), ■ Restlessness
iments to healing should be avoided.5 In addition, the and local analgesics are the ■ Anxiety
psychologic impact of pain is to create a cycle of anxi- predominant types of drugs
■ Guarding of surgical
ety, fear, and sleep deprivation, all of which further ex- used for postoperative pain re-
acerbate the delay in tissue healing.5 lief.6,8,10,12,14 area
The key steps to managing pain successfully are to Although pain is most ■ Vocalization?
(1) recognize the presence of pain and identify its commonly reduced by phar- ■ Tachypnea
source and (2) provide the most appropriate form of macologic methods, alterna- ■ Tachycardia
analgesia. Good-quality nursing care must also be tive pain relief methods may ■ Mydriasis
provided. After surgery, animals should be placed in be explored. Acupuncture
■ Salivation
a quiet environment with warm, dry, and well-padded has long been recognized as
cages. an effective treatment for ■ Hyperglycemia
pain and has been used suc- ■ Premature atrial
Recognizing Pain cessfully in the conservative or ventricular
Veterinarians must be able to determine whether an management of interverte- contractions
animal is in pain. If behavioral changes or clinical signs bral disk disease in dogs.10,13
a
that are abnormal for the individual or for the species Other available methods in- Each animal responds dif-
ferently to pain. The signs of
are observed, pain should be suspected. A stoic animal clude transcutaneous electri- pain may be difficult to in-
may need to be assessed subjectively. For instance, if a cal stimulation (TENS) and terpret.
stimulus applied to a human is considered painful, the acupressure.10

PHYSIOLOGIC CHANGES ■ CLINICAL SIGNS ■ PHARMACOLOGIC MANAGEMENT

The Compendium February 1997 Small Animal

TABLE I
Drugs Used for Postoperative Pain Relief in Canine Spinal Surgery Patients
Dosage Duration
Drug (mg/kg) (hr) Side Effects

Opioids
Morphine 0.25–1.25 IM, SQ 3–5 Emesis; respiratory depression; increased
intracranial pressure

Oxymorphone 0.05–0.2 IV, IM 2–5 Respiratory depression; auditory

hypersensitivity; altered thermoregulation

Meperidine 2.0–5.0 IM, SQ 1–2 Mild gastrointestinal effects

Butorphanol 0.1–0.8 IV, IM, SQ 2–4 Some nausea and vomiting

Buprenorphine 0.005–0.01 IV, IM, SQ 6–8 Mild respiratory depression; sedation

Nonsteroidal Antiinflammatory Drugs

Aspirin 10 PO 12–14 Gastrointestinal hemorrhage; platelet
dysfunction

Phenylbutazone 20 IV, PO 12–24 Gastrointestinal hemorrhage; renal toxicity

Piroxicam 0.2–0.4 PO 12–24 Gastrointestinal hemorrhage; renal toxicity

Carprofen 4.0 IV, SQ, PO 12–24 None

Ketoprofen 1.0 IV, IM, PO 12–24 Gastrointestinal hemorrhage; renal toxicity

IM = intramuscularly, IV = intravenously, PO = orally, SQ = subcutaneously.

Opioids and less gastrointestinal stimulation.8,10,14

Narcotic agonists have traditionally been the main-
stay of postoperative analgesia in dogs (Table I). Opi-
oids act both peripherally, by inhibiting transmission
from primary afferent nociceptors to the dorsal root
ganglia, and centrally, by inhibiting nociceptive condi-
tions locally in the spinal cord.
Morphine has profound analgesic and sedative ef-
fects.8,10,14 The onset of action of morphine can be up to
45 minutes, and it has an intermediate duration of ac-
tion of 3 to 5 hours.15 The side effects of morphine in-
clude emesis and defecation, respiratory depression,
and increases in intracranial pressure.8,10,14
Meperidine has milder narcotic and gastrointestinal
effects than morphine but only provides effective anal-
gesia for 1 to 2 hours.8,10,14,15 Intravenous injection of
morphine or meperidine has been associated with his-
tamine release; therefore, these drugs should be adminis-
tered by intramuscular and subcutaneous routes only.15
Oxymorphone is commonly used and provides good
analgesia with mild sedative effects. It has 10 times the
potency of morphine, with less respiratory depression
Buprenorphine is a partial opioid agonist that is 30
times more potent than morphine. It provides excellent
analgesia for 6 to 8 hours and has minimal respiratory
and gastrointestinal effects.15,16
Butorphanol is a mixed agonist–antagonist that is
five times more potent than morphine. It is an excellent
analgesic for moderate levels of pain. The respiratory
depression associated with butorphanol is dose related
up to a point beyond which higher doses do not further
depress respiratory effort.8,10,14,15
Fentanyl, which has a short duration of action when
given parenterally, is now available in a transdermal
therapeutic system patch.17,18 Effective pain relief has
been attained using the transdermal patch in our clinic.
Advantages of using the patch are that therapeutic lev-
els of fentanyl are achieved and that injections of other
opioids are required less frequently or not at all.17,18
Nonsteroidal Antiinflammatory Drugs
Nonsteroidal antiinflammatory drugs exert their
analgesic effect by acting peripherally, with the inhibi-

DURATION OF ACTION ■ RESPIRATORY EFFECTS ■ GASTROINTESTINAL EFFECTS

Small Animal
tion of cyclooxygenase, and thereby blocking the pro-
duction of prostaglandins during the inflammatory
process. NSAIDs have less sedative effect and a longer
duration of action than opioids. Although not as effec-
tive as opioids for the acute phase of postoperative
pain, NSAIDs can be administered 72 hours after
surgery if pain persists. Because all NSAIDs can pro-
duce gastric irritation, caution must be exercised with
their use in patients that have undergone spinal surgery
and that have previously received corticosteroids.8,10,14
A new NSAID, carprofen, which is a weak inhibitor
of cyclooxygenase, has been recently shown to have
equal or better analgesic effects than meperidine or pa-
paveretum (a morphine-based opioid).19,20 Whether
carprofen is associated with gastrointestinal side effects
is unknown. 19,20 Additional studies are necessary to
evaluate its efficacy after spinal surgery.
Adequacy of Analgesia
A recent retrospective study showed that dogs and
cats may not be receiving adequate analgesia postopera-
tively; therefore, it is important for veterinarians to an-
ticipate the likelihood of postsurgical pain and to ad-
minister appropriate analgesic therapy. 11 Animals
should not be expected to tolerate pain any greater than
humans would voluntarily tolerate.11 Careful patient
monitoring and a sound knowledge of the pharmacolo-
gy of analgesics are necessary to ensure that pain does
not occur during the postoperative period.
BLADDER MANAGEMENT
Bladder management is the most important and
most challenging issue faced after spinal surgery. Failure
to maintain adequate voiding of urine can lead to such
potentially severe problems as cystitis, bladder atony,
pyelonephritis, and iatrogenic bladder rupture. The
neurogenic bladder dysfunction that is generally seen in
patients with spinal cord disease is described on the ba-
sis of location of the lesions (termed lower motor neuron
bladder and upper motor neuron bladder).
The lower motor neuron bladder occurs with spinal
cord lesions at the level of the sacral cord, cauda
equina, pelvic nerve, and pudendal nerve. Such lesions
abolish both the voluntary and reflex phases of normal
micturition. Consequently, contraction of the detrusor
muscle is eliminated, and urethral sphincter muscle
tone is lost.21–24 The bladder retains urine, and overflow
incontinence results. Manual bladder expression is gen-
erally straightforward, but voiding occurs only as long
as external pressure is applied.23 In rare instances, inner-
vation to the internal sphincter via the hypogastric
nerve can remain intact, resulting in a bladder that is
difficult to express.22,24
CARPROFEN ■ NEUROGENIC BLADDER DYSFUNCTION ■ CATHETERIZATION
The Compendium February 1997
The upper motor neuron bladder results from spinal
cord lesions between the pons and the lumbar spinal
cord segment 7. Reflex micturition can occur, but vol-
untary control of urination is lost. Overflow inconti-
nence without any attempt to urinate may be present
in the early stages after surgery.22,24 Usually, urethral
sphincter tone is exaggerated, and the bladder may be
extremely difficult to express.21,24 Several days to weeks
may pass before the sacral reflex is restored.22 When the
upper motor neuron bladder persists for a prolonged
period, the animal urinates without awareness, and a
large residual volume of urine is usually retained after
voiding.21–24
Manual Bladder Expression and Catheterization
The primary goal of bladder management immedi-
ately after surgery is to maintain normal or reduced
bladder volume and to prevent bladder overdisten-
tion.24 Because the abdominal muscles are often tense
after surgery, the bladder may be difficult to palpate.
Ultrasonography can help determine the extent of blad-
der distention. Alternatively, the patient can be cathe-
terized to measure urine volume.
Manual expression and intermittent or indwelling
catheterization can be used to help dogs void urine.
Our preference is for manual expression, except in dogs
with excessive urethral tone or when nursing care is fa-
cilitated by catheterization. Most dogs with lower mo-
tor neuron bladders and some with upper motor neu-
ron bladders respond to manual expression. In smaller
dogs, the caudal abdomen is gently squeezed with the
thumb and fingers of one hand while supporting the
dog with the other hand.25 In larger dogs, both hands
are required to express the bladder. The pressure ap-
plied should be firm enough to create a steady stream
of urine.21 Initially, this procedure should be repeated
every 4 to 6 hours. This interval can be adjusted later,
depending on the amount of bladder distention and
the volume of urine voided (Figure 2).
Catheterization of the bladder may be necessary in
dogs with neurogenic bladder dysfunction, particularly
those with hypertonic urethral sphincters. Strict atten-
tion to aseptic technique (e.g., using sterile catheters
and gloves) helps reduce the incidence of nosocomial
infections caused by bladder catheterization.26 The vul-
va or prepuce should be surgically prepared, and a ster-
ile lubricant should be applied to the tip of the cathe-
ter.
Catheters are made of a variety of materials, includ-
ing plastic, rubber, metal, glass, and nylon.26 Some dogs
may have an inflammatory reaction to a particular type
of catheter, but such responses seem to vary among
dogs and catheters. 27 A red rubber feeding tube or
The Compendium February 1997 Small Animal

polypropylene catheter of pair the mucosal defense

the smallest diameter should barrier.26
26–28
be used. A Foley-type Urinary tract infection
catheter can be used as an may be a complication after
indwelling catheter in fe- spinal surgery because of an
male dogs because the bal- increase in the residual vol-
loon can be inflated to aid ume of urine and the need
in catheter retention.26,28 for catheterization. Urinaly-
Intermittent, as opposed sis and urine culture should
to indwelling, catheteriza- be performed if catheteriza-
tion may reduce the risk of tion continues for more
bladder infection.26,29 Inter- than 4 days or if clinical
mittent catheterization, signs of cystitis occur. In
however, must be repeated dogs with spinal cord injury,
regularly (depending on the Figure 2—With a small dog, the bladder can be expressed by the classic signs of dysuria
amount of urine retrieved) gently squeezing the bladder with the thumb and fingers of and pollakiuria may not be
to ensure that the bladder one hand while supporting the dog with the other hand. present, but hematuria should
does not become overdis- be readily identifiable. 25
tended. The risk of bladder Common bacteria found on
infection increases with the culture of urinary tract in-
number of catheterizations.26 fections include Escherichia
Because intermittent cathe- coli, Staphylococcus species,
terization may be difficult to Streptococcus species, and
perform in female dogs, in- Proteus mirabilis. Klebsiella
dwelling catheterization may pnemoniae and Pseudomonas
be preferable. aeruginosa have also been
When using an in- recognized.25,32
dwelling catheter, a closed Antibiotic selection should
urinary collection system is be based on the results of
essential. An empty intra- bacterial sensitivity test-
venous fluid bag attached to ing.25,32 Empirical treatment
the catheter via a sterile in- with penicillins, cephalo-
travenous fluid line makes sporins, trimethoprim-sulfa-
Figure 3—A closed urinary collection system is essential with
an excellent closed drainage an indwelling catheter. The collection bag should be posi- diazine, or enrofloxacin
system (Figure 3). The pro- tioned lower than the dog. should not be discouraged
phylactic use of antibiotics while awaiting results of the
with catheterization is con- sensitivity testing. It is rec-
traindicated because of the inherent risk of developing ommended that monthly or bimonthly culture and uri-
resistant bacteria.26–28 nalysis be done in animals with long-term hindlimb
and urinary paralysis.25,32
Urinary Tract Infections
Various defense mechanisms in the bladder and ure- Pharmacologic Bladder Management
thra protect the normal canine bladder from infec- Drug therapy is occasionally necessary to improve
tion.30,31 Normal micturition provides complete voiding bladder and urethral function. The pharmacologic
of an adequate volume of urine. Anatomic structures, management of bladder disorders, however, is not al-
such as urethral length, urethral peristalsis, and urethral ways effective and should be done on a short-term basis
high-pressure zones, contribute to resistance from in- only.21 Owners should be made aware that the drugs
30,31
fection. The mucosa of the bladder wall and urethra being prescribed do not restore normal bladder control
in addition to the antimicrobial effects of the urine it- but merely assist in overall bladder management. Drug
self provide a barrier to infection.30,31 The protective ef- therapy aids micturition until normal bladder function
fect of many of these factors is greatly reduced, howev- is restored (Table II).
er, in animals with neurogenic bladder dysfunction. The hypertonicity of the internal urethral sphincter
Abnormal urine voiding and altered urethral tone im- in animals with upper motor neuron bladders may be

BLADDER INFECTION ■ URINE CULTURE ■ ANTIBIOTICS

The Compendium February 1997
TABLE II
Drugs Used for Pharmacologic Management of Neurogenic Bladder Dysfunction
Drug Dosage
Phenoxybenzamine 5–15 mg SID, PO
Bethanechol 2.5–25 mg TID, PO
Diazepam 2–10 mg TID, PO
Dantrolene 1–5 mg/kg BID, PO
Phenylpropanolamine 12.5–50 mg TID, PO
Propantheline 7.5–30 mg/kg TID, PO
BID = twice daily, PO = orally, SID = once daily, TID = three times daily.
reduced by using the α-adrenergic blocking agent phe-
noxybenzamine. Response to treatment depends on the
type of lesion. An assessment of effectiveness may re-
quire several days. Treatment should be discontinued
after 1 to 2 weeks if no clinical response is seen.22–24,33
Detrusor contractility may be enhanced with the
cholinergic drug bethanechol. The extent of detrusor
atony determines the clinical response to this drug. If
no response is seen after 1 week of treatment, therapy
should be considered to be ineffective. In addition,
bethanechol has a weak nicotinic effect on the bladder
neck, which can increase urethral outflow resistance.
For this reason, bethanechol may be used most effec-
tively in combination with phenoxybenzamine.
Bethanechol should not be used if urethral obstruction
is suspected.22–24,33
The tone of the external urethral sphincter, which
consists of skeletal muscle, may be reduced by using di-
azepam.22–24,33 Less frequently used drugs for bladder
management include dantrolene, phenylpropanola-
mine, and propantheline.22–24,33
PHYSICAL THERAPY
After spinal surgery, patients are often recumbent and
confined to their cages. Physical therapy plays a key
role in hastening successful recovery. Physical therapy
can improve muscular strength and speed the healing of
inflamed and injured tissues while helping to maintain
the normal range of motion in joints.34–36 In addition,
BETHANECHOL ■ RECOVERY PROCESS ■ COLD PACKS
Small Animal
Clinical Effects Side Effects
α-Adrenergic; reduces hypertonicity Hypotension, tachycardia
of internal urethral sphincter
Cholinergic; enhances detrusor Vomiting, diarrhea,
contractility hypersalivation, abdominal
cramps
Indirect skeletal muscle relaxant Sedation
Direct skeletal muscle relaxant Weakness, hepatotoxicity
α-Adrenergic agonist; increases Hypertension
urethral sphincter tone
Anticholinergic; decreases Constipation, decreased
detrusor contraction salivation, gastric
hypermotility
muscle atrophy and fibrosis may be prevented.36,37
A well-designed physical therapy program can de-
crease the duration of hospitalization and help to im-
prove patient attitude and mental status.37 Initiation of
physical therapy depends on the location and severity
of the lesion; the surgical technique performed; and the
animal’s condition, attitude, and demeanor.
Cold Therapy
Cold therapy using the conduction of cold with cold
packs, cold water, or ice may be indicated in the first
12 to 48 hours after surgery. Local hypothermia de-
creases nerve conduction velocity (creating mild analge-
sia), causes vasoconstriction (reducing edema), and re-
laxes skeletal muscles.36–39
Cold packs should be placed over a sterile, water-
impermeable dressing and should be kept in place for 5
to 10 minutes, two to four times daily. Treatments
should never exceed 30 minutes because extended cold
therapy sessions may lead to vasodilatation and subse-
quent edema formation.36
Commercially produced cold packs that are available
for human physical therapy can be adapted for use in
dogs. A simple ice pack can be constructed by filling a
plastic bag with ice, wrapping the bag in a towel, and
placing the bag on the wound.36–39
Heat Therapy
Heat therapy is indicated from 48 to 72 hours after
Small Animal The Compendium February 1997

surgery to decrease swelling, kneading, and friction.

pain, and muscle spasm at Stroking is a superficial touch
the surgical site.36–39 In addi- that precedes kneading and
tion, heat therapy may en- friction. It is performed by
hance subsequent massage using light strokes of uni-
and exercise therapy and, form pressure—working
therefore, should precede from the edge to the center
these supplementary thera- of the area to be massaged—
pies. at a rate of 15 strokes/min.
Local hyperthermia in- Stroking accustoms the ani-
creases tissue temperature, mal to the therapist’s touch
thereby producing analgesia, and produces a mild seda-
sedation, and an increase in tive effect.34–38,40
local metabolism. The re- Kneading involves picking
sults of local hyperthermia Figure 4—Local hyperthermia (as provided here by a hot pack up the skin and muscle,
combined with the concur- on the back of this dog) decreases swelling, pain, and muscle which are then rolled and
rent vasodilatation aid the spasm at the surgical site. Hot packs should be insulated compressed—always in the
healing process by enhanc- from the patient’s skin. direction of the heart. Knead-
ing local blood flow and de- ing should be done firmly
creasing edema.36–39 but gently enough not to
Absorbent paper towels or cause pain34–38,40 (Figure 5).
cloths that have been im- Friction is useful for loos-
mersed in water and then ening scar tissue and adhe-
placed in a sealable plastic sions as well as for aiding the
bag can be heated in a mi- absorption of local effusion.
crowave oven to make an The skin is moved rapidly in
excellent, inexpensive, and a circular motion over a
reusable hot pack. Commer- small area three to four times
cial hot packs are available; before moving to an adja-
hot towels may also be cent area. Pressure should be
used.36–39 moderate and should not
Treatments should last be- cause pain.34–38,40
tween 10 and 20 minutes Massage sessions usually
and can be repeated two to Figure 5—Massage therapy decreases the incidence of muscle last between 15 and 20 min-
three times daily. 36–39 Hot atrophy and fibrosis. Massage sessions should be performed utes and should be repeated
packs should be insulated one to two times daily for between 15 and 20 minutes per every 12 to 24 hours. The
from the skin with towels or session. sessions should begin and
paper tissue to eliminate the end with stroking to main-
possibility of burning. The tain muscle relaxation and
skin should be felt every few minutes to ensure that it is the sedative effects.34–38,40
not excessively hot (Figure 4).
Passive Exercise
Massage Therapy Passive exercise involves no voluntary muscle con-
The objective of massage is to increase blood and traction and usually follows heat therapy and massage.
lymph flow through the massaged tissues. This action The therapist flexes and extends the limbs through a
increases the delivery of nutrients to the area and has- normal, pain-free range of motion. This is done 5 to 10
tens the removal of waste products and edema flu- times for two to three sessions daily, beginning 3 or 4
id.34,36–38,40 Muscle atrophy, a common postoperative days after surgery.36 Limbs can be handled individually,
complication in recumbent animals, is minimized by or both limbs on the ipsilateral side of the animal can
using massage in combination with passive and active be treated concurrently.36 Passive exercise maintains the
38
exercise. Massage can also stretch tendons and de- normal range of motion in joints and prevents contrac-
crease the likelihood of fibrosis. ture and muscle wasting. It also improves blood flow
Three forms of massage used for dogs are stroking, and sensory awareness.35,36

LOCAL HYPERTHERMIA ■ STROKING ■ KNEADING ■ FRICTION

Small Animal
Active Exercise
Active exercise involves
voluntary motor control by
the animal. This form of ex-
ercise is very beneficial to
recovering spinal surgery pa-
tients. Active exercise pro-
duces an improvement in
coordination and cardiovas-
cular function.35,38 In addi-
tion, repeated voluntary
contractions of muscles in
affected limbs may decrease
synaptic resistance, thereby
improving nerve impulse Figure 6—Active exercise helps to improve muscle strength, drotherapy.34–38,40
conduction. The result is in- coordination, and cardiovascular function. Active exercise
creased muscle strength.38 can be assisted with the use of a towel under the dog’s ab- sessions should begin slowly
During active exercise, the domen or a commercially available sling.
patient should always be en-
couraged and supported. If the animal’s mental attitude
worsens, the therapy may be ineffective and even detri-
mental, thereby delaying recovery.36
When stabilization procedures are performed, for ex-
ample, in dogs with atlantoaxial instability, cervical ver-
tebral instability, or spinal fracture/luxation, it is im-
portant not to risk implant failure. In these cases, active
exercise and hydrotherapy should be delayed.
For active exercise, the therapist assists the patient by
partially supporting its weight. Tail walking is the sim-
plest form of assisted active exercise and is best used for
paraparetic small dogs. Tail walking consists of holding
the tail at its base and allowing the dog to walk with its
pelvic limbs on a nonslip surface. The amount of sup-
port needed depends on the neurologic status of the
animal.
In larger dogs, a similar technique that involves sup-
porting the dog’s weight with a towel or commercially
available hindlimb sling around the dog’s caudal ab-
domen is used (Figure 6). Two assistants may be need-
ed with large-breed dogs.34–38,40 Quadriplegic animals
can be placed in specially constructed body slings.
These slings enable the dog to bear some weight on all
four limbs and reduce the incidence of decubital
ulcers.34–38,40
Hydrotherapy
Hydrotherapy is an ideal form of active exercise. The
animal’s natural buoyancy and the hydrostatic pressure
of water provide support and help improve circula-
tion.34–38,40 A paraparetic patient will move its joints vol-
untarily far more readily in water. Swimming also aids
in cleansing paraplegic animals of feces and urine on
the skin.34–38,40
TAIL WALKING ■ SWIMMING ■ WHIRLPOOLS ■ PATIENT MONITORING
The Compendium February 1997
The physical therapy reg-
imen is enhanced when heat
and water turbulence (which
provide a form of heat ther-
apy and massage) are added
to the hydrotherapy. 34–38,40
Heating the water to between
35.5˚ and 40.0˚C (96˚–
105˚F) produces a superfi-
cial hyperthermic effect.34–38,40
Whirlpools use a combina-
tion of water currents and
air bubbles to add a mild
massaging action to hy-
Swimming and whirlpool
to accustom the animal to
the water and the proce-
dure. Weak patients may re-
quire constant manual support. Depending on the neu-
rologic status of the animal, the level of the water can
be adjusted to allow some weight bearing.
Hydrotherapy sessions should not begin until ap-
proximately 5 to 7 days after surgery. Sessions should
last between 5 and 30 minutes. The surgical wound
should be dry and impervious to water. Swimming and
whirlpool tanks should be regularly disinfected. Anti-
septics (e.g., povidone-iodine) can be added to the wa-
ter to prevent urine scald, pyoderma, and decubital ul-
cers.34–38,40
Client Education
All appropriate physical therapy techniques must be
demonstrated at the clinic to owners. Owners should
then be observed while they perform the physical thera-
py with their animals to ensure that techniques are be-
ing done correctly. In addition, before an animal is dis-
charged, owners must be made aware of the importance
of encouraging and supporting their pet for physical
therapy to be successful.
A physical therapy chart for recording daily sessions
should be given to clients to assist in compliance and
understanding of the required therapy. 37 Regular
rechecks and/or in-clinic therapy sessions should be
scheduled in advance to assess patient progress and
maintain client contact.
CONCLUSION
The management of dogs that have undergone spinal
surgery is a challenging undertaking, but successful re-
turn to satisfactory neurologic function can be very re-
warding to both practitioners and pet owners. Early
Small Animal
and preemptive use of analgesic agents to manage pain
results in less patient apprehension and distress when
the important phases of bladder management and
physical therapy begin. The goal of bladder manage-
ment is to ensure adequate voiding of urine using phys-
ical and/or pharmacologic means and to quickly diag-
nose and treat urinary tract infections.
Physical therapy can maintain strength and integrity
of muscles and joints with such modalities as cold ther-
apy, heat therapy, massage, and passive and active exer-
cise. Part II of this article will address the potential
complications associated with the surgical wound, the
gastrointestinal tract, and the long-term management
of recumbency.
About the Authors
Drs. Jerram and Hart are affiliated with the Department of
Small Animal Medicine and Surgery, College of Veteri-
nary Medicine, Texas A&M University, College Station,
Texas. Dr. Schulz was also at the Department of Small
Animal Medicine and Surgery, College of Veterinary
Medicine, Texas A&M but is currently at the Department
of Surgical and Radiological Sciences, School of Veteri-
nary Medicine, University of California, Davis, California.
Dr. Schulz is a Diplomate of the American College of Vet-
erinary Surgeons.
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