How do I determine if a dog with IVDD is a surgical versus medical management candidate?

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The primary driver of the surgical versus medical management decision in canine IVDD is the severity of neurological signs, specifically ambulatory status and the presence or absence of deep pain perception. For non-ambulatory dogs, surgery is the recommended treatment. The 2022 ACVIM consensus statement designates surgical decompression as the standard of care for non-ambulatory dogs with IVDD. 1 Surgical decompression has historically been associated with higher success rates, quicker recovery, and lower recurrence risk compared to medical management. 1 That said, conservative management remains a valid alternative when surgery is unavailable due to financial or geographic constraints — a large proportion of small, non-brachycephalic dogs with acute thoracolumbar disc extrusion do recover ambulation without surgery. 4 Deep pain perception status is the critical triage point within the non-ambulatory group. For deep pain-positive (DPP) non-ambulatory dogs, an estimated 86% recover ambulation with conservative management alone. 4 For deep pain-negative (DPN) dogs — the most severely affected — surgical outcomes range from 25% to 76% success, compared to close to 100% for less severely affected dogs. 5 Conservative management can still yield functional recovery in some DPN dogs, including those with severe spinal cord compression on MRI, though the exact clinical and imaging predictors of which DPN dogs will recover without surgery remain incompletely defined. 4 For cervical IVDD specifically, the threshold for surgery differs from thoracolumbar disease. Medical management — analgesics, anti-inflammatory drugs, muscle relaxants, and strict exercise restriction — is the first-line approach for dogs with a first episode of neck pain and no or minor neurological deficits. 7 Surgery is recommended for dogs with recurrent cervical pain or those presenting with neurological deficits. 6 Medical management of cervical IVDD carries a success rate of 48.9%, with 33% of dogs ex