Clinical Features and Risk Factors for Gastrointestinal Complications in Dogs Treated Surgically for Thoracolumbar Intervertebral Disc Extrusion

Abstract

Gastrointestinal (GI) complications and their clinical implications are poorly characterized in dogs treated surgically for acute thoracolumbar intervertebral disc extrusion (TL-IVDE). The objective of this retrospective study was to characterize GI signs (including vomiting, diarrhea, melena, and hematochezia) in dogs undergoing hemilaminectomy for acute TL-IVDE. One-hundred and sixteen dogs were included. Frequency, type and severity of GI signs during hospitalization, duration of hospitalization and outcome were obtained from the medical record. Potential risk factors for the development of GI signs were explored using univariable and multivariable analyses. Gastrointestinal signs occurred in 55/116 dogs (47%); 22/55 dogs (40%) had one episode and 21/55 (38%) had ≥5 episodes. Diarrhea was the most common (40/55, 73%) while melena was rare (1/55, 2%). GI signs developed in 8/11 dogs (73%) treated perioperatively with both non-steroidal anti-inflammatories and corticosteroids with or without a washout period and in 25/52 dogs (48%) treated prophylactically with proton pump inhibitors. Median hospitalization was 7 days (4–15 days) vs. 5 days (4–11 days) in dogs with or without GI signs, respectively. Duration of hospitalization was associated with development of any GI signs, diarrhea and more severe GI signs (p = 0.001, 0.005, 0.021, respectively). Pre-operative paraplegia with absent pain perception was identified on univariable analysis (p = 0.005) and longer anesthetic duration on multivariable analysis to be associated with development of more severe GI signs (p = 0.047). In dogs undergoing surgery for acute TL-IVDE, GI signs were common and associated with duration of hospitalization and anesthesia. The influence of specific medications and neurologic severity on development of GI signs requires further investigation.

ACVIMconsensus statement on diagnosis and management of acute canine thoracolumbar intervertebral disc extrusion

“…159,170,[183][184][185][186][187][188] They occur at comparable rates in dogs treated with NSAIDs or corticosteroids alone, but at higher rates if these drug classes are combined. 182 However, fatal colonic perforations have been described in dogs treated with high doses of dexamethasone, [189][190][191] and dogs treated with dexamethasone are more likely to develop urinary tract infections (UTIs) and diarrhea than those treated with other or no glucocorticoids. 159 Although high doses of methylprednisolone sodium succinate (MPSS) cause GI bleeding on endoscopy, 162 compared with 2 other study arms, although dogs that already had received an NSAID or other corticosteroid were excluded from this trial.…”

“…Although high doses of methylprednisolone sodium succinate (MPSS) cause GI bleeding on endoscopy, 162 1 RCT did not encounter a higher rate or severity of GI signs in dogs receiving high dose MPSS when compared with 2 other study arms, although dogs that already had received an NSAID or other corticosteroid were excluded from this trial 155 . Different Gl protectants have been used to decrease or prevent GI signs, but studies suggest that these are not effective 182,185 …”

“…However, it is difficult to determine the relative contribution of pain medications to the development of complications in the setting of disc-associated SCI, hospitalization, anesthesia, and surgery. 182 Many dogs with IVDE treated with corticosteroids alone or in combination with NSAIDs develop subclinical or clinical adverse gastrointestinal (GI) effects such as diarrhea, gastritis, GI ulceration, regurgitation and pancreatitis. 159,170,[183][184][185][186][187][188] They occur at comparable rates in dogs treated with NSAIDs or corticosteroids alone, but at higher rates if these drug classes are combined.…”

“…Medications used for pain control are known to have potential adverse effects. However, it is difficult to determine the relative contribution of pain medications to the development of complications in the setting of disc‐associated SCI, hospitalization, anesthesia, and surgery 182 …”

“…Many dogs with IVDE treated with corticosteroids alone or in combination with NSAIDs develop subclinical or clinical adverse gastrointestinal (GI) effects such as diarrhea, gastritis, GI ulceration, regurgitation and pancreatitis 159,170,183‐188 . They occur at comparable rates in dogs treated with NSAIDs or corticosteroids alone, but at higher rates if these drug classes are combined 182 . However, fatal colonic perforations have been described in dogs treated with high doses of dexamethasone, 189‐191 and dogs treated with dexamethasone are more likely to develop urinary tract infections (UTIs) and diarrhea than those treated with other or no glucocorticoids 159 .…”