Study highlights postoperative risks of hydrotherapy following surgery for IVDE 

A study has shown that early hydrotherapy may be associated with an increased risk of postoperative complications following surgical treatment for thoracolumbar intervertebral disc extrusion (IVDE).

The study – “Safety of early postoperative hydrotherapy in dogs undergoing thoracolumbar hemilaminectomy” – has been published in the Journal of Small Animal Practice (JSAP).

Medical records

Researchers retrospectively reviewed the medical records of a single referral hospital in Sweden to identify dogs that had been treated with hemilaminectomy for acute or chronic thoracolumbar IVDE and had commenced hydrotherapy within five days after surgery.

Information collected from the medical records included signalment, presenting clinical signs, severity of neurological signs, initiation and duration of hydrotherapy, postoperative complications and follow-up.

Postoperative complications were considered major if there was a need for hospitalisation, surgery, or if the dog died or was euthanised as a direct consequence of the complication. A complication was deemed minor if outpatient medical treatment was sufficient to rectify it.

Postoperative

A total of 83 dogs were included in the study. Hydrotherapy was started within a mean of 2.7 (1 to 5) days after surgery and consisted of swimming without underwater treadmill (UWTM) in dogs with severe paraparesis or paraplegia.

With neurological improvement, and when supported ambulation was possible, UWTM was initiated.

In total, 96% of the dogs used swimming as postoperative hydrotherapy, starting with a mean of 2.7 days after surgery, 57% of the dogs used UWTM as the postoperative hydrotherapy, starting with a mean of 13 days after surgery.

The percentage of dogs using both hydrotherapeutic modalities was 45%.

Complications

Abtin Morjarradi, corresponding author for the paper, said: “A total of 10 minor complications were recorded during the study period, including surgical site infection (SSI; n=5), diarrhoea (n=4) and urinary tract infection (n=1). Major complications were recorded in 26 dogs during the study period and included euthanasia (n=13), acute dermatitis (n=1), spinal abscess (n=1) and disc extrusion (n=1).

“Reasons for euthanasia were urinary incontinence (n=5), lack of neurological improvement (n=2), clinical suspicion of progressive myelomalacia (PMM; n=2), persistent pain (n=1), aggression (n=1) and widespread cellulitis with an abscess caudal to the right stifle without known cause (n=1).

“Follow-up visits for 71 dogs were performed at a mean of 15.3 (9 to 30) days, and 68 dogs at a mean of 45.9 (30 to 111) days, after surgery. At the first follow-up visit, 68% of the dogs were ambulatory with Modified Frankel Score (MFS) 4 or higher.

“At the last follow-up visit 97% of the dogs were ambulatory with MFS 4 or higher, with 34% demonstrating normal neurological function. None of these dogs deteriorated after the initiation time of hydrotherapy.”

High number

Nicola Di Girolamo, editor of JSAP, added: “While previous studies indicate that early rehabilitation may be beneficial after acute spinal cord injury, the optimal timing to start hydrotherapy is unclear.

“Despite a high number of complications being recorded in the present study, it is not clear how many of these complications were directly related to the initiation time of hydrotherapy and, therefore, further research is required.”