An update on practice patterns of North American and European veterinary neurology and surgery specialists for surgical management of acute canine thoracolumbar intervertebral disc extrusion.

Objectives: A thorough understanding of common practice patterns in a particular specialty can help identify and design new interventions to improve care delivery and access to care. The goals of this study were to document current practice patterns among veterinary "neurologists" and small animal "surgeons" in the surgical management of acute canine thoracolumbar intervertebral disc extrusion, to compare approaches between these two groups and to discuss current results compared to those published in 2016.

Materials and methods: A web-based survey was distributed in October 2024 to collect responses from board-certified and regionally recognised neurology and surgery specialists in North America and Europe. Data were summarised using descriptive statistics. Chi-squared analysis assessed differences in response distribution between "neurologists" and "surgeons" for specific questions.

Results: A total of 385 survey responses were received. There was a significant difference in the distribution of responses related to caseload between specialties, where "surgeons" most reported 1 to 25 cases per year and "neurologists" most reported managing >100 cases per year. "Surgeons" and "neurologists" did not differ with respect to surgical recommendations based on the severity of neurologic signs. Eighty per cent of "neurologists" and 47% or "surgeons" reported performing concurrent fenestration at the time of surgical decompression. Compared to 2016, utilisation of methylprednisolone sodium succinate and performance of after-hours surgery were reduced in both groups.

Clinical significance: Results of the present survey indicate substantial shifts in practice patterns for surgical management of this disease, some in alignment with current literature and some not. Future work should focus on the comparison of clinical outcomes in dogs imaged with CT versus MRI. Results also suggest a continued lack of clinical equipoise around prognostic factors for recovery and risk factors for progressive myelomalacia, such that future prospective studies could help improve clinician confidence in these areas.