Disk Injection Better Than Surgery?

Hello Summarians!

Something worth noticing about this week's three studies: they are all, in different ways, about reconsidering the obvious.

One asks whether we've been measuring pulmonary hypertension correctly all along. One makes a serious case that intradiscal injection may prevent disk herniation recurrence better than surgery. And one wonders, more quietly, who will actually own the veterinary clinics of the next generation.

Not radical papers. Just the kind that makes you rethink what you thought you already knew.

New Way To View Pulmonary Hypertension In Dogs

Pulmonary vascular resistance (PVR) is an important hemodynamic parameter in the evaluation of pulmonary hypertension (PH), yet its role in dogs has been less well characterized compared to human medicine. In people, PVR is routinely measured using right heart catheterization to complement echocardiographic findings, but this invasive procedure is rarely performed in client-owned dogs due to cost, risk, and practicality. As a result, veterinary medicine has relied more heavily on noninvasive echocardiographic estimates such as systolic pulmonary artery pressure (SPAP), typically derived from tricuspid regurgitation velocity (TRV). However, SPAP alone does not adequately reflect PVR, and dogs with similar SPAP values may have markedly different underlying pulmonary vascular dynamics. 

This study addresses the gap by evaluating echocardiographic methods of estimating PVR in dogs using formulas validated in humans. The authors compare PVR across different groups, including healthy dogs, dogs with PH, and subtypes of PH such as pre-capillary and post-capillary disease. They hypothesize that dogs with pre-capillary PH will have higher PVR than those with post-capillary PH, and that dogs with combined forms of disease will show the highest resistance values. 

A key concept highlighted is that PH can arise from multiple mechanisms, including increased pulmonary blood flow, elevated left atrial pressure, or intrinsic pulmonary vascular disease. These differing mechanisms may produce similar SPAP measurements but reflect very different pathophysiology. Additionally, certain clinical factors—such as right ventricular dysfunction or severe tricuspid regurgitation—can obscure true pulmonary pressures on echocardiography. 

The study emphasizes that PVR is not only diagnostically relevant but also has prognostic and therapeutic implications. Importantly, the authors identify a subset of dogs with discordant findings, where SPAP and PVR do not align. These cases may be particularly clinically significant, as relying on SPAP alone could lead to misclassification and suboptimal treatment. Overall, the findings support incorporating PVR estimation into routine echocardiographic assessment of dogs with PH to provide a more comprehensive understanding of disease severity and guide management decisions

Alba Stavri, Maya Krasnow, Karsten E Schober, Echocardiographic evaluation of pulmonary vascular resistance in 459 dogs with Doppler-derived pulmonary hypertension, Journal of Veterinary Internal Medicine, Volume 40, Issue 2, March-April 2026, aalag051, https://doi.org/10.1093/jvimsj/aalag051 

Bottom line — May be useful to help evaluate more fully.

IV Disk Injection Vs Surgery

Surgery for thoracolumbar disk herniation in dogs, such as laminectomy or hemilaminectomy, has been considered the standard treatment since the mid-1900s, especially for dogs that cannot walk after an acute disk problem. This belief has grown stronger over the past 30 years with better imaging tools. However, this “standard-of-care” status is based more on tradition and observational studies rather than strong comparative evidence showing it is better than other treatments.  

Historically, the main alternative to surgery has been conservative treatment, such as rest and medications. This approach has been thought to result in lower recovery rates and higher chances of the problem coming back. However, newer research suggests that this assumption may not always be correct and needs to be reconsidered.  

More recently, another option has been studied: injecting a substance called chondroitinase ABC (ChABC) directly into the affected disks. Early data suggest that dogs treated with this method may recover just as well and just as quickly as those treated with surgery.  

One major concern with any treatment is whether the condition will come back. Many believe surgery lowers the risk of recurrence compared to conservative care, but the evidence is limited and inconsistent. Some studies report recurrence rates as high as 50% after surgery, which is similar to rates seen with non-surgical treatment.  

ChABC works by breaking down specific components within the disk, which may reduce the chance of future herniations at treated sites. Although this idea makes sense biologically, it has not been fully studied until recently. Because most recurrences happen within a few years, shorter follow-up periods can still capture many cases.  

The goal of this research was to measure how often dogs treated with ChABC experienced recurrence and to compare those results with dogs treated by surgery, reflecting real-world veterinary practice. 

We conclude that there is substantial evidence to consider that intradiskal ChABC injection at 4 adjacent “at-risk” disks greatly reduces the risk of recurrence of clinical signs associated with thoracolumbar intervertebral disk extrusion when compared to routine decompressive surgery. 

Poacher, J., Tammaro, W. J., Jeffery, N. D., & Freeman, P. M. (2026). Comparison of owner-reported recurrent clinical signs of thoracolumbar disk herniation following multiple chondroitinase ABC intradiskal injections or routine surgical management. Journal of the American Veterinary Medical Association https://doi.org/10.2460/javma.26.01.0005 

Bottom line — Very interesting conclusion.

New Grads And Practice Ownership

This study looks at what influences veterinary students and recent graduates when deciding whether to own a veterinary practice. It also explains how ownership trends are changing and what factors may shape the future of the profession.  

The percentage of veterinarians who own practices has been decreasing, while the average age of owners is increasing. This raises concerns about the long-term sustainability of privately owned clinics. At the same time, ownership offers clear benefits. Practice owners tend to report higher job satisfaction, better work-life balance, and lower burnout compared to associate veterinarians. They also have greater long-term earning potential and the opportunity to build financial equity in a business.  

The study surveyed veterinary students and recent graduates, finding that about half are interested in owning a practice. The biggest reason for wanting ownership is the freedom to practice medicine in their own way. Other important motivations include job satisfaction, leadership opportunities, and flexible schedules.  

However, many participants are discouraged by the responsibilities that come with ownership. The most common concerns include managing a business, handling administrative tasks, dealing with legal responsibilities, and the risk of stress and burnout. A lack of business knowledge is also a major barrier.  

Certain factors increase the likelihood of wanting to own a practice. Men, members of business-focused student organizations, and those interested in mixed-animal practice are more likely to pursue ownership. Family background and exposure to business experience also play a role.  

The study also highlights broader challenges, such as rising corporate ownership of veterinary clinics, high student debt, and gender differences in ownership rates. These trends may limit opportunities for independent practice ownership in the future.  

Overall, the findings suggest that while ownership remains appealing, better education in business skills and stronger mentorship are needed to help future veterinarians feel prepared to pursue it.

 Compton, L., Vroegindewey, G., & Wisnieski, L. (2026). Practice ownership aspirations among veterinary students and recent graduates are influenced by autonomy, perceived responsibility, and career interests. American Journal of Veterinary Research https://doi.org/10.2460/ajvr.26.02.0047 

Bottom line — A complex issue.

Just putting things in perspective …