Canis ISSN: 2398-2942

Cervical spondylopathy

Synonym(s): Wobbler syndrome, Caudal cervical spondylomyelopathy (CCSM, Cervical malformation-malarticulation syndrome, Cervical stenotic myelopathy

Contributor(s): Rodney Bagley, Simon Platt, Harry Scott

Introduction

  • Wobbler's syndrome encompasses a number of cervical vertebral abnormalities. These include vertebral malarticulation/malformation, disk extrusion, articular facet hypertrophy and ligament hypertrophy.
  • Significant cause of subacute or chronic neurological dysfunction in certain breeds of dog.
  • Occasionally can result in acute exacerbations of neurological deterioration.
  • Doberman and Great Dane breeds primarily affected but other large (Dalmatian) and giant breeds (Bernese Mountain dog, English Mastiff) can also be affected.
  • Identical changes can also be seen in small breeds such as the Chihuahua.
  • Signs: progressive ataxia, hindlimb paresis and short choppy forelimb gait.
  • Neck pain is not a common feature; neck extension can cause most dogs to collapse on their hindlimbs.
  • Diagnosis: MRI, CT scan, contrast radiography and clinical signs.
  • Treatment: dorsal and/or surgical decompression + - stabilization + - distraction.
  • There is debate in veterinary circles regarding the validity of ventral slotting versus distraction-fusion techniques. Currently, debate seems to be focusing on selecting criteria to allow rational decision making.
  • Prognosis: guarded in severe cases particularly if patient is recumbent at presentation unless there has been an acute onset; fair if minimal neurological deficits.
    Print off the owner factsheet on Wobbler syndrome Wobbler syndrome to give to your client.

Pathogenesis

Etiology

  • Micro- or macro-instability in the caudal cervical area leads to chronic hypertrophic changes in the local soft tissue and osseus structures. These compress the spinal cord and cause degenerative changes which result in clinical signs.
  • Congenital stenosis of the vertebrae, as is seen with the Great Dane, can cause a chronic compressive syndrome and subsequent demyelination.

Pathophysiology

  • While the pathophysiology of this disease is not completely known, some caudal cervical instability coupled with increased flexion force due to the pull of gravity in a relatively large head size predisposes to damage to the intervertebral disk space and the associated articulations.
  • The disease is characterized by ventral compressive lesions of the caudal cervical area from ligamentous hypertrophy and disk (usually anulus) protrusion.
  • An attempt is made by the body to decrease this instability by hypertrophy of the associated ligamentous supporting structures.
  • This hypertrophy, however, encroaches into the vertebral canal leading eventually to spinal cord compression.
  • In addition to compression damage to axons, impingement of spinal cord vessels results in ischemic damage to the spinal cord.
  • Various underlying causes proposed:
    • Multifactorial and breed associated.
    • Congenital stenosis of the vertebral canal.
    • Chronic degenerative disk disease.
    • Ligamentum flavum pathology and/or vertebral arch malformation.
    • Vertebral tipping subsequent to vertebral malformation.
    • Malformation of the vertebral facet joints which can be primary and congenital or can be in response to instability of the adjacent vertebrae.
  • The middle-aged Doberman is the most classically described breed affected with this disease. This breed also suffers chronic disk degeneration of the caudal cervical vertebrae which can exacerbate the results of vertebral instability.
  • The nucleus pulposus can no longer absorb shock and the annulus fibrosus thickens by hypertrophy.
  • Dorsal thickening causes protrusion into the cervical spinal canal and causes compression of the cord leading to clinical signs.
  • The disk degeneration is believed to be due to abnormal forces loaded onto the disks due to malformation of individual vertebrae, commonly C6 and C7.
  • As dorsal instability and joint failure most likely contribute to the pathophysiology of the disease, it seems logical that internal stabilization dorsally may decrease the progression of the disease.
  • Unfortunately, by the time the disease is recognized, ventral compression is severe enough that dorsal extension of the neck results in worsening spinal compression.
  • This dynamic worsening often precludes dorsal fixation in extension.
  • If, however, the disease could be recognized in its early stages, dorsal fusion may be beneficial in decreasing the progression of the disease.
  • Younger, large breed dog such as the Great Dane have a similar disease, but most likely with a differing pathophysiology: there is stenosis of the cranial aspect of the cervical vertebra +/- articular facet malformation usually at C4-C6.
  • In this instance, disease of the dorsal articular facets predisposes to hypertrophy of the associated joint capsule and ligaments, resulting also in spinal cord compression.
  • A similar-type compression is rare in older dogs.

Timecourse

  • Very variable, from acute onset to slow progression of signs over many months.

Diagnosis

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Treatment

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Prevention

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Outcomes

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • da Costa R C, Parent J M, Holmberg D L, Sinclair D, Monteith G (2008) Outcome of medical and surgical treatment in dogs with cervical spondylomyelopathy: 104 cases (1988-2004). JAVMA 233 (8), 1284-1290 PubMed.
  • Shamir M H, Chai O, Loeb A (2008) A method for intervertebral space distraction before stabilization combined with complete ventral slot for treament of disc-associated wobbler syndrome in dogs. Vet Surg 37 (2), 186-192 PubMed.
  • da Costa R C, Parent J M (2007) One-year clinical and magnetic resonance imaging follow-up of Doberman Pinschers with cervical spondylomyelopathy treated medically or surgically. JAVMA 231 (2), 243-250 PubMed.
  • da Costa R C, Parent J, Dobson H, Holmberg D, Partlow G (2006) Comparison of magnetic resonance imaging and myelopathy in 18 Doberman pinscher dogs with cervical spondylomyelopathy. Vet Radiol Ultrasound 47 (6), 523-531PubMed.
  • da Costa R C, Parent J M, Partlow G, Dobson H, Holmberg D L, Lamarre J (2006) Morphologic and morphometric magnetic resonance imaging features of Doberman Pinschers with and without clinical signs of cervical spondylomyelopathy. Am J Vet Res 67 (9), 1601-1612 PubMed.
  • Penderis J, Dennis R (2004) Use of traction during magnetic resonance imaging of caudal cervical spondylomyelopathy ("wobbler syndrome") in the dog. Vet Radiol Ultrasound 45 (3), 216-219 PubMed.
  • Rusbridge C, Wheeler S J & Torrington A M (1998) Comparison of two surgical techniques for the management of cervical spondylomyelopathy in dobermanns. JSAP 39 (9), 425-31 PubMed.
  • Dixon B C, Tomblinson J L & Kraus K H (1995) A modified distraction-stabilization technique for canine caudal cervical spondylomyelopathy using an interbody polymethyl methacrylate plug. Vet Surg 24, 425.
  • Al-Mefty O, Harkey H L, Marawi I et al (1993) Experimental chronic compressive cervical myelopathy. J Neurosurg 79 (4), 550-61 PubMed.
  • Sharp N J H, Wheeler S J & Cofone M (1992) Radiological evaluation of 'Wobbler' syndrome - caudal cervical spondylomyelopathy. JSAP 33 (10), 491 VetMedResource.
  • Lewis D G (1991) Radiological assessment of the cervical spine of the doberman with reference to cervical spondylo-myelopathy. JSAP 32 (2), 75 Wiley Online Library.
  • Bruecker K A, Seim III H B & Blass C E (1989) Caudal cervical spondylomyelopathy - decompression by linear traction and stabilization with Steimann pins and polymethyl methacrylate. JAAHA 25, 677 AGRIS FAO.
  • Lewis D G (1989) Cervical spondylo-myelopathy ('wobbler' syndrome) in the dog - a study based on 224 cases. JSAP 30 (12), 657-65 VetMedResource.
  • McKee W M, Lavelle R B & Mason T A (1989) Vertebral stabilization for cervical spondylopathy using a screw and washer technique. JSAP 30 (6), 337-42 VetMedResource.
  • Chambers J N, Oliver Jr J E & Bjorling D E (1986) Update on ventral decompression for caudal cervical disk herniation in Doberman pinschers. JAAHA 22 (6), 775-8 VetMedResource.
  • Seim III H B & Withrow S J (1982) Pathophysiology and diagnosis of caudal cervical spondylomyelopathy with emphasis on the Doberman pinscher. JAAHA 18, 241 AGRIS FAO.
  • Hurov L (1979) Dorsal decompressive cervical laminectomy in the dog - surgical considerations and clinical cases. JAAHA 15 (3), 301-9 VetMedResource.
  • Denny H R, Gibbs C & Gaskell C J (1977) Cervical spondylopathy in the dog - a review of thirty-five cases. JSAP 18 (2), 117-32 PubMed.
  • Trotter E J, deLaHunta A, Geary J C et al (1976) Caudal cervical vertebral malformation - malarticulation in Great danes and Doberman pinschers. JAVMA 168 (10), 917-30 VetMedResource.

Other sources of information

  • Typical gait pattern that may be observed in a dog with cervical disc disease. Fitzpatrick Referrals: www.youtube.com/watch?v=6_6cNZOYbL4
  • Bojrab M J (1993) Disease Mechanisms in Small Animal Surgery. 2nd edn. Philadelphia: Lea & Febiger. pp 979.
  • deLaHunta A (1983) In:V eterinary Neuroanatomy and Clinical Neurology. 2nd edn. Philadelphia: W B Saunders.


ADDED