Cervical Spondylomyelopathy (Wobbler’s Syndrome)

Wobbler’s is neurological condition mostly affecting large breed dogs, especially Dobermans, Dalmatians, Bernese Mountain Dogs, and Great Danes, although can also occur in toy and small breed dogs such as Chihuahuas and Yorkshire Terriers. The age of onset ranges from 3 months to 9 years, with the mean age being 6-7 years old. Wobbler’s is a compression of the spinal cord as a result of degenerative changes and congenital stenosis (narrowing of the spinal canal) in the cervical spine (neck area). These changes may include disc protrusion, changes in the ligaments of the neck, synovial cyst formation, and/or degenerative joint disease in the vertebrae. Signs vary from neck pain, ataxia (unsteady gait) to tetraplegia (paralysis of all four limbs). Signs in the hind limbs are more severe than in the front limbs. If there is compression in the lower cervical area, dogs often have a short gait in the front limbs and uncoordinated, disconnected gait in the hind limbs. If there is nerve root entrapment, there can be front limb lameness and muscle atrophy.

Diagnosis is made based on symptoms, examination, and imaging. Radiographs may show degenerative changes common with Wobbler’s but will not show areas of spinal cord compression. MRI can show any areas of compression and is necessary for surgical planning if surgery is indicated.

Treatment depends on the severity of the signs. Mildly affected cases can be treated conservatively with crate rest for 4-6 weeks. Neck collars and leashes should be avoided and instead use a harness to decrease neck strain. Pain medication should be used if there is pain, however many dogs do not experience pain. In severe cases, surgery may be indicated if there is significant neurologic deficits or if there is a progression of symptoms despite conservative management. The goal of surgery is to decompress and stabilize the cervical spine. Unmonitored activity should be restricted and controlled exercise and physical therapy implemented.

Physical therapy is important for pain control, positioning post-operatively, strengthening, gait training, neuromuscular rehabilitation, and to assess for assistive devices if needed.

References:

Platt, Simon & Olby, Natasha. (2019). BSAVA Manual of Canine and Feline Neurology (4th edition). British Small Animal Veterinary Association

Millis, Darryl L. & Levine, David. (2014). Canine Rehabilitation and Physical Therapy (2nd edition), Elsevier

This week’s blog is the last in this series. I think I have covered the main diagnoses that are seen for rehab, but if I’ve forgotten something or if there’s something you would like me to cover, please drop me a note and let me know!

Next week: Physical therapy treatments