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Review article: How we manage “Wobblers”

Cervical Spondylomyelopathy (CSM) or ‘Wobblers’ is a disease seen in large and giant breed dogs; Great Danes, Dalmatians and Dobermann Pinschers being particularly over-represented, but cases in German Shorthaired Pointers and German Shepherd Dogs have also been seen. Onset is usually insidious, with the owner describing vague signs comprising a combination of thoracic limb lameness, pelvic limb incoordination and weakness.  Neck pain is an uncommon sign. Occasionally, perhaps associated with a stumble or fall, dogs can present acutely with quadriplegia and severe neck pain. Most dogs respond to rest and anti-inflammatories in the short/ medium term. However, the vast majority of cases progress to involve weakness of all four limbs, and eventually become non-ambulatory. Neurologic examination should localise the lesion to the mid-to-low cervical spinal cord segment (upper motor neuron pelvic limb signs, mixed signs in the thoracic limbs).

Differential diagnoses (intervertebral disc prolapse/ ischemic myelopathy/ discospondylitis/ neoplasia/ GME, etc) are ruled out by means of neuroimaging (MRI or dynamic myelography) and CSF analysis. The extradural compression seen with CSM is often mild as compared to disc prolapse, but usually has a dorsal and/ or lateral (facet joint) component as well as bulging of the intervertebral disc ventral to the cord.

The prognosis with conservative management is guarded as signs usually progress. Options for surgical management of CSM are several: Most work on the basis of removing ventral cord compression by means of slotting the affected intervertebral disc and/ or distraction and fusion of the disc space with a variety of implants and bone graft, all performed via a ventral approach. The advantages of these procedures are relatively good success rates immediately post-operatively, and relatively low perioperative morbidity. The disadvantages include potential haemorrhage from the venous sinuses during slotting, and one paper highlights erosion of the cervical oesophagus bysuture material that had been used to close the longus coli muscle layers. However, the most significant drawback is the propensity for the original lesion to recur should implants fail, or vertebral end-plates/ bodies collapse. Also, it is not uncommon for neighbouring discs to become affected (the ‘domino effect’) when fusion techniques have been employed. The rate of recurrence ranges from 33-50% in long term follow up studies.

intraoperative photograph of dorsal laminectomy in a Great Dane with CSM lesions at Ce3-4 and Ce4-5

An alternative method used here, which has found favour in several institutions in the States and Europe, is continuous dorsal laminectomy. The site of decompression spans the entire region affected by the condition and may therefore continue cranially to Ce3 or 4 and caudally to T1. The technique, although time-consuming, requires no particular additional instrumentation and avoids the need to leave implants behind. The largest drawback is higher postoperative morbidity, with patients frequently requiring hospitalisation for several days. However, recovery is predictable, and the rate of recurrence is lower (<10%).

In summary, should you suspect a case of wobblers, please do not hesitate to contact us to discuss the options in more detail, as early, aggressive surgical management has maximal chance of success.