Cervical Spondylomyelopathy (Wobbler’s Syndrome)
Disc Associated
Cervical spondylomyelopathies encompasses a number of cervical vertebral abnormalities. These include vertebral malarticulation/malformation, intervertebral disk extrusion and protrusion, articular facet disease, and spinal ligamentous disease. These abnormalities often result in ataxia or a “wobbly” gait, hence the clinically descriptive term used. The constellation of these pathologic alterations contribute to the diverse clinical and pathologic conditions grouped together under the heading “wobbler syndrome”. Hence, wobbler syndrome does not describe a single specific disease entity.
While the pathophysiologic processes associated with these clinical abnormalities are complex, two general clinical manifestations predominate: an osseous-associated form in younger large to giant breed dogs and a disc-associated form in older large breed dogs.
The form of wobbler syndrome as epitomized in the middle-aged to older Doberman is characterized by ventral compressive spinal cord lesions primarily in the caudal cervical area. These lesions result primarily from ligamentous hypertrophy and intervertebral disk (usually annulus fibrosis) protrusion. While the pathophysiology of this disease is not entirely understood, some degree of caudal cervical instability possibly coupled with increased flexion force (due to the pull of gravity in a comparatively large head size) predisposes to damage to the intervertebral disk elements and the associated vertebral articulations. The associated vertebral abnormalities are more often a secondary change associated with the consequences of IVDD and the subsequent pathological forces placed upon the vertebral elements. It is also possible that an inherent degeneration occurs in the intervertebral disk as an initiating factor as the disk itself provides significant stability to the spinal column. It is also possible that some degree of vertebral malformation predisposes to the IVDD. Hypertrophy of the associated ligamentous supporting structures (dorsal longitudinal ligament, dorsal intervertebral ligament, ligamentum flavum) is most likely a secondary reaction of the body in an attempt to decrease this instability and “strengthen” or to naturally “fuse” these vertebral segments. Bony malformation alone rarely results in spinal cord compression in this clinical condition. Hypertrophied “soft” tissue, however, often encroaches into the vertebral canal, eventually leading to spinal cord compression. In addition to compression damage to axons and neurons, impingement of spinal cord vessels results in ischemic damage to the spinal cord. This ischemic spinal cord injury often contributes significantly to the clinical signs. In some instances, actual extrusion of nuclear material from the intervertebral disk may also occur.
While the pathophysiologic processes associated with these clinical abnormalities are complex, two general clinical manifestations predominate: an osseous-associated form in younger large to giant breed dogs and a disc-associated form in older large breed dogs.
The form of wobbler syndrome as epitomized in the middle-aged to older Doberman is characterized by ventral compressive spinal cord lesions primarily in the caudal cervical area. These lesions result primarily from ligamentous hypertrophy and intervertebral disk (usually annulus fibrosis) protrusion. While the pathophysiology of this disease is not entirely understood, some degree of caudal cervical instability possibly coupled with increased flexion force (due to the pull of gravity in a comparatively large head size) predisposes to damage to the intervertebral disk elements and the associated vertebral articulations. The associated vertebral abnormalities are more often a secondary change associated with the consequences of IVDD and the subsequent pathological forces placed upon the vertebral elements. It is also possible that an inherent degeneration occurs in the intervertebral disk as an initiating factor as the disk itself provides significant stability to the spinal column. It is also possible that some degree of vertebral malformation predisposes to the IVDD. Hypertrophy of the associated ligamentous supporting structures (dorsal longitudinal ligament, dorsal intervertebral ligament, ligamentum flavum) is most likely a secondary reaction of the body in an attempt to decrease this instability and “strengthen” or to naturally “fuse” these vertebral segments. Bony malformation alone rarely results in spinal cord compression in this clinical condition. Hypertrophied “soft” tissue, however, often encroaches into the vertebral canal, eventually leading to spinal cord compression. In addition to compression damage to axons and neurons, impingement of spinal cord vessels results in ischemic damage to the spinal cord. This ischemic spinal cord injury often contributes significantly to the clinical signs. In some instances, actual extrusion of nuclear material from the intervertebral disk may also occur.
Age of Onset: Greater than 5 years of age
Sex Predisposition: Any sex of animal can be affected
Clinical Course:
Signs usually progress relatively slowly over weeks to months. Occasionally, acute exacerbation of clinical signs may occur
Signs usually progress relatively slowly over weeks to months. Occasionally, acute exacerbation of clinical signs may occur
Clinical Signs:
Posture and Appearance
Scuffing of nails on weight-bearing digits of the pelvic limbs
Head may be held in a flexed position
Movement
Tetraparesis (pelvic limbs are typically worse than the thoracic limbs)
Truncal ataxia
Forelimb strides shorter than hindlimb strides (two engine gait)
Proprioception
General proprioceptive deficits to the pelvic limbs more severe than the thoracic limbs
Spinal Reflexes
Decreased flexor reflex in the pelvic limbs
Increased extensor tone in the thoracic limbs or all 4 limbs
Muscle Atrophy
Atrophy of the supraspinatus and infraspinatus muscles
Pain Sensation
Cervical hyperesthesia
Posture and Appearance
Scuffing of nails on weight-bearing digits of the pelvic limbs
Head may be held in a flexed position
Movement
Tetraparesis (pelvic limbs are typically worse than the thoracic limbs)
Truncal ataxia
Forelimb strides shorter than hindlimb strides (two engine gait)
Proprioception
General proprioceptive deficits to the pelvic limbs more severe than the thoracic limbs
Spinal Reflexes
Decreased flexor reflex in the pelvic limbs
Increased extensor tone in the thoracic limbs or all 4 limbs
Muscle Atrophy
Atrophy of the supraspinatus and infraspinatus muscles
Pain Sensation
Cervical hyperesthesia
Spinal - Cervical spinal cord
Disc-Associated: C5-C7
Disc-Associated: C5-C7
Unknown
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Osseous Associated
Cervical spondylomyelopathies encompasses a number of cervical vertebral abnormalities. These include vertebral malarticulation/malformation, intervertebral disk extrusion and protrusion, articular facet disease, and spinal ligamentous disease. These abnormalities often result in ataxia or a “wobbly” gait, hence the clinically descriptive term used. The constellation of these pathologic alterations contribute to the diverse clinical and pathologic conditions grouped together under the heading “wobbler syndrome”. Hence, wobbler syndrome does not describe a single specific disease entity.
While the pathophysiologic processes associated with these clinical abnormalities are complex, two general clinical manifestations predominate: an osseous-associated form in younger large to giant breed dogs and a disc-associated form in older large breed dogs.
Younger, large-breed dogs, such as the Great Danes, Mastiffs, and Saint Bernards, have a similarly named disease, but apparently differing underlying pathophysiologic and clinical forms of “Wobbler syndrome”. In these younger and larger dogs, there is disease and degeneration primarily of the dorsal articular facets with secondary hypertrophy of the associated joint capsules and supporting ligaments. This hypertrophied tissue results in a more dorsal and lateral anatomical arrangement of spinal compression. The articular facet joints may inherently degenerate or may be damaged due to ineffectual ability to support the weight of the head. Some animals may have congenital bony malformations of the articular facets predisposing to a stenotic vertebral canal associated with bony compression of the spinal cord. In still other instances, small portions of synovial tissue containing synovial fluid may become entrapped and "pinched off." These sacs of inspissated synovial fluid are known as synovial cysts. These cysts may compress the spinal cord, either statically or with vertebral movement (dynamic compression).
Development of osseous-associated cervical spondylomyelopathy may be associated with excess energy intake. If clinical signs are recognized early on, disease progression may be able to be mitigated by diet restriction.
While the pathophysiologic processes associated with these clinical abnormalities are complex, two general clinical manifestations predominate: an osseous-associated form in younger large to giant breed dogs and a disc-associated form in older large breed dogs.
Younger, large-breed dogs, such as the Great Danes, Mastiffs, and Saint Bernards, have a similarly named disease, but apparently differing underlying pathophysiologic and clinical forms of “Wobbler syndrome”. In these younger and larger dogs, there is disease and degeneration primarily of the dorsal articular facets with secondary hypertrophy of the associated joint capsules and supporting ligaments. This hypertrophied tissue results in a more dorsal and lateral anatomical arrangement of spinal compression. The articular facet joints may inherently degenerate or may be damaged due to ineffectual ability to support the weight of the head. Some animals may have congenital bony malformations of the articular facets predisposing to a stenotic vertebral canal associated with bony compression of the spinal cord. In still other instances, small portions of synovial tissue containing synovial fluid may become entrapped and "pinched off." These sacs of inspissated synovial fluid are known as synovial cysts. These cysts may compress the spinal cord, either statically or with vertebral movement (dynamic compression).
Development of osseous-associated cervical spondylomyelopathy may be associated with excess energy intake. If clinical signs are recognized early on, disease progression may be able to be mitigated by diet restriction.
Age of Onset: Less than 1 year of age (typically by a few months of age)
Sex Predisposition: Any sex of animal can be affected
Clinical Course:
Signs usually progress relatively slowly over weeks to months. Occasionally, acute exacerbation of clinical signs may occur
Signs usually progress relatively slowly over weeks to months. Occasionally, acute exacerbation of clinical signs may occur
Clinical Signs:
Posture and Appearance
Scuffing of nails on weight bearing digits of the pelvic limbs
Head may be held in a flexed position
Movement
Truncal ataxia
Hypermetria
Hypometria
Spastic, stiff, or floating gait
Mild paraparesis to tetraparesis
“paws of the thoracic limbs are “flipped” forward at the carpus prior to impacting the ground”
Forelimb strides shorter than hindlimb strides (two engine gait)
Proprioception
General proprioceptive deficits to the pelvic limbs more severe than the thoracic limbs
Spinal Reflexes
Decreased flexor reflex in the pelvic limbs
Increased extensor tone in the thoracic limbs or all 4 limbs
Muscle Atrophy
Atrophy of the supraspinatus and infraspinatus muscles
Pain Sensation
Cervical hyperesthesia
Posture and Appearance
Scuffing of nails on weight bearing digits of the pelvic limbs
Head may be held in a flexed position
Movement
Truncal ataxia
Hypermetria
Hypometria
Spastic, stiff, or floating gait
Mild paraparesis to tetraparesis
“paws of the thoracic limbs are “flipped” forward at the carpus prior to impacting the ground”
Forelimb strides shorter than hindlimb strides (two engine gait)
Proprioception
General proprioceptive deficits to the pelvic limbs more severe than the thoracic limbs
Spinal Reflexes
Decreased flexor reflex in the pelvic limbs
Increased extensor tone in the thoracic limbs or all 4 limbs
Muscle Atrophy
Atrophy of the supraspinatus and infraspinatus muscles
Pain Sensation
Cervical hyperesthesia
Spinal cord - Cervical
Multiple cervical segments caudal to C2
Multiple cervical segments caudal to C2
Unknown
To read more about this disease click below:
To read more about this disease click below:
