Wobbler Syndrome | Cervical Spondylomyelopathy – Frequently Asked Questions 

The causes include: 

  • Vertebral Canal Stenosis: Narrowing due to growth abnormalities in the vertebral pedicles. Compared to normal Great Dane, Great Danes with OAWS have a significantly smaller vertebral canal at C6/C7 and C7/TI. In addition, the middle foraminal height is smaller in OAWS-affected Great Danes from C3-C4 through C7-T1.  CSM affected Dobermans also have a relative stenosis of the caudal cervical vertebral canal especially at C7 where the cannel is funnel-shaped 
  • Vertebral Body Malformation: Abnormal shape from stresses caused by breed-specific conformation (e.g., Dobermans’ Great Dane and Dalmatians upright neck carriage). The vertebra has seven centres of ossification, and these growth plates are susceptible to damage by abnormal stresses. This leads to changes in vertebral shape, particularly the development of a ploughshare shape. The cranial aspect of the vertebral body becomes rounded, and the cranial dorsal ridge becomes more prominent. 
  • Vertebral Instability: Misalignment or subluxation of the vertebrae, although the significance of this is debated and it has not been proved satisfactorily that vertebral instability actually exists.  
  • Articular Facet Changes and neuroforaminal stenosis: Middle foraminal height is smaller in OAWS-affected Great Danes from C3-C4 through C7-T1. Dobermans have a greater tendency for concave caudal articular surfaces – it is proposed that this increases axial rotation and increases stress on the intervertebral discs

Yes, secondary factors include: 

  • Intervertebral Disc Failure: Herniation or tearing and extrusion of the intervertebral disc causing spinal cord compression. 75-80% of dogs with clinical signs of caudal cervical spondylopathy have spinal cord compression associated with hypertrophied and herniated dorsal annulus. The common site of compression is C6/C7 or C5/C6 or both. The peak age of presentation is between 6 and 7 years old and male dogs are over-represented. 
  • Hypertrophy of vertebral canal ligaments: Thickening of ligamentum flavum and joint capsules resulting in vertebral canal stenosis (narrowing).  
  • Osteoarthritis: Degeneration of articular facets with new bone formation leading to stenosis. 
  • Stenosis of the neuroforamen: Due to a combination of intervertebral disc degeneration and protrusion, osteoarthritis of the articular facets, synovial cysts and primary factors.  
  • Domino Lesions: Adjacent segment and disc degeneration caused by altered biomechanical forces after surgical intervention. 
  • Spinal cord atrophy: Spinal cord atrophy occurs in chronic cases.  These cases have a poorer prognosis for improvement after surgery.

Yes, there is strong anecdotal evidence that diet in the first 24 months may influence development of this disease  

  • Overnutrition – many young giant breeds with Wobblers syndrome have received excessive calories in the form of high protein premium meat-based diets in the mistaken belief that rapid weight gain rapid is desirable in large and giant breeds.  
  • Inappropriate calcium supplementation (calcium / phosphorus balance) may influence – both excessive and insufficient. 

Yes, large and giant breeds such as Dobermans, Great Danes, and Dalmatians are at higher risk. The neck conformation and head carriage “standards” of these breeds may contribute to the development of the condition for example the Dobermann the neck “carriage is upright and shows much nobility” and the Great Dane “neck shall be firm, high set, well arched, long and muscular”. This tends to encourage a more upright neck and head carriage and shift the centre of gravity from the mid cervical to the caudal cervical vertebrae which in turn affects vertebral development and biomechanical stress on the intervertebral discs and ligaments.   

  • Proprioceptive ataxia – click here for a video example of mild disc associated wobbler syndrome and here for a video example of more severe disease  
  • Pelvic limb hypermetria (long stride “wobbling) with short, choppy thoracic limb gait (hypometria) – click here for a video example of this gait  
  • Neck pain and fore limb lameness due to nerve root compression. 
  • Proprioceptive deficits, especially in the hind limbs. 
  • Tetraparesis - Characterized by upper motor neuron signs in the pelvic limbs, including increased spinal reflexes (click here for video) and heightened muscle tone, and lower motor neuron signs in the thoracic limbs, such as muscle atrophy and reduced spinal reflexes. In acute, non-ambulatory tetraparetic cases, increased muscle tone may lead to rigid hyperextension in all four limbs. 

 

Useful for assessing bony changes and planning surgical interventions. CT myelography can also be used in the evaluation of the CSM especially if MRI cannot be performed, for example if there is post-operative deterioration following implanted surgery.  Dobermans with wobbler syndrome are at higher risk of seizures and neurological deterioration following myelography. 

Previously a common diagnostic tool, myelography is now less accurate compared to MRI for evaluating Wobbler Syndrome. It can identify specific changes such as: 

  • Ventral extradural compression from type II disc protrusions/extrusions and narrowed intervertebral disc space. 
  • Dorsal extradural compression caused by articular facet osteoarthritis or ligamentum flavum hypertrophy. 
  • Subluxation (tilting) of vertebrae resulting in vertebral canal stenosis and spinal cord compression. 
  • Traction View: Many veterinarians advocate the use of traction views during myelography to assess for dynamic compression—lesions causing intermittent stenosis based on posture. This involves stretching the neck by applying tension to the head (forward) and thoracic limbs (caudally). Improvement seen during traction supports the rationale for surgical interventions like distraction and fusion to address the underlying instability. 

While useful in geographical regions where MRI or CT is not available, myelography tends to underestimate the extent of disease compared to MRI. Additionally, Dobermans with wobbler syndrome are at higher risk of seizures and neurological deterioration following this procedure. 

While radiography has limited diagnostic value for Wobbler Syndrome, in geographical regions where MRI, CT or myelography is not available it can help identify vertebral changes such as vertebral canal stenosis, vertebral malformations (e.g., ploughshare shape), ventral spondylosis, and "stepping" (a displacement greater than 3 mm between the floors of adjacent vertebrae). 

  • Caused by abnormal stress leading to bony remodelling and proliferation  
  • Characterised by bony changes such as hypertrophy of articular facets or ligamentum flavum. 
  • Predominantly seen in giant breeds, such as Great Danes. However, one study found 27% were large breeds  
  • Multiple sites of spinal cord compression are common (78%) and the presence of multiple compression sites is associated with more severe spinal and foraminal stenosis. 
  • Compression often lateralised due to facet joint changes. 
  • Foraminal stenosis is common (91%).  
  • May be associated with intervertebral disc degeneration (80%)  
  • Typically seen in younger dogs (~2-4 years). 

Many dogs may exhibit both disc-associated and osseous-associated compressions, leading to compounded clinical signs and more severe neurologic deficits.  A recent study found that approximately 26% had intervertebral disc protrusion and osseous proliferation and 67% of these cases had both types of compressions occurring at the same cervical site 

Treatment can be conservative or surgical: 

  • Conservative Management: Includes exercise restriction, physiotherapy, and anti-inflammatory medications. Appropriate for mild cases but offers a lower chance of long-term resolution compared to surgical interventions. 
  • Surgical Intervention: Surgical intervention for Wobbler Syndrome (cervical spondylomyelopathy) in dogs focuses on alleviating spinal cord compression, stabilising the cervical vertebrae, and restoring normal neurological function. The choice of surgical technique depends on factors such as the specific anatomical abnormalities, the severity of the condition, and the surgeon's expertise and bias. Techniques include: 
  • Direct access decompression surgeries (e.g., ventral slot surgery or dorsal laminectomy). Effective for focal ventral (for example torn extruded annulus fibrosis) or dorsal compressions. 
  • Distraction-stabilization surgeries (e.g., intervertebral cement plug, pins/screw with PMMA, plates). Offers better long-term stability with lower recurrence rates but carries risks of implant failure. 
  • Cervical Arthroplasty – disc replacement systems (Adamo Prosthetic Disc, Custom Devices). Said to maintain mobility at affected segment.  

  • Intervertebral Distraction and Fusion: This technique involves distracting (separating) the affected vertebrae to relieve compression and then stabilizing them to prevent abnormal movement. Methods include the use of bone grafts, metal implants (such as screws and plates), or intervertebral cages to achieve fusion. The goal is to restore normal disc space height and achieve long-term stability. Complications can include implant failure, infection, and adjacent segment disease. 
  • Cervical Arthroplasty: Also known as total disc replacement, this procedure replaces the degenerated intervertebral disc with an artificial implant to maintain motion at the affected segment while alleviating compression. It aims to reduce the risk of adjacent segment degeneration associated with fusion. However, its use in veterinary medicine is less common, and long-term outcomes are still being evaluated. 

The prognosis for dogs undergoing surgical management for Wobbler Syndrome is guarded, with outcomes varying based on the severity of the condition, the surgical technique used, and individual patient factors. Success rates range from 48% to 90%, but long-term results cited in published papers often lack consistency due to limitations in case series, such as small sample sizes and subjective and varying outcome assessments. The wide array of surgical techniques (over 20) developed for managing Wobbler Syndrome highlights the ongoing controversy and the inherent challenges in treating this condition. If a single procedure consistently yielded excellent success rates, it would likely be universally adopted by surgeons. 

Key factors influencing prognosis include: 

  1. Timing of Intervention: Early surgical intervention generally results in better outcomes, as it prevents prolonged spinal cord compression and irreversible damage. 
  1. Potential Complications: Implant failure, infections, or the development of additional spinal issues at adjacent segments (domino effect) can negatively impact long-term success. 
  1. Age and Coexisting Conditions: The age of the dog is a critical consideration. For example, in a case series where the average age was 7 years, approximately 25% of surgically managed dogs died from unrelated diseases, such as cancer or dilated cardiomyopathy, within two years of surgery. 

  • Restrict activity for six weeks post-surgery. 
  • Gradual reintroduction to normal exercise. 
  • Regular physiotherapy, including hydrotherapy, is recommended to improve strength and mobility.

  • Passive Range of Motion (PROM) Exercises: 
    • Involves gentle flexion and extension of joints without active muscle engagement. 
    • Prevents joint stiffness and muscle atrophy in non-ambulatory dogs. 
    • Avoid excessive force if resistance is encountered to prevent injury. 
  • Massage Therapy: 
    • Relieves muscle tension and improves circulation. 
    • Reduces pain and promotes relaxation in affected muscles. 
  • Hydrotherapy: 
    • Non-weight-bearing exercise in water to strengthen muscles and improve mobility. 
    • Ideal for dogs with reduced coordination or weakness. 
  • Weight Shifting and Balance Exercises: 
    • Encourages controlled weight-bearing on affected limbs. 
    • Improves balance and proprioception. 
  • Core Strengthening: 
    • Techniques such as standing on unstable surfaces (e.g., wobble boards) to engage core muscles. 
    • Strengthens spinal stabilizers to support cervical spine. 
  • Assisted Ambulation: 
    • Use of harnesses or slings to support mobility while reducing spinal load. 
    • Encourages gradual improvement in gait and muscle function. 
  • Neuromuscular Electrical Stimulation (NMES): 
    • Stimulates muscle contraction in atrophied or weakened areas. 
    • Supports recovery of motor function. 

Domino lesions refer to the accelerated degeneration of intervertebral discs adjacent to surgically treated segments. This occurs due to altered biomechanical forces and is seen in 10-20% of cases, emphasizing the importance of thorough pre-surgical imaging. 

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