Wobbler disease
Encyclopedia
Wobbler disease is a condition of the cervical vertebrae
that causes an unsteady (wobbly) gait and weakness in dog
s and horse
s. The term wobbler disease refers to a number of different conditions of the cervical (neck) spinal column that all cause similar symptoms. These conditions may include malformation of the vertebrae, intervertebral disc
protrusion, and disease of the interspinal ligament
s, ligamenta flava
, and articular facet
s of the vertebrae. Wobbler disease is also known as cervical vertebral instability, cervical spondylomyelopathy (CSM), and cervical vertebral malformation (CVM). In dogs, the disease is most common in large breeds, especially Great Dane
s and Dobermanns. In horses, it is not linked to a particular breed, though it is most often seen in tall race-bred horses. It is most likely inherited in dogs, it may be hereditary to some extent in horses.
Wobbler disease is probably inherited in the Borzoi
, Great Dane, Doberman, and Basset Hound
. Instability of the vertebrae of the neck (usually the caudal
neck) causes spinal cord
compression. In younger dogs such as Great Danes less than two years of age, wobbler disease is caused by stenosis
(narrowing) of the vertebral canal. This narrowing of the canal is related to degeneration of the dorsal
articular facets and subsequent thickening of the associated joint capsule
s and ligaments. A high protein diet may contribute to its development. In middle aged and older dogs such as Dobermans, intervertebral disc disease leads to bulging of the disc or herniation
of the disc contents, and the spinal cord is compressed. In Great Danes the C4 to C6 vertebrae are most commonly affected; in Dobermans it is the C5 to C7 vertebrae.
The disease tends to be gradually progressive. Symptoms such as weakness, ataxia
, and dragging of the toes start in the rear legs. Dogs often have a crouching stance with a downward flexed neck. The disease progresses to the front legs, but the symptoms are less severe. Neck pain is sometimes seen. Symptoms are usually gradual in onset but may progress rapidly following trauma. X-ray
s may show malaligned vertebrae and narrow disk spaces, but it is not as effective as a myelogram
, which reveals stenosis of the vertebral canal. MRI
has been shown to be more effective at showing the location, nature, and severity of spinal cord compression than a myelogram. Treatment is either medical to control the symptoms, usually with corticosteroid
s and cage rest, or surgical to correct the spinal cord compression. The prognosis
is guarded in either case. Surgery may fully correct the problem, but it is technically difficult and relapses may occur. Types of surgery include ventral
decompression of the spinal cord (ventral slot technique), dorsal decompression, and vertebral stabilization. One study showed no significant advantage to any of the common spinal cord decompression procedures. Another study showed that electroacupuncture
may be a successful treatment for Wobbler disease.
T2 weighted MRI in neutral (A) and linear traction (B) of a 7 year old Doberman with a 2 year history of cervical pain treated with NSAID and presented acutely tretraplegic. A C6-C7 and C5-C6 traction responsive myelopathy are evident on MRI. The spinal cord hyperintensity seen at the C5-C6 is suggestive of chronic lesion and most likely responsible for the chronic history of cervical pain, while the C5-C6 lesion was most likely responsible for the acute tetraplegia.
Same dog (A) treated with double implant (B) three days post-surgery. The dog became ambulatory 3 days after surgery. Four weeks post-surgery had ataxia without conscious proprioceptive deficits, and 3 months post-surgery he was neurologically normal. Owner reported that it was 2 years since the dog was not able to hold the neck in elevated position.
s, where it is often called Wobbler's Syndrome, refers to several conditions beyond those listed above, including equine wobbles anemia. It is also used as a catchall phrase within the horse community to designate a neurological problem that has no more specific diagnosis. Some forms, such as cervical vertebral malformation (CVM), are not thought to be hereditary, but rather a congenital condition or a growth disorder. Other forms, such as Equine wobbles anemia, are concentrated in certain breeds and may be hereditary to some extent. Horses with wobbler disease often exhibit ataxia
(implying dysfunction of parts of the nervous system), show weakness in the hindquarters, or may knuckle over in their fetlock
s, particularly in the rear. With advanced stages of the disease they are prone to falling. While some cases are successfully treated with nutritional and medical management, surgery is also used. One method is the use of Titanium
baskets, placed to fuse the vertebrae, thereby preventing compression of the spinal cord. Some horses are able to return to work, with a few able to reach competitive levels. There is currently no complete "cure" for the condition.
Because wobbler's is the best known of the neurological conditions that affect horses, other, unrelated conditions, such as Equine Protozoal Myeloencephalitis
and cerebellar abiotrophy
are sometimes misdiagnosed as wobbler's, even though the causes and symptoms differ.
Cervical vertebrae
In vertebrates, cervical vertebrae are those vertebrae immediately inferior to the skull.Thoracic vertebrae in all mammalian species are defined as those vertebrae that also carry a pair of ribs, and lie caudal to the cervical vertebrae. Further caudally follow the lumbar vertebrae, which also...
that causes an unsteady (wobbly) gait and weakness in dog
Dog
The domestic dog is a domesticated form of the gray wolf, a member of the Canidae family of the order Carnivora. The term is used for both feral and pet varieties. The dog may have been the first animal to be domesticated, and has been the most widely kept working, hunting, and companion animal in...
s and horse
Horse
The horse is one of two extant subspecies of Equus ferus, or the wild horse. It is a single-hooved mammal belonging to the taxonomic family Equidae. The horse has evolved over the past 45 to 55 million years from a small multi-toed creature into the large, single-toed animal of today...
s. The term wobbler disease refers to a number of different conditions of the cervical (neck) spinal column that all cause similar symptoms. These conditions may include malformation of the vertebrae, intervertebral disc
Intervertebral disc
Intervertebral discs lie between adjacent vertebrae in the spine. Each disc forms a cartilaginous joint to allow slight movement of the vertebrae, and acts as a ligament to hold the vertebrae together.-Structure:...
protrusion, and disease of the interspinal ligament
Interspinal ligament
The interspinal ligaments , thin and membranous, connect adjoining spinous processes and extend from the root to the apex of each process.They meet the ligamenta flava in front and the supraspinal ligament behind....
s, ligamenta flava
Ligamenta flava
The ligamenta flava are ligaments which connect the laminae of adjacent vertebrae, all the way from the axis to the first segment of the sacrum...
, and articular facet
Articular facet
An articular facet is a surface where two anatomical structures meet.-Structures with articular facets:* cricoid cartilage* lateral malleolus* medial malleolus* tubercle of rib...
s of the vertebrae. Wobbler disease is also known as cervical vertebral instability, cervical spondylomyelopathy (CSM), and cervical vertebral malformation (CVM). In dogs, the disease is most common in large breeds, especially Great Dane
Great Dane
The Great Dane , also known as German Mastiff or Danish Hound , is a breed of domestic dog known for its giant size...
s and Dobermanns. In horses, it is not linked to a particular breed, though it is most often seen in tall race-bred horses. It is most likely inherited in dogs, it may be hereditary to some extent in horses.
Wobbler disease in dogs
Borzoi
The borzoi is a breed of domestic dog also called the Russian wolfhound and descended from dogs brought to Russia from central Asian countries. It is similar in shape to a greyhound, and is also a member of the sighthound family.The system by which Russians over the ages named their sighthounds...
, Great Dane, Doberman, and Basset Hound
Basset Hound
The Basset Hound is a short-legged breed of dog of the hound family. They are scent hounds, bred to hunt rabbits and hare by scent. Their sense of smell for tracking is second only to that of the Bloodhound....
. Instability of the vertebrae of the neck (usually the caudal
Anatomical terms of location
Standard anatomical terms of location are designations employed in science that deal with the anatomy of animals to avoid ambiguities that might otherwise arise. They are not language-specific, and thus require no translation...
neck) causes spinal cord
Spinal cord
The spinal cord is a long, thin, tubular bundle of nervous tissue and support cells that extends from the brain . The brain and spinal cord together make up the central nervous system...
compression. In younger dogs such as Great Danes less than two years of age, wobbler disease is caused by stenosis
Stenosis
A stenosis is an abnormal narrowing in a blood vessel or other tubular organ or structure.It is also sometimes called a stricture ....
(narrowing) of the vertebral canal. This narrowing of the canal is related to degeneration of the dorsal
Anatomical terms of location
Standard anatomical terms of location are designations employed in science that deal with the anatomy of animals to avoid ambiguities that might otherwise arise. They are not language-specific, and thus require no translation...
articular facets and subsequent thickening of the associated joint capsule
Joint capsule
An articular capsule is an envelope surrounding a synovial joint.-Layers:Each capsule consists of two layers:* an outer layer composed of avascular white fibrous tissue...
s and ligaments. A high protein diet may contribute to its development. In middle aged and older dogs such as Dobermans, intervertebral disc disease leads to bulging of the disc or herniation
Spinal disc herniation
A spinal disc herniation , informally and misleadingly called a "slipped disc", is a medical condition affecting the spine due to trauma, lifting injuries, or idiopathic, in which a tear in the outer, fibrous ring of an intervertebral disc allows the soft, central portion A spinal disc herniation...
of the disc contents, and the spinal cord is compressed. In Great Danes the C4 to C6 vertebrae are most commonly affected; in Dobermans it is the C5 to C7 vertebrae.
The disease tends to be gradually progressive. Symptoms such as weakness, ataxia
Ataxia
Ataxia is a neurological sign and symptom that consists of gross lack of coordination of muscle movements. Ataxia is a non-specific clinical manifestation implying dysfunction of the parts of the nervous system that coordinate movement, such as the cerebellum...
, and dragging of the toes start in the rear legs. Dogs often have a crouching stance with a downward flexed neck. The disease progresses to the front legs, but the symptoms are less severe. Neck pain is sometimes seen. Symptoms are usually gradual in onset but may progress rapidly following trauma. X-ray
X-ray
X-radiation is a form of electromagnetic radiation. X-rays have a wavelength in the range of 0.01 to 10 nanometers, corresponding to frequencies in the range 30 petahertz to 30 exahertz and energies in the range 120 eV to 120 keV. They are shorter in wavelength than UV rays and longer than gamma...
s may show malaligned vertebrae and narrow disk spaces, but it is not as effective as a myelogram
Myelography
Myelography is a type of radiographic examination that uses a contrast medium to detect pathology of the spinal cord, including the location of a spinal cord injury, cysts, and tumors...
, which reveals stenosis of the vertebral canal. MRI
Magnetic resonance imaging
Magnetic resonance imaging , nuclear magnetic resonance imaging , or magnetic resonance tomography is a medical imaging technique used in radiology to visualize detailed internal structures...
has been shown to be more effective at showing the location, nature, and severity of spinal cord compression than a myelogram. Treatment is either medical to control the symptoms, usually with corticosteroid
Corticosteroid
Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex. Corticosteroids are involved in a wide range of physiologic systems such as stress response, immune response and regulation of inflammation, carbohydrate metabolism, protein catabolism, blood electrolyte...
s and cage rest, or surgical to correct the spinal cord compression. The prognosis
Prognosis
Prognosis is a medical term to describe the likely outcome of an illness.When applied to large statistical populations, prognostic estimates can be very accurate: for example the statement "45% of patients with severe septic shock will die within 28 days" can be made with some confidence, because...
is guarded in either case. Surgery may fully correct the problem, but it is technically difficult and relapses may occur. Types of surgery include ventral
Anatomical terms of location
Standard anatomical terms of location are designations employed in science that deal with the anatomy of animals to avoid ambiguities that might otherwise arise. They are not language-specific, and thus require no translation...
decompression of the spinal cord (ventral slot technique), dorsal decompression, and vertebral stabilization. One study showed no significant advantage to any of the common spinal cord decompression procedures. Another study showed that electroacupuncture
Electroacupuncture
Electroacupuncture is a form of acupuncture where a small electric current is passed between pairs of acupuncture needles. Another term is Percutaneous Electrical Nerve Stimulation ....
may be a successful treatment for Wobbler disease.
Commonly affected dog breeds
- Great DaneGreat DaneThe Great Dane , also known as German Mastiff or Danish Hound , is a breed of domestic dog known for its giant size...
- Doberman
- St. BernardSt. Bernard (dog)The St. Bernard is a breed of very large working dog from the Italian and Swiss Alps, originally bred for rescue. The breed has become famous through tales of alpine rescues, as well as for its large size.-Appearance:The St. Bernard is a large dog...
- WeimaranerWeimaranerThe Weimaraner is a dog that was originally bred for hunting in the early 19th century. Early Weimaraners were used by royalty for hunting large game such as boar, bear, and deer. As the popularity of large game hunting began to decline, Weimaraners were used for hunting smaller animals like...
- German Shepherd DogGerman Shepherd DogThe German Shepherd Dog , also known as an Alsatian or just the German Shepherd, is a breed of large-sized dog that originated in Germany. The German Shepherd is a relatively new breed of dog, with its origin dating to 1899. As part of the Herding Group, the German Shepherd is a working dog...
- BoxerBoxer (dog)Developed in Germany, the Boxer is a breed of stocky, medium-sized, short-haired dog. The coat is smooth and fawn or brindled, with or without white markings. Boxers are brachycephalic , and have a square muzzle, mandibular prognathism , very strong jaws and a powerful bite ideal for hanging on to...
- Basset HoundBasset HoundThe Basset Hound is a short-legged breed of dog of the hound family. They are scent hounds, bred to hunt rabbits and hare by scent. Their sense of smell for tracking is second only to that of the Bloodhound....
- Rhodesian RidgebackRhodesian RidgebackThe Rhodesian Ridgeback is a dog breed developed in Southern Africa, where it was used to hunt Lions. This is most likely why this dog is known for its bravery...
- DalmatianDalmatian (dog)The Dalmatian is a breed of dog whose roots are often said to trace back to Dalmatia, a region of Croatia where the first illustrations of the dog have been found. The Dalmatian is noted for its unique black- or brown-spotted coat and was mainly used as a carriage dog in its early days...
- SamoyedSamoyed (dog)The Samoyed dog takes its name from the Samoyedic peoples of Siberia. An alternate name for the breed, especially in Europe, is Bjelkier...
- Old English SheepdogOld English SheepdogThe Old English Sheepdog is a large breed of dog which was developed in England from early herding types of dog. The Old English Sheepdog has very long fur covering the face and eyes...
- Bull Mastiff
- NewfoundlandNewfoundland (dog)The Newfoundland is a breed of large dog. Newfoundlands can be black, brown, gray, or black and white. They were originally bred and used as a working dog for fishermen in the Dominion of Newfoundland, now part of Canada. They are known for their giant size, tremendous strength, calm dispositions,...
- GreyhoundGreyhoundThe Greyhound is a breed of sighthound that has been primarily bred for coursing game and racing, and the breed has also recently seen a resurgence in its popularity as a pedigree show dog and family pet. It is a gentle and intelligent breed...
A Recent Update in the Treatment of Wobbler's Disease in Canines
Prognosis for dogs with Wobbler's Disease has been recently changed and it is no longer poor. A new surgical treatment is now available for dogs with Disc-Associated Wobbler's Syndrome. This surgical treatment involves implanting an artificial disc (cervical arthroplasty) in place of the affected disc space. This is a less invasive technique with minimal risks and post-operative care. All dogs treated have displayed excellent short and long terms clinical results. Cervical arthroplasty can also be applied in multiple spaces and it is cost effective. For further reading on the new procedure, please see "Cervical Arthroplasty in Two Dogs with Disc Associated Cervical Spondylomyelopathy." JAVMA, Vol 239, No 6, September 15, 2011, http://www.scribd.com/doc/56257403/DrAdamoFullArticle.T2 weighted MRI in neutral (A) and linear traction (B) of a 7 year old Doberman with a 2 year history of cervical pain treated with NSAID and presented acutely tretraplegic. A C6-C7 and C5-C6 traction responsive myelopathy are evident on MRI. The spinal cord hyperintensity seen at the C5-C6 is suggestive of chronic lesion and most likely responsible for the chronic history of cervical pain, while the C5-C6 lesion was most likely responsible for the acute tetraplegia.
Same dog (A) treated with double implant (B) three days post-surgery. The dog became ambulatory 3 days after surgery. Four weeks post-surgery had ataxia without conscious proprioceptive deficits, and 3 months post-surgery he was neurologically normal. Owner reported that it was 2 years since the dog was not able to hold the neck in elevated position.
Wobbler disease in horses
Wobbler disease is also found in horseHorse
The horse is one of two extant subspecies of Equus ferus, or the wild horse. It is a single-hooved mammal belonging to the taxonomic family Equidae. The horse has evolved over the past 45 to 55 million years from a small multi-toed creature into the large, single-toed animal of today...
s, where it is often called Wobbler's Syndrome, refers to several conditions beyond those listed above, including equine wobbles anemia. It is also used as a catchall phrase within the horse community to designate a neurological problem that has no more specific diagnosis. Some forms, such as cervical vertebral malformation (CVM), are not thought to be hereditary, but rather a congenital condition or a growth disorder. Other forms, such as Equine wobbles anemia, are concentrated in certain breeds and may be hereditary to some extent. Horses with wobbler disease often exhibit ataxia
Ataxia
Ataxia is a neurological sign and symptom that consists of gross lack of coordination of muscle movements. Ataxia is a non-specific clinical manifestation implying dysfunction of the parts of the nervous system that coordinate movement, such as the cerebellum...
(implying dysfunction of parts of the nervous system), show weakness in the hindquarters, or may knuckle over in their fetlock
Fetlock
Fetlock is the common name for the metacarpophalangeal and metatarsophalangeal joints of horses, large animals, and sometimes dogs. It is formed by the junction of the third metacarpal or metatarsal bones proximad and the proximal phalanx distad...
s, particularly in the rear. With advanced stages of the disease they are prone to falling. While some cases are successfully treated with nutritional and medical management, surgery is also used. One method is the use of Titanium
Titanium
Titanium is a chemical element with the symbol Ti and atomic number 22. It has a low density and is a strong, lustrous, corrosion-resistant transition metal with a silver color....
baskets, placed to fuse the vertebrae, thereby preventing compression of the spinal cord. Some horses are able to return to work, with a few able to reach competitive levels. There is currently no complete "cure" for the condition.
Because wobbler's is the best known of the neurological conditions that affect horses, other, unrelated conditions, such as Equine Protozoal Myeloencephalitis
Equine Protozoal Myeloencephalitis
Equine protozoal myeloencephalitis, or EPM, is a disease cause by a protozoal infection of the central nervous system of horses.-History:...
and cerebellar abiotrophy
Cerebellar abiotrophy
Cerebellar abiotrophy , also referred to as the cerebellar cortical abiotrophy , which is a genetic neurological disease in animals best known to affect certain breeds of horses and dogs. It develops when the neurons known as Purkinje cells, located in the cerebellum of the brain, begin to die...
are sometimes misdiagnosed as wobbler's, even though the causes and symptoms differ.
Commonly affected horse breeds
- ThoroughbredThoroughbredThe Thoroughbred is a horse breed best known for its use in horse racing. Although the word thoroughbred is sometimes used to refer to any breed of purebred horse, it technically refers only to the Thoroughbred breed...
- StandardbredStandardbred horseStandardbreds are a breed of horse best known for their ability to race in harness at a trot or pace instead of under saddle at a gallop. Developed in North America, the breed is now recognized worldwide for its harness racing ability...
- American Quarter HorseAmerican Quarter HorseThe American Quarter Horse is an American breed of horse that excels at sprinting short distances. Its name came from its ability to outdistance other breeds of horses in races of a quarter mile or less; some individuals have been clocked at speeds up to 55 mph...
- American Paint HorseAmerican Paint HorseThe American Paint Horse is a breed of horse that combines both the conformational characteristics of a western stock horse with a pinto spotting pattern of white and dark coat colors. Developed from a base of spotted horses with Quarter Horse and Thoroughbred bloodlines, the American Paint Horse...