Managing Disorders of the Canine Spine

Introduction

Dog being examined

Low back pain is a common complaint in canine patients but many low back disorders have similar clinical symptoms and history and should be considered in the differential diagnosis.[1] This page discusses some of the most common causes of spinal cord dysfunction in dogs. The following highlights it is important to consider whenever a canine patient presents with apparent pelvic pain:[2]

• Severe abdominal pain is one of the few conditions that will cause the dog to hear “scream or cry”.
• Dogs with spinal pain may exhibit more postural abnormalities such as downward head bowing and torticollis
• Nerve root sign indicates nerve root irritation leading to unilateral limpness of the extremity
• Compression or degeneration of the spine may cause paralysis/paralysis of the limbs with ataxia. However, it is important to note that these changes can also be due to lesions other than the spine, such as brain tumors and midthoracic lesions
• Dogs with acute and/or progressive underlying spinal pain must always be referred to a veterinarian as an urgent matter

Atlantoaxial Instability

Accidental jumping can cause AA instability

Atlantoaxial (AA) instability occurs after subluxation or dislocation of the atlantoaxial joint. This can be congenital (usually due to abnormal musculature in the animal’s spinal cord) or occurs after an accident.[2][3] This is especially true for small dog injuries ahuruhuruw fi adan attenen so.[2]

AA instability can cause:[2]

• Spinal cord compression
• Pain and disability

It can occur in dogs and cats but in feline patients it is more common in young toys or small dogs.[4][5] Its presence should therefore be suspected in any small dog presenting with symptoms of C1 to C5 myelopathy.[2] Instability of AA can often be seen on exploratory radiographs.[5]

[6][7]

Treatment

Treatment can be conservative or surgical. It is important to note that manipulation of the neck should be avoided if AA instability is suspected.[2]

Conservative

Conservative management is indicated when:[2]

• An acute history of neurological signs
• Surgery may not provide sufficient stability for immature bones
• Financial considerations

The goal of conservative treatment is to promote fibrous tissue capable of stabilizing AA arthrogenesis and prevent further subluxation. Treatment includes:[2]

• Cervical splints
• Pain management
• Severely restrict exercise for about 8 weeks

Cervical splinting has been found to be a viable treatment option for unstable and clinically symptomatic young dogs with acute onset AA, regardless of the severity of the neurological deficit. [8]

Surgical

The goal of surgical treatment of AA instability is to reduce subluxation. Recommended for patients with neurological deficit or neck pain who do not respond to conservative treatment. [5]

Both back and forth approaches have been described. The prognosis for postoperative patients is generally good.[5]

Physiotherapy Management

As both conservative and surgical patients are likely to be in splint initially the treatment strategies will be similar. Patients are rarely referred to physiotherapy during the first stage of recovery (i.e. after being splinted).

Owners should be advised to perform exercises that focus on maintaining strength and function in the rest of the body. Exercises may include:[2]

• Static proprioceptive and balance training
  • Rhythmic stabs
  • 3-legged stand / diagonal stand (patients must be supported to avoid falling) .
  • Abnormalities such as walking backwards (depending on patient control) .
• Functional exercises such as sit-stand / down-stand (depending on the patients code) .
• Once the patient is out of slings, gradual restoration of functional cervical range of motion (ROM) and restoration of cervical spine strength and autonomy can begin
• It is important to ensure that the dog has good stability and can maintain the lung tube

Caudal Cervical Spondylomyelopathy

Young great dane, higher risk of CCSM

Caudal cervical spondylomyelopathy (CCSM) also known as Wobblers syndrome and cervical vertebra instability is a progressive disease of the intervertebral disc ligaments and facet joints of the cervical spine that eventually leads to compression of the spinal cord and nerve roots.

It can affect any dog but young Great Danes and older Dobermanns are more common.[10] Disc‐associated CCSM is commonly seen in the Doberman pinscher and other large dogs.[9]

Abnormal infections associated with CCSM can be roughly divided into two groups based on the age of the animal at presentation:[2]

1. Typically, young dogs (e.g. Great Danes under two years of age) have spinal degeneration with secondary soft tissue changes that cause stiffness in the spinal cord
2. Middle-aged dogs (typically large and large) have spinal stenosis due to excessive dorsal annulus fibrosis or Hansen type 2 disc rupture

Most dogs with CCSM will be presented with a history of slow onset of symptoms that gradually worsens over time. However, it is important to note that severe complications are possible. CCSM usually occurs at C5/6 and/or C6/7.[2]

Key Features

Key characteristics of CCSM include a “wobbly” gait and pelvic pain:[11][2]

• Symptoms range from hindlimb weakness to immobile tetraparesis
• The owner will report that the dog has a steady gait with wobble in the hind legs and “kicks” on the hind legs
• Affected dogs typically have a low head and neck posture and resist extension of the cervical spine
• Abdominal pain is rare but a few dogs will experience mild abdominal pain on neck adjustment
• Dogs with CCSM typically walk with a strong stilted gait in the front leg
• Defects of the hind legs are common – these are exacerbated when the neck is extended
• Arthritis abnormalities in the forelimbs will not be as persistent or severe as those in the hindlimbs apart from the most severely affected dogs
• The diagnosis can only be made with myelography

[12]

Treatment

Conservative Management

It is usually indicated only in the presence of financial hardship or if the animal has co-morbidities that would preclude surgery.[2] De Decker and colleagues found that conservative use of CCSM was associated with “secured forecasting”.[13]

Treatment usually consists of:[9]

• Restricted activity
• Using a body harness
• Analgesia and / or steroids

Surgical Management

Surgical techniques include:[2]

• Dorsal laminectomy
• Ventral cervical decompression
• A modified distraction-level approach

Postoperative care depends on the animal’s neurological state, but dogs will require a harness rather than a collar for the rest of their life. [2]

Physiotherapy Management

In the case of surgery, activity limitations will be determined by the surgeon. It is important to maintain and improve a dog’s general strength mobility and exercise tolerance. Progression will depend on patient tolerance and surgeon guidelines.

Treatment will focus on:[2]

• Managing pain
• Enhance cervical spine strength proprioception/sensory motor function
• Active ROM (avoiding hyperextension)
• Static strengthening of the neck muscles – this can start in the first post-op week
• If the dog has the ability to retrieve the object – progressive loading of the neck extensors in the moderate range can be achieved by allowing the dog to retrieve the object

Sensorimotor rehabilitation may include:[2]

• Eye Movements – Initially neutral neck position, then move to progressive lateral flexion
• Foraging activities
• Dog touching a target with its nose

Degenerative Myelopathy

DM, common in German Shepherds

Degenerative myelopathy (DM) is an insidious, progressive neurodegenerative disorder of the spinal cord. It begins in late adulthood and has been compared to amyotrophic lateral sclerosis in humans. It’s common in German Shepherds, but can occur in any breed. [14] Neurologic symptoms usually begin Develops in dogs 5 years or older. The average age of onset in large dogs is 9 years. DM causes generalized proprioceptive ataxia and spastic paralysis of the upper motor neurons (UMNs) of the pelvic extremities. Eventually it can lead to paraplegia. [15]

The earliest clinical signs of DM are:[15]

• Pelvic limb ataxia and mild spastic paralysis
• Frayed nails and asymmetrical limping of pelvic limbs
• Spinal reflexes consistent with UMN palsy (usually limited to T3 to L3 or L3-S3) [16]

With increasing disease duration, dogs develop lower motor neuron (LMN) paralysis in the pelvic extremities and eventually the thoracic extremities as well. Signs of LMN developed, including decreased patellar and withdrawal reflexes, flaccid paralysis, and extensive muscle atrophy. biggest Ambulatory paresis (i.e., inability to support their body weight) in dogs within 6 to 9 months of clinical signs of DM [15]

Diagnosis

Because DM can present similarly to other acquired spinal cord disorders, diagnosis can be difficult. In addition, older dogs often have various orthopedic and neurologic comorbidities, which can make diagnosis even more challenging. [15]

Conditions that may mimic and coexist with DM include: [15]

• Degenerative lumbosacral syndrome
• Intervertebral disc disease
• Spinal cord neoplasia
• Degenerative joint disease (such as hip dysplasia or cranial cruciate ligament rupture)

The diagnosis of DM can only be made during autopsy [17], so DM is usually given as a “presumptive diagnosis” based on clinical signs and after excluding other pathological conditions. [15]

[18][19]

Treatment

Overall, the long-term prognosis of DM is poor. [20] The management of DM lacks an evidence-based medical approach. Although DM is thought to be an immune-mediated neurodegenerative disease, immunosuppressive therapy does not appear to have any long-term benefit. [15]

It has been suggested that an administration approach including sports vitamin support aminocaproic acid and N-acetylcysteine may be beneficial. [2]

Physiotherapy Management

Dog wheelchair, available commercially.

Exercise therapy focusing on strenght exercise tolerance and exercise-related activities is considered an important component of supportive and symptomatic care for DM [2]. However, the course of DM continues regardless of physical therapy. Therefore, the target Physiotherapy is about delaying adaptation and maintaining function for as long as possible. [2] A study by Kathmann and colleagues found that dogs that received intensive physical therapy survived longer (255 days) than dogs that received moderate (130 days) or no physical therapy (50 days). [16]

The exercise program used in Kathmann’s study included: active exercise, passive exercise, massage, hydrotherapy, and paw protection. [16] However, the authors do not describe how they developed their protocol, and there is little consensus in the literature on which patterns are beneficial For DMs. To view this agreement, please see page 2 of the study.

Follow this link to learn about training a dog to use a wheelchair

General recommendations

• Cardiorespiratory exercise training
• Alternate periods of exercise with rest to avoid excessive fatigue
• Aquatics – Allows for greater flexibility and strength gains
• Strength training
• Flexibility exercise

It is important to remember that interventions should be designed around the patient’s unique presentation and environmental challenges and should focus on function. [2]

Spondylosis

Old large dogs most affected by Spondylosis

Spondylosis is defined as ankylosis of a joint of the spine[21] (i.e. bony formation around the spine). It is a non-inflammatory condition that commonly occurs in the caudal thoracic and cranial lumbar spine in canine patients. Older, larger dogs have size risk of developing this condition.[2][21] This condition is generally not considered to be of great clinical importance[22] except in working dogs where decreased spinal flexibility may restrict function. However in severe cases osteophyte formations may extend dorsolaterally compressing the spinal the position of the intervertebral foraminae of the nerve roots.[2]

Diffuse Idiopathic Skeletal Hyperostosis (DISH) is a subtype of skeletal hypertosis. DISH is a systemic disorder affecting the axial and peripheral skeleton.[21]

• It is more prevalence in ageing dogs
• It ossifies soft tissues including the spinal ventral longitudinal ligament[2][23].
• Severe spondylosis is often misdiagnosed
• Diagnosis is made on X-ray CT and MRI [22]

Grading of spondylosis:[2]

• Grade 0: No enthesophytes
• Grade 1: Small osteophytes at the epiphyseal margin, not extending beyond the endplates
• Grade 2: Enthesophyte that extends beyond the endplates but does not connect to adjacent vertebrae
• Grade 3: Attachments on adjacent vertebrae connect to each other, forming a radiographic bony bridge between the two

Key Features

Patients are usually asymptomatic until an acute event causes the flare, such as a bone spur or a fracture of a bridge. [2]

If present, clinical signs may include:[2][22]

• Stiffness
• Limited spinal and hindlimb motion and associated gait changes
• Pain

Note: Spondylosis can coexist with other spinal disorders such as osteoarthritis, disc disease, and DISH. [2]

Treatment

Patients with significant spinal pain and stiffness tend to be managed conservatively with NSAIDs or analgesics, and lose weight as needed. Patients with neurological deficits or severe/persistent spinal pain require further diagnostic testing such as CT MRI and analysis Cerebrospinal fluid to narrow down the cause of its symptoms. [2]

Physiotherapy Management

There are no evidence-based clinical guidelines available, and treatment is determined based on the dog’s assessment deficits. Spondylosis is often associated with areas of secondary joint degeneration, and these dysfunctions must also be identified and addressed. [2]

Physiotherapy aims to:[2]

• Manage pain if present
• Optimizing spinal mobility – “normal” spinal mobility may not be realistic due to bony bridges
• Appropriate enhancements to improve functionality
• Optimizing general and spinal proprioception
• Modify activities as needed (to maintain function and slow down dysregulation)
• Educate clients on the likelihood and associated signs of osteophyte fractures

Depending on where and how advanced the skeletal changes are, dogs with spondylosis are often able to live full lives. Activity tolerance varies widely between patients and may change as the pathology progresses. Encouraging optimal liquidity is important, but respect pain. [2]

Because of the extensive nature of spondylosis exercises, exercise is directed by the patient. For example, some dogs may respond well to hydrotherapy while others may experience hot flashes. Improvements should be made according to patient comfort. Clients also need to be educated on how it can exacerbate symptoms on why these occur and how to manage them. These patients can often become chronic pain patients with central pain episodes when symptoms develop.[2]

Maintaining physical strength and mobility should become part of the patient’s life for a long time. It is important to work with the patient to find practical ways to implement a consistent and consistent appropriate program in the home or office.[2]