CERVICAL VERTABRAL INSTABILITY (WOBBLERS)
Wobblers or cervical vertabral instability is a group of conditions which are associated with abnormalaties of the lower neck of large dogs. There can be anatomical abnormalaties of the spinal canal, the vertabra, the vertabral discs or the ligaments associated with the spine of the lower neck.
There are some studies suggesting an inherited genetic mechanism is responsible for some dogs with this condition. This is also likely considering the higher prevalence in some breeds.
Signs of disease
All the abnormalaties described above can cause compression of the spinal cord. This often leads to a wobbly gait (ataxia) in the hind limb and the forelimbs. This is where the name Wobblers comes from. The change in gaits can be different in the front legs and hind legs. The fore legs are often affected by lower motor neuron signs - that is to say they are ataxic and have low muscle tone. The hind limbs are usually affected by upper motor neuron signs. The hind legs will have ataxia with high muscle tone.
Generally dogs with Wobblers get worse with a gradual onset of these signs. Some dogs will have a sudden onset and are often due to disc herniation in the neck.
Which breeds are affected
Although any breed may be affected it is most common in Dobermans and Great Danes.
A history of ataxia in the front legs increases suspicion of Wobblers. Xray may be helpful for diagnosis in a few cases but the majority of dogs suffering with this condition are identified with myelogram, CT and MRI.
Conventional treatment includes surgery and anti-inflammatory medications. These therapies are quite helpful in some Wobbler patients and have little benefit in others.
Conservative management of these pets should be considered due to the unreliable effectiveness of conventional therapies currently available.
Conservative treatments offered by Balance Vet Rehab that may be beneficial for these pets include:
Many of these guys have pain associated with a prolapsed disc. Pulsed electromagnetic field therapy has been shown in studies to be helpful in disc disease.
The Effect of Electromagnetic Fields on Post-Operative Pain and Locomotor Recovery in Dogs with Acute, Severe Thoracolumbar Intervertebral Disc Extrusion: A Randomized Placebo-Controlled, Prospective Clinical Trial Natalia Zidan et al
Once again in these patients disc disease is part of the clinical picture. Manual therapies can help reduce pain associated with disc pain. More studies are still needed in pets with cervical instability to establish the benefits of manual therapies.
Osteopathic Manual Treatment and Ultrasound Therapy for Chronic Low Back Pain: A Randomized Controlled Trial John C. Licciardone)
Acupuncture has been shown to help dogs with wobblers by the highly esteemed Dr Xie from the United States. Certainly a worthwhile treatment to pursue.
Meta-Analysis: Acupuncture for Low Back Pain Eric Manheimer et al
Acupuncture for Neck Pain and Wobbler Syndrome S.H. Xie et al
If your dog has pain secondary to disc pain from wobblers disease the electroacupuncture may help as part of an overall treatment protocol.
Clinical Effect of Additional Electroacupuncture on Thoracolumbar Intervertebral Disc Herniation in 80 Paraplegic Dogs Hyun-Jung Han et al
Laser therapy is a quick painless modality that can be part of the multi modal approach to dogs with cervical vertabral instability.
(Low‐level laser therapy reduces time to ambulation in dogs after hemilaminectomy: a preliminary study W.E. Draper et al
Careful consideration of the home environment and physical activities should be part of the management of these guys.
The Efficacy of Systematic Active Conservative Treatment for Patients With Severe Sciatica: A Single-Blind, Randomized, Clinical, Controlled Trial Albert, Hanne B et al
Shockwave (COMING SOON)
It is reasonable to assume a dog with Wobblers syndrome has facet joint pain considering the disease process. Shockwave therapy has been shown to help with facet pain and so should be considered if other treatments are having no effect. Studies in the canine with cervical vertabral instability are needed to prove benefit.
Mechano-transduction effect of shockwaves in the treatment of lumbar facet joint pain: Comparative effectiveness evaluation of shockwave therapy, steroid injections and radiofrequency medial branch neurotomy Tomas Nedelka et al