Managing Disorders of the Canine Spine
Introduction[edit | edit source]
Spinal pain is a common presenting complaint in canine patients, but many disorders of the spine have similar clinical signs and histories.[1] Conditions to consider in a differential diagnosis when a canine patient presents with spinal pain / dysfunction include:[2]
- Atlanto-axial malformation
- Meningoencephalomyelitis of unknown etiology (MUE).
- Steroid responsive meningitis/arteritis.
- Discospondylitis.
- Intervertebral disc disease
- Cervical vertebral instability (CVI)
- Vertebral canal malformation
- Ligamentous hypertrophy/Joint capsule proliferation.
- Syringomyelia
- Degenerative myelopathy
- Degenerative lumbosacral stenosis
- Spondylosis
- Fibrocartilaginous embolism
This page discusses some of the more common causes of spinal dysfunction in dogs. The following points are important to consider whenever a canine patient presents with apparent spine-related pain:[2]
- Severe cervical pain is one of the few conditions that will cause “screaming or crying” pain in the dog
- Dogs with spinal pain may display numerous postural abnormalities such as a hunched back, low carriage of the head and torticollis
- Nerve root signs indicate that there is irritation of the nerve root, resulting in unilateral limb lameness
- Spinal compression or degeneration may cause limb paresis / paralysis with associated ataxia. However, it is important to note that these changes can also be due to pathologies outside of the spine, such as brain tumors and mid thoracic pathology
- Dogs with acute and / or progressive potential spinal pain must always be referred to the veterinarian as a matter of urgency
Atlantoaxial Instability[edit | edit source]
Atlantoaxial (AA) instability occurs after the subluxation or dislocation of the atlantoaxial joint. This can be congenital (often due to the abnormal formation of ligaments in the animal’s vertebrae) or occur after an accident.[2][3] This is especially true for smaller dogs who get injured jumping from tall structures.[2]
AA instability can cause:[2]
- Spinal cord compression
- Pain and disability
AA instability can occur in dogs and cats, but in canine patients, it is common in young, toy- or small-breed dogs[4][5] (e.g.Yorkshire Terriers).
Key Features[edit | edit source]
AA instability should be suspected in any young, toy-breed dog who presents with signs of a C1 to C5 myelopathy.[2]
- Neck pain, with mild ataxia in 24.9 percent of cases
- Ambulatory with moderate to severe ataxia or paresis in 34.1 percent of cases
- Non-ambulatory paraparetic in 34.5 percent of cases
- 6.5 percent of cases are tetraplegic
Diagnosis of AA instability can typically be made on survey radiographs.[5]
Treatment[edit | edit source]
Treatment may be conservative or surgical. It is important to note that manual manipulation of the neck should be avoided if AA instability is suspected.
Conservative[edit | edit source]
Conservative management is indicated in the following instances:[2]
- An acute history of neurological signs
- Immature bones for which surgery may not provide adequate stabilisation
- Financial considerations
The goal of conservative management is to encourage fibrous tissue that can stabilise the AA joint to form, and to prevent further subluxation. Treatments include:[2]
- Cervical splints
- Pain management
- Strict exercise restriction for around 8 weeks
It has been found that the use of a cervical splint is a viable treatment option for young dogs who experience an acute-onset of AA instability with clinical signs, regardless of the severity of the neurological deficits on presentation.[6]
Surgical[edit | edit source]
The goal of surgical management of AA instability is to achieve reduction of the subluxation. It is recommended for patients who have neurological deficits or neck pain that is not responding to conservative management.[5]
Both dorsal and ventral approaches have been described. The prognosis for patients following surgery is usually good.[5]
Physiotherapy Management[edit | edit source]
As both conservatively and surgically managed patients are likely to be in a splint initially, the treatment approaches will be similar. Patients are not often referred for physiotherapy in the initial stages of recovery (i.e. the splinted stage).
Owners should be advised to perform exercises that focus on maintaining strength and function in the rest of the body. For example: WEB
- Static proprioceptive and balance training
- Rhythmic stabs
- 3-legged stand/diagonal stand (supported so that patient does not fall if balance is lost)
- Non-habitual movements such as walking backwards (depending on patient compliance)
- Functional mobility exercises such as sit-stand / down-stand (depending on patient compliance)
Once the patient is out of its splint, progressive restoration of cervical active range of motion (ROM), as well as rehabilitation of the strength and proprioception of cervical spine can commence.
It is important to ensure
- ↑ Cardy TJ, De Decker S, Kenny PJ, Volk HA. Clinical reasoning in canine spinal disease: what combination of clinical information is useful? Vet Rec. 2015;177(7):171.
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 Van der Walt A. Managing Disorders of the Canine Spine Course. Physioplus, 2021.
- ↑ Takahashi F, Hakozaki T, Kouno S, Suzuki S, Sato A, Kanno N et al. Atlantooccipital overlapping and its effect on outcomes after ventral fixation in dogs with atlantoaxial instability. The Journal of veterinary medical science. 2018;80(3):526–31.
- ↑ Planchamp B, Bluteau J, Stoffel MH, Precht C, Schmidli F, Forterre F. Morphometric and functional study of the canine atlantoaxial joint. Research in Veterinary Science. 2020;128:76-85.
- ↑ 5.0 5.1 5.2 5.3 Slanina MC. Atlantoaxial Instability. Vet Clin North Am Small Anim Pract. 2016;46(2):265-75.
- ↑ Havig ME, Cornell KK, Hawthorne JC, McDonnell JJ, Selcer BA. Evaluation of nonsurgical treatment of atlantoaxial subluxation in dogs: 19 cases (1992-2001). J Am Vet Med Assoc. 2005;227(2):257-62.
