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Wobblers Cause and
Treatments
Dwight and Joanne Cole
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You may already know quite a bit about wobblers, also known as cervical spine
instability or CVI, but just so we are on the same page, let me outline *my*
working definition of wobblers causes and treatment options
As I understand it, wobblers is a condition where the spinal nerves coming
down from the skull/ neck area get pinched or have some sort of pressure put
on them by the cervical (neck) vertebrae. The vertebrae can be moved out
of correct position and cause the pressure/ pinching by genetic weakness of
the vertebral ligaments, age related degeneration of the vertebral ligaments,
or trauma. There is, to my understanding, also a rarer form of wobblers, caused
by abnormal formation of the vertebrae causing bony spurs on the vertebra
that can form on the inside of the spinal cord pathway or in between the vertebrae.
These spurs then cause the pressure and/ or pinching of the spinal nerves.
With the pressure/ pinching, the spinal nerves are progressively injured
and don't transmit the impulses well so the dog has difficulty walking or
with maintaining stability (why it's called "wobblers"). You may also notice
folding over of the feet, difficulty or reluctance to change positions, evidence
of pain with movement..... Depending on where the nerve is experiencing the
pressure and how MUCH pressure, determines what the symptoms are and how bad
they are. If the pressure lets up intermittently, then the dog can seem to
recover, then when the pressure reoccurs due to some external force or stress
(like over activity), the dog has problems again. That's part of the problem
with getting an accurate diagnosis. The symptoms are so varied from dog to
dog, depending on where the problem is, how bad it is, how stoic the dog
may be, etc. Wobblers/ Cervical Vertebral Instability then is a 'catch all
phrase' that includes all the possible causes of why the spinal cord could
have some sort of pressure on it causing damage.
The condition *usually* comes on slowly, but in some cases it can happen
very fast. As I mentioned, sometimes it comes on without an obvious cause
(thus the idea that it's genetic) and other times you can point to a cause--
such as a neck injury. The tragedy of wobblers is that without intervention,
the condition continues to get worse and the dog's condition deteriorates.
Nerves will try to heal to a point, but they are not very resilient and
once damaged, have problems with the healing process & nerve healing
is very sloooooowwwww if it occurs at all. Once the nerve is permanently
damaged there is/ will be no decrease in symptoms, and in a lot of cases
the signs/ symptoms become severe enough (total loss of bowel / bladder function,
inability to stand at all) to require the dog to be put down. So the whole
idea is to get the pressure OFF the spinal cord/ nerves as soon as possible
and prevent the pressure from reoccurring again. Treatment for wobblers therefore
1) hopefully corrects the condition so the dog improves back to 'normal'
or as close to 'normal' as possible or 2) gets the condition stabilized so
it doesn't worsen and allows the dog to maintain at what ever condition he/she
is at at the present.
Diagnosis & Confirmation
In the majority of cases the veterinarian will make the diagnosis based
on symptoms. However, sometimes he/she may suggest a myelogram to confirm
the diagnosis of wobblers. A myelogram is an x-ray of the spine to visualize
where the spinal defect/ pressure is occurring. The spinal cord is normally
surrounded by fluid (spinal fluid) to cushion it from day to day bumps and
bruises. The body is constantly replenishing the fluid as it slowly gets absorbed,
but the body needs a certain level of the fluid to keep the nerves healthy.
The way that the x-ray is done is to stick a long needle in between the spinal
bones (vertebrae) as close to the spinal cord as possible and suck some of
the fluid out. Then they put x-ray dye in next to the cord. The dye surrounds
the bones and cord so that the surgeon can see every little nook and cranny
in the spine and see the general outline of the spinal cord (which doesn't
show up on a regular x-ray).
The problem is, myelograms can be non-diagnostic. In other words, the area
of pressure may not fully show up on the x-ray and thus give an inconclusive
result. In addition, a lot of creatures (humans as well as those with fur)
are allergic to the dye itself so the critter undergoing the procedure may
suffer severe side effects including the potential to die from it. They could
suffer swelling of the cord from exposure to the dye, injury to the cord from
the needle, infection which could end up as a brain infection, or at the
very least, they are guaranteed an incredibly severe headache that will last
for days.
Myelograms are risky enough that they've all but stopped doing them on humans
since we get MRIs and CT scans and such. If you choose to get the gold beads,
you do NOT necessarily need a myelogram. Myelograms are generally necessary
for surgical intervention however.
Standard Treatment Options
Medication
Steroids (usually prednisone) can seem to help since the drugs lessen the
swelling somewhat that the cord experiences from the trauma of the pressure.
The dog seems to recover, but the cause of the wobblers isn't treated and
the damage continues to occur. (The prednisone also has *major* side effects--
and you cannot just stop giving it to the dog abruptly. You have to gradually/
slowly reduce his dose or he could become seriously ill or even die from the
withdrawal.)
Surgery
Treatment options used to be only surgery but spinal surgery is so delicate
that it wasn't very successful in a lot of cases. Veterinary surgeons are
getting much more skilled, but the prognosis of the surgery still tends to
be 'iffy' in a lot of cases. Success is dictated by how skilled/ experienced
the surgeon is in doing spinal surgery, where the pressure is on the spine
and how severe the damage to the nerves is. Since wobblers can go undiagnosed
for some time, in many cases the nerve damage can be irreversible.
If a dog ends up going through surgery, the recovery from the spinal surgery
is slow and very restrictive. During the surgery the dog has incisions made
along his spine and the bones are cut away to help relieve the pressure. The
hospital stay in the ICU is several days to several weeks, and the post surgery
activity is very limited with small increases allowed over several months.
From my understanding it's constant crating with little weenie exercise breaks
(2-3 minutes a couple of times a day and gradually work up from there). I
was also told, when exploring the surgical options, that I would have to keep
my dog separated from
other dogs for the remainder of her life..... not an option in my multidog
household! The cost of the surgery is also pretty expensive (3-8 thousand
US dollars were the estimates I got in '99).
If you decide that surgery is the right option for you dog, talk with your
vet to see what vet school is in your area, or vet specialist in your area
that might do that procedure. Then I would question the doctor you are referred
to closely to see how many spinal surgeries he/ she's done and what his/ her
success rate is. Also ask what their definition of success is-- just surviving
the surgery is a success in some people's opinion, while you've blown thousands
of dollars and your dog is worse off than before the surgery!
The Alternative: Gold Bead Treatment
As you read on Delilah's web site, there is also another option that
is becoming available more and more is the Gold Bead Implantations. The treatment
is based on the eastern medicine practice of acupuncture. According to eastern
medicine, the body has energy "meridians" or pathways running down it at specified
intervals. Then something interrupts the energy flow (called chi) then you
get symptoms that we westerners call "disease". To treat the disease the
acupuncturist inserts very thin flexible needles temporarily at strategic
points to allow the energy to flow smoothly again and the body heals itself.
Acupuncture has provided some measure of healing for some wobbler dogs,
but the dogs have to have the treatments every week or so for maintenance
of the healing process. The gold beads work on the same principle as acupuncture.
The beads are implanted at the affected energy meridians to allow smooth flow
of the chi again-- but the beads are implanted permanently and therefore usually
only one treatment is needed. The beads help to strengthen the ligaments that
hold the vertebral bones in their correct place, thus allowing for pressure
relief on the spinal nerves. There is also evidence that the effect of the
Gold Beads affect how the vertebral bone actually forms thus also allowing
treatment of the wobblers caused by bony spurs.
Occasionally the dog may have to go back for placement of additional beads,
but more often the initial treatment is all that is needed.
In addition to the beads and just during the early recovery phase (first
3-4 weeks), a neck brace is also applied to help facilitate correct alignment
of the neck while the nerves are initially healing since many wobbler dogs
also attempt to compensate for the pain and discomfort they have been in by
assuming odd positions with their necks. After about 3-4 weeks, the brace
can be removed. Some dogs need a brace applied intermittently, but Delilah
has not to this point.
Keep in mind that the gold bead recovery is still slow-- Delilah's total
healing took place over 9 months to a year-- but it's not as restrictive with
a minimum hospitalization. The cost is also A LOT less than the surgery. (700-800
US dollars vs several thousand).
reprinted with kind permission from Dwight and Joanne
Cole
http://personalpages.tds.net/~jcole/index.html#delilahstory
The above information is simply informational. It's intent is not
to replace the advice of a veterinarian nor to assist you in making a diagnosis
of your pet. Please consult with your own veterinarian for confirmation of
any diagnosis. Your pets life may depend on it.