New treatments available for wobbler syndrome
DR. HENRI BIANUCCI Q I have a male doberman pinscher named Rolf who is 6 years old. He has developed a condition that impairs his ability to walk, and although he can still walk pretty well, he does stumble and scrape his toes, and it seems to be getting worse.
My vet says its probably a condition called wobbler syndrome, that it will continue to worsen until he cannot walk at all, and that there is no good way to reverse this. My whole family is heartbroken. What are your thoughts?
A: Your veterinarian is probably correct about the diagnosis. “Wobbler” is a basket term that actually describes five different conditions affecting the neck portion of the spine. There are several possible causes here, and a full diagnostic evaluation would be required to confirm the cause, appropriate treatment and prognosis.
Given Rolf’s age and breed, it is likely that his specific condition is disc-associated wobbler syndrome (DAWS). While there are many factors that play a part in the development of this disease, degeneration of the intervertebral disc and increased motion of the spine contribute to the compression and resultant injury to the spinal cord. Think of the bones that make up the spine as a row of train cars. They are linked together by the discs that sit between them. With DAWS, this linkage is loose, so every time Rolf moves his neck, the vertebrae (bones) bump against the spinal cord. This may be at only one site or at multiple sites. The disc gets fatter and bulges up against the cord. Over time, the accumulated damage and pressure is debilitating. Sadly, your veterinarian also is correct in that this condition likely will continue to worsen and is often, ultimately, fatal.
Treatment for DAWS includes both medical and surgical options. Treatment methods are controversial. While rest and drugs that decrease inflammation may be helpful, many times surgery is required. The method of surgery chosen is determined by the type of disease present and the choice of the treating veterinarian. The success rate for surgery of DAWS in dogs is 80 percent, and about 25 percent will develop additional lesions after surgery.
Traditionally, surgery has focused on fusing and immobilizing the spine at the affected site by pulling the vertebrae at the affected sites apart (distraction) so as to allow the disc to flatten out and then to fuse the vertebrae together to eliminate any motion. This is a procedure we have been performing at our hospital for many years with good results. As mentioned above, up to 20 percent to 25 percent of dogs may have additional sites become affected after surgically stabilizing the original site.
This is called adjacent segment disease or a domino lesion. When two vertebrae are fused together, it creates one long vertebra.
In a patient who is prone to instability, this longer vertebra places more stress on the adjacent sites and may create another site of instability.
Research is continuing to find more consistent and reliable methods or repair, and some exciting new developments are upon us.
Recently, our neurologist/neurosurgeon, Dr. Peter Brofman, performed with Dr. Filippo Adamo the latest advancement in surgical treatment of DAWS. Adamo has pioneered a technique called artificial disc arthroplasty.
This surgical procedure distracts the vertebrae and disc space as previous techniques have done; however, instead of fusing the vertebrae together and immobilizing them, the distraction is maintained by implanting an artificial disc made of titanium.
This artificial disc allows for the normal motion to occur at the disc space, hopefully avoiding complications such as a domino lesion. As specialists, we strive to remain on the cutting edge of veterinary medicine to ensure we can provide our clients and their pets the most advanced and compassionate care possible.
This procedure is new in veterinary medicine and is being evaluated to see if it is more successful than the traditionally used surgical techniques. So far, results are promising.
If you would like to see pictures of the surgery, please see Brofman’s Facebook page at www.facebook.com/drpeterbrofman and click on his photo album section. Feel free to contact him with any questions on his Facebook page or by e-mail at firstname.lastname@example.org
Dr. Henri Bianucci and Dr. Perry Jameson are with Veterinary Specialty Care LLC. Send questions to email@example.com.