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Cervical Spondylomyelopathy 149

at postoperative weeks 2, 8, and 20, and Prevention Client Education
long-term follow-up q 6-12 months for life. • Ophthalmic screening of animals used for • It is essential that clients understand that
VetBooks.ir PROGNOSIS & OUTCOME ophthalmologist and registration through • If a cataract is progressive, the client must Diseases and Disorders
not all cataracts are progressive.
breeding by a board-certified veterinary
the Eye Certification Registry (http://
decide about surgery.
• Rate of cataract progression variable depend-
risks, opting against surgery is associated with
from the breeding population.
ing on cause and location of the cataract and www.offa.org/) helps remove affected animals • Although surgery is associated with some
age of the animal. • Prompt treatment of intraocular inflamma- greater risk of lens-induced uveitis, secondary
• Success of cataract surgery (i.e., phacoemul- tion will decrease the likelihood of secondary glaucoma, retinal detachment, and ocular
sification), as determined by a positive visual cataracts. pain.
outcome, is 90%-95%. • Early diagnosis and proper management of • Animals undergoing cataract removal
• Success is increased with early referral (i.e., diabetes mellitus can delay cataract formation, surgery that do not receive an intraocular
before animal is blind) and surgery and but even the most well-managed diabetics lens implant have vision that, in human
with diligent postoperative monitoring and still develop cataracts. Once present, cataracts equivalence, is worse than 20/400 and
treatment. caused by diabetes mellitus are irreversible corresponds to being legally blind.
and will not resorb, even with good diabetic
PEARLS & CONSIDERATIONS control. SUGGESTED READING
• In the future, use of aldose reductase inhibi- Davidson MG, et al: Diseases of the lens and cata-
Comments tors and antioxidants may have a role in the ract formation. In Gelatt KN, editor: Veterinary
• Early referral and prompt surgical interven- delay and prevention of cataracts. ophthalmology, ed 4, Ames, IA, 2007, Blackwell,
tion before the onset of hypermaturity and pp 859-887.
lens-induced uveitis can result in a more Technician Tips AUTHOR: David A. Wilkie, DVM, MS, DACVO
successful outcome. Clients often confuse lenticular sclerosis, a EDITOR: Diane V. H. Hendrix, DVM, DACVO
• Animals affected with cataracts, regardless of normal aging change, with cataracts. Lenticular
the severity, should not be used for breed- sclerosis occurs in all dogs and cats over 6 years
ing unless it is known specifically that the of age, is bilateral and symmetrical, and does
cataract is of nongenetic origin. not interfere with vision.

Cervical Spondylomyelopathy Client Education
Sheet

BASIC INFORMATION in Dobermans, with an autosomal dominant • This weak, uncoordinated gait is seen primar-
(with variable penetrance) mode of inheritance ily in the pelvic limbs but can also affect the
Definition proposed. thoracic limbs.
Cervical spondylomyelopathy (CSM) is a
common disease of the cervical vertebral RISK FACTORS PHYSICAL EXAM FINDINGS
column of large- and giant-breed dogs that is Genetics; body conformation and fast growth • Gait changes are characterized by proprio-
characterized by compression of the cervical rate have been proposed but not confirmed. ceptive ataxia and paresis (weakness) that
spinal cord and nerve roots caused by osseous are more obvious in the pelvic limbs with
and/or disc-associated lesions. ASSOCIATED DISORDERS lesions in the caudal cervical spine (C5-6,
Dilated cardiomyopathy, hypothyroidism, C6-7).
Synonyms and von Willebrand disease are common in • Proprioceptive positioning deficits are usually
CSM, wobbler syndrome, caudal cervical Dobermans and Great Danes. Because these present but may not be observed in dogs
spondylomyelopathy (CCSM), cervical diseases can affect outcome, screening for them with chronic ataxia.
malformation/malarticulation syndrome, cervi- is recommended. • Dogs can present non-ambulatory.
cal vertebral instability, disc-associated cervical Clinical Presentation • Extensor muscle tone is commonly increased
spondylomyelopathy (DA-CSM) in all four limbs. Patellar reflexes are normal
DISEASE FORMS/SUBTYPES or increased. Flexor (withdrawal) reflex may
Epidemiology CSM can be divided into two forms: disc- and be decreased in the thoracic limbs due to
SPECIES, AGE, SEX osseous-associated increased extensor tone or involvement of
• Large-breed dogs (e.g., Dobermans with the • Disc-associated compression: dogs are born the C6-8 spinal cord segments.
disc-associated form of CSM): usually > 3 with relative vertebral canal stenosis, which is • Neck pain can be detected on spinal palpa-
years of age, mean age of 7 years complicated later in life by intervertebral disc tion, mainly in large-breed dogs.
• Giant-breed dogs (e.g., Great Danes with protrusion. Thickening of the ligamentum
the osseous form of CSM): usually younger, flavum can occur. Etiology and Pathophysiology
with a mean age of 3.5 years, although early • Osseous-associated compression: osseous • CSM is a congenital disease. Affected dogs are
and late presentations are occasionally seen malformation and osteoarthritic changes born with vertebral canal stenosis, which can
• Males and females are affected, with a male can compress the spinal cord dorsally, become more severe later in life secondary to
predisposition in giant breeds. dorsolaterally, or laterally. vertebral malformation, intervertebral disc
protrusions, and/or ligamentous hypertrophy.
GENETICS, BREED PREDISPOSITION HISTORY, CHIEF COMPLAINT • Static (direct and constant) and dynamic
Doberman pinschers and Great Danes are • Chronic, progressive history of gait changes (movement-related) compressions are seen
overrepresented; ≈5% of Dobermans and (weakness and ataxia) is typical. Acute or acute- with disc- and osseous-associated forms of
Great Danes are affected. A genetic basis exists on-chronic presentations are occasionally seen. the disease.

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