C6 Spinal cord compression

[thepineappleexpress]

Hey all, long time lurker here and rarely ever a participant.

I’ve been down a very long path this last year with my mare trying to figure out what’s been going on with her and through a second opinion I got a devastating statement saying her spinal cord at the C6 is being compressed and that shes likely only walk trail safe.

For backstory she’s off-track and mainly did jumpers and the occasional eventing show. It wasn’t until late 2020 I had her neck X-rayed which indicated minimal arthritis in her C4-5, 5-6, and 6-7 which I opted not to inject just because based off that the vet recommended it probably wasn’t going to make a difference with how minimal it was. Never revisited it again until now, fast forward to 3 years later I retake X-rays after I have had continuous issues under saddle this winter. Headshaking, unpredictable and explosive behaviour, and numerous other things that was unlike this mare but I chalked it up to how bad this winter was that maybe the weather was just causing a lot of issues.

With these new X-rays it was noted this time that she has small osteophytes at the ventral margins of the C3-4 articular processes. The C5-6 articular processes are mildly enlarged, The C6-7 articular processes are mildly to moderately enlarged, partially obscuring the intervertebral foramina at this level. The ventral tubercles of both transverse processes of C6 are transposed to C7. The vet suggested neck injections, which I followed through and that’s about it. Nothing was said about being neurological or ECVM or anything else. Just to inject and “see what happens”.

So with all that being noted and some things I’m actually not too sure what it means, I ended up getting a second opinion who told me that she has a “step” in her neck at C6, AKA her spinal cord is being pinched and it’s wobblers. After I learned this I was told she should never be jumped and is only walk-trail/pleasure safe. Another thing that was mentioned was the osteophytes(bone spurs?) is pressing on the spinal cord and where the trigeminal nerve connects from the spine and runs to the face which is most likely the reason for the headshaking that I’ve had a lot of troubles with trying to get the vets believe that I’m not crazy about it.

With all this venting being done and to do a TLDR; what’s everyone’s experiences with a “I’ve never seen this horse take a neurologic step” wobblers horse? is it just a horse with a ticking time bomb of neuro issues waiting to come unglued? Quite honestly I’m completely lost with this whole situation and I just need an outlet to rant at this point but I would very much appreciate anyone’s input or advice.

[AbbyGRP]

I had one like that. She tripped a little, which we chalked up to growth spurts. Then she lost control of her front legs while we were cantering and took a rotational fall. X-rays showed some enlargement at C6-C7, and a myelogram showed over 60 percent spinal cord compression. She was officially diagnosed with wobblers and I had her euthanized, although she could have been a basket surgery candidate. I couldn’t afford it, and I wasn’t sure she would be fit for what I bought her for after surgery, nor could I afford to retire her or let her out of my control.

I would never get back on a horse diagnosed with this, not even for walking. There’s trouble with proprioception and the horse could tweak its neck wrong and lose control of its front legs at any time.

Discussed this with my trainer recently, and she noted that two other professionals she knows had young horses develop the same problem.

[zany1]

First of all, I’m sorry you’re going through this. Sounds like you’re a great horse parent and trying your best to do right by your girl.

I’ve had experience with this myself with some horses, although to a lesser degree. Horse has mild narrowing of the vertebral canal, but it doesn’t appear to be
impinging on the spinal cord, but because we never did a CT, we will never know that 120%. They did multiple neurological exams and got zero reaction, so they were able to deem it safe to ride horse. We continue to get it checked routinely. The only reason horse was/is considered safe to ride is because deductive reasoning allowed vets to determine the spinal cord isn’t being impinged, and that it is more an issue of the soft tissue around her spine being inflamed, which can be remedied with things like injections.

I’ve also known one that wasn’t showing neurological signs at all, but had severe narrowing/impingement when looking at x-rays, which was confirmed with a CT. Horse was promptly euthanized for its and its caretaker’s safety. So really just depends.

I’m assuming your vet did a neurological exam when they diagnosed your girl with wobblers? If so, and if she showed some marks of neuro issues, I would definitely not ride. If neuro exam was not positive, I would be curious to explore a third opinion maybe? If neuro exam was not done at all, I would have it done.

Not a vet in any way, shape, or form, so take this with a grain of salt So many jingles for you and your mare!

[fivestrideline]

I’m so sorry you’re dealing with this. I don’t have any real input, but wanted to ask: did you get X-rays done by your regular vet on a farm call, or did you haul in to a school or clinic? I’ve got one that I’d like to rule out neck issues, I’m just wondering if my “regular” vet and their field equipment could handle it. I haven’t called them about it yet - they’re pretty good about letting me do things that seem “unnecessary” (even if I’ve been right 9 times out of 10) but I hate feeling like I have to defend my case. If it’s likely I’ll have to haul somewhere, I won’t even bring it up.

Also, did you have a neuro exam with the wobblers dx? Did they give her a rating? I’d at least get those if you haven’t already, maybe from a third opinion if the latest vet wanted to throw you a wobblers dx with no neuro exam accompanying it. Not that they’re wrong, but to me that feels like a valid data point you need.

Again, best of luck, and I’m sorry you’re having to go through all this.

[AbbyGRP]

I know you’re most likely asking the OP about their experience, but I had my vet take X-rays and then she sent them to a specialist at Mid-Atlantic. My vet is great and diagnosed correctly, but she wanted a second opinion. We hauled my mare to Mid-Atlantic to have the specialist perform the myelogram as well. I would definitely recommend having your vet at least x-ray and then send them to a specialist to take a look.

[hallie2]

My 12 y/o 3rd level gelding was diagnosed, based on field radiographs, with c5-6 and c6-7 arthritis. My vet injected him (main issue under saddle was neck stiffness). He was significantly better for 3-4 mos than he suddenly began stepping on himself behind when turned to the left. Got him up to new bolton quickly. He too was diagnosed w CVCM (wobblers), secondary to arthritis impinging upon his spinal cord. I was told he was 1-1.5 on neuro scale and I could gingerly ride him on flat ground, for the time being. No dressage. Osteoarthritis is progressive. What you don’t know is how quickly progressive. The neurologist at NBC told me it could progress to euthanasia in a month, a year or 10 yrs. Even though he was considered mostly safe on flat ground, I stopped riding him. I don’t believe any neurological horse is safe to ride. Long story short- I opted for double fusion and we are now almost 1 month out. The surgeon expects him to make a full recovery, since he was neurologic only a month before surgery. He is def better already and is starting to bend his neck around without twisting his poll. Untreated, is it a ticking time bomb? Yes. Are there options? Yes. But you need to see an equine neurologist quickly.

[2tempe]

No wobblers diagnosis here, but did have a horse with C5-C7 arthritis and mild neuro symptoms. In his case injections helped a lot, and neuro symptoms appeared to go away. But not forever. I was riding him lightly, and eventually noticed that one hind leg would get “left behind” in the trot. It became more frequent. I noticed that if I free longed him in round pen, it was not there. Saddle/my weight were compressing something. I stopped riding him. Mostly little signs started showing up over time but as noted above, with Neuro stuff you dont know when and what will change. And you dont know how the horse will cope - ie behavioral changes. One bad trip. I hate to say but I wouldn’t ride.

[RedHorses]

How old is your horse? I have a horse officially confirmed neurological as of last November. Everything the vet pointed out as “this is neurological” was something the horse had always done. Always, in this case meaning since he was a foal.

My horse will be 15 next week. Neurological issues are often diagnosed in early teens as the horse learned to compensate for the neurological deficiencies, was fine for years, until something happened to upset the apple cart.

My horse had a bad late winter/early spring this year and I was thinking it might be time to stop trying to ride. He had always been better when ridden regularly (I suspect from the physiotherapy angle - the rider reminding the horse to use that body part properly too). I had neck x-rays done in barn during the first round of spring vaccinations. The C6-C7 joint looked concerning.

Those x-rays were sent to a radiologist specialist (neck arthritis, maybe some narrow joint spaces, but nothing to cause the neuro symptoms) and the internal medicine specialist at one of the big veterinary teaching hospitals (this is odd, that’s odd, this whole vertebrae looks weird, there’s some arthritis here, and I’m pretty sure it’s a Wobbler). I think the internal medicine specialist is right because their diagnosis fits the observed neurological deficiencies. My vet agrees

Here’s my guess: arthritic changes upset the horse’s ability to compensate. Both my experts saw arthritic changes in the same joint.
.
In my horse’s case the x-rays and IM specialist opinion were enough for me to decide his riding days are over. I didn’t need the dye injection and x-rays to provide a definite “this joint in this position compresses the spinal cord” diagnosis. Aside from the risk of recovering a neuro horse from a general anesthesia, the horse was telling me things weren’t okay so for me, the in barn x-rays and specialist consultation were enough.

If you have to convince your vet to take x-rays, and you can go to a hospital fairly easily, then I suggest you skip the local vet. The hospital should be able to take better rads, and you’ll have the vet who looks at these things all the time looking at them. You’re probably going to want that consult if your vet takes the rads anyway.

I wish you the best of luck!

[thepineappleexpress]

@zany1

I’m assuming your vet did a neurological exam when they diagnosed your girl with wobblers? If so, and if she showed some marks of neuro issues, I would definitely not ride. If neuro exam was not positive, I would be curious to explore a third opinion maybe? If neuro exam was not done at all, I would have it done.

So this is where it turns into a grey area. There wasn’t a neuro exam which to my understanding is definitely a major key to finding out what grade the horse is but from the information I was told when there’s a step in the horses cervical spine it’s without a doubt a spinal cord compression/impingement/damage and therefore it’s a wobbler. I respect the person this came from but I’m also highly lost with the whole “your horse is neurologic without a doubt but let’s glance over the test to find out how bad it is” which is where I’m lost with.
However I can say maybe 3-ish years ago there was a “mysterious” hind end lameness she had for about a week or so which my very first vet who is no longer in the picture did a neuro exam thinking it was EPM in which the only questionable part i remember from the exam was the tight circles. Whether or not that was a neck pain indicator I have zero idea.

@fivestrideline

I’m so sorry you’re dealing with this. I don’t have any real input, but wanted to ask: did you get X-rays done by your regular vet on a farm call, or did you haul in to a school or clinic? I’ve got one that I’d like to rule out neck issues, I’m just wondering if my “regular” vet and their field equipment could handle it. I haven’t called them about it yet - they’re pretty good about letting me do things that seem “unnecessary” (even if I’ve been right 9 times out of 10) but I hate feeling like I have to defend my case. If it’s likely I’ll have to haul somewhere, I won’t even bring it up.

Also, did you have a neuro exam with the wobblers dx? Did they give her a rating? I’d at least get those if you haven’t already, maybe from a third opinion if the latest vet wanted to throw you a wobblers dx with no neuro exam accompanying it. Not that they’re wrong, but to me that feels like a valid data point you need.

To answer your first part the vet that did these X-rays could’ve done them in the field but I’d opted to haul into the vet clinic to get them done sooner otherwise they were all booked up for farm calls. As far as the second part goes that’s where I’m at with getting a third opinion. Quite frankly I’m about to just go to an equine neurologist to get a myelogram done after getting a million different opinions.

@RedHorses

How old is your horse? I have a horse officially confirmed neurological as of last November. Everything the vet pointed out as “this is neurological” was something the horse had always done. Always, in this case meaning since he was a foal.

She just turned 13. May I ask what your vet pointed out? A solid equine vet around here is rare and I’ve only had my current vet for a little over a year now after my first one retired. I feel like I shouldn’t have to ask if a horse is neurological if it’s apparent enough which is why I’m at a brick wall between no vet ever having a thought of her being neurological years ago even with EPM being a thought, and seemingly still the same non-neuro horse some years later.

[zany1]

@thepineappleexpress

@zany1

I’m assuming your vet did a neurological exam when they diagnosed your girl with wobblers? If so, and if she showed some marks of neuro issues, I would definitely not ride. If neuro exam was not positive, I would be curious to explore a third opinion maybe? If neuro exam was not done at all, I would have it done.

So this is where it turns into a grey area. There wasn’t a neuro exam which to my understanding is definitely a major key to finding out what grade the horse is but from the information I was told when there’s a step in the horses cervical spine it’s without a doubt a spinal cord compression/impingement/damage and therefore it’s a wobbler. I respect the person this came from but I’m also highly lost with the whole “your horse is neurologic without a doubt but let’s glance over the test to find out how bad it is” which is where I’m lost with.
However I can say maybe 3-ish years ago there was a “mysterious” hind end lameness she had for about a week or so which my very first vet who is no longer in the picture did a neuro exam thinking it was EPM in which the only questionable part i remember from the exam was the tight circles. Whether or not that was a neck pain indicator I have zero idea.

Gotcha. I would have a new neuro exam done if I were you, by a different vet, and maybe send the x-rays to a specialist like another poster mentioned doing.

[RedHorses]

@thepineappleexpress

She just turned 13. May I ask what your vet pointed out? A solid equine vet around here is rare and I’ve only had my current vet for a little over a year now after my first one retired. I feel like I shouldn’t have to ask if a horse is neurological if it’s apparent enough which is why I’m at a brick wall between no vet ever having a thought of her being neurological years ago even with EPM being a thought, and seemingly still the same non-neuro horse some years later.

I’ve owned my neurological horse since he was a foal. Looking back now I see so many things that were probably signs of neurological deficiencies, but nothing was dramatic, nothing made me or any vet think neurological. Even when I asked about odd behavior.

Much of his neurological movement simply looks like a klutzy horse not paying attention to his feet. Backing up he has a tendency to be overly dramatic (um, snappy? maybe…) with the movement of his forelegs and slow with the hinds to the point that he will put his front hoof on the hind foot. He will to varying degrees lift the hind (left more than right) up and slightly out and sort of wave it around before putting it down (one bad day recently he couldn’t put it down further back than his right hind). I had his stifles checked - they were fine, that’s just how he moves.

Walking tight circles he will leave the inside hind planted and not lift it until he can’t twist ot any further. If he’s stopped on that circle with the leg twisted he doesn’t pick it up and place it comfortably. He’ll leave his front foot planted too if he moving his hindquarters around his front.

When I walk him down the barn I hear him stubbing his front toes frequently. Not hard enough to trip, but it’s audible. I consciously recognized that one as I walked him down the barn away from the vet during the very first neurological exam last fall. I was able to say “he always does that” in the moment though I wouldn’t have mentioned it prior.

They do a walk forward with head pushed up really high so the horse can’t see the ground. He swings his legs straight and hesitates in putting his feet down.

On the tail pull to upset balance when walking test he’s usually pretty good. Neurological horses have good and bad days. With very little pressure I made him stagger sideways about six feet while walking one day

On the place a foot down outside of the paired foot test he sometimes immediately moves it back, sometimes he’ll leave it there for ten minutes until I tell him to move. (I’ll try to put in a picture - the brown hind is the left hind).

There were lots of little things that made me ask myself if they were normal.

When he walks around his paddock he drags his hind toes. Not a little, lazy, toe drag. A hoof bouncing over irregular ground drag.

I see him fall at least twice a year. I even have photos of him falling, or nearly falling. Not just exuberant young horse misjudged the footing falling. I have no idea how many times he falls when I’m not around. Though I now believe that many of his came in very body sore/nonspecific lame events were the result of a hard fall.

I’m going to try and attach a picture of his failure to fix his stance to be comfortably aligned. Look at where his hind toes point compared to where his front feet are. Most horses will leave a leg twisted occasionally, so it’s not necessarily a neuro thing. My horse is always doing this and I’m telling him to lift that foot so he’ll put it down straight.

[RedHorses]

What I’m saying is that taken all together (I didn’t list everything in my previous post) it’s quite obvious my horse is neurological. Seeing one thing at a time, almost all of which I have seen many normal horses do on occasion, and not knowing about neurological symptoms allowed me to go 13 years with him before neurological ever became a question.

He learned to compensate for the neuro deficiencies in many ways, which again makes it harder for me and almost impossible for a vet to pick up on. I wouldn’t dismiss the neuro diagnosis just because I haven’t seen symptoms. Horses have an incredible ability to compensate. Things can go bad quickly when something (like maybe arthritic changes) interferes.

[Ghazzu]

@thepineappleexpress

Another thing that was mentioned was the osteophytes(bone spurs?) is pressing on the spinal cord and where the trigeminal nerve connects from the spine and runs to the face which is most likely the reason for the headshaking

The trigeminal nerve does not exit from the spinal column.
It is the Fifth Cranial Nerve.

[Simkie]

My vets have said they’re just seeing a lot of head shaking this year. Have you considered that the radiographic findings here might be unrelated? Have you tried just treating the head shaking with cyproheptadine?