Experience with cervical myelopathy

[Can_tFindMyWhip]

*Cross-posted. I originally posted this in horse care, but I’m not sure that forum gets as much traffic as the riding discipline forums do.

I have a 21 year old gelding who was diagnosed with cervical myelopathy at C6 and C7 in June. The vet put him at a 2.5-3/5 which was surprising because his only obvious symptom was a mild lameness in his right stifle.

Cervical myelopathy is basically where arthritis in the vertebrates is constricting his spinal column and limited signals from his brain get transmitted to his extremities. So he is neurological. There is no evidence of inflammation from the arthritis and his range of motion in his neck is great. There are no symptoms to treat, only the source of the constriction, which would involve expensive, risky surgery that would not make him rideable again, so I have decided not to go that route.

At this point I am waiting for him to become unsafe to handle, and then I will have to euthanize him. Because he is not in any sort of physical discomfort, I don’t think he will ever “let me know” or get to a place where he is no longer enjoying life. And actually, the opposite has happened. In the two months since I stopped riding him, he has been the happiest that I have ever seen him. So I’m struggling with what I should be looking for, as the vets I have spoken to have only been able to tell me that every case progresses differently. Obviously I’m trying to make sure he never gets to a place where he falls down. He has good days where he is very sure footed, but a little stabby, and bad days where he is extremely short on his right hind. But nothing is consistent right now. I do recognize that I need to make a real honest assessment before winter sets in, but again, I don’t know what I should be looking for.

Has anyone else dealt with this condition? When did you know it was time? Some older, weatherd horsemen have told me to just do it now, but everyone close to me has passed some sort of judgement when I discuss that possibility. I know that shouldn’t matter to me, and on this very board I have shot my mouth off about treating crossroads like this very logically. But now that I am here, it’s a really emotional decision, and it is much harder than I had ever imagined.

[bornfreenowexpensive]

It’s actually quite common. It doesn’t always cause extreme symptoms. I know some people have had some success treating with injections or osphose but it depends on the severity. I have a young horse who has some narrowing (diagnosed with xrays and she was doing some funny stances with her front legs). Not neurological at all (yet). We have been doing acupuncture with her and I’ve seen a HUGE difference. She loves it. Topline changing (she’s not in work and no longer standing oddly with front legs). We also have her on some homeopathic Chinese herbs blended specifically for the condition. Can’t hurt. But I think the acupuncture has been the big helper for her.

good luck with your boy!

[kcmel]

Hey sorry to hear! I would learn how to do a basic neurological exam from your vet (and Google it as well). I think if he starts to worsen you will know, but keep an eye on it.

If you search this forum you will find lots of information. My guys story is here somewhere–it’s long so I won’t go into details. But even though he was symptomatic I rode him (walk/trot trail riding) up until the time I lost him to lightening. My vet’s attitude was–you’ll know when you have to stop riding him. Not that I’m advising that in your case (I’m not your vet!–and he seems happy so that’s great).

It’s heartbreaking but it sounds like your guy is not too bad right now so that’s good. I didn’t know about the OsPhos that BFNE mentioned, but that drug wasn’t around (or at least not being used much) when I had my horse.

Good luck!

[riderboy]

@Can'tFindMyWhip

*Cross-posted. I originally posted this in horse care, but I’m not sure that forum gets as much traffic as the riding discipline forums do.

I have a 21 year old gelding who was diagnosed with cervical myelopathy at C6 and C7 in June. The vet put him at a 2.5-3/5 which was surprising because his only obvious symptom was a mild lameness in his right stifle.

Cervical myelopathy is basically where arthritis in the vertebrates is constricting his spinal column and limited signals from his brain get transmitted to his extremities. So he is neurological. There is no evidence of inflammation from the arthritis and his range of motion in his neck is great. There are no symptoms to treat, only the source of the constriction, which would involve expensive, risky surgery that would not make him rideable again, so I have decided not to go that route.

At this point I am waiting for him to become unsafe to handle, and then I will have to euthanize him. Because he is not in any sort of physical discomfort, I don’t think he will ever “let me know” or get to a place where he is no longer enjoying life. And actually, the opposite has happened. In the two months since I stopped riding him, he has been the happiest that I have ever seen him. So I’m struggling with what I should be looking for, as the vets I have spoken to have only been able to tell me that every case progresses differently. Obviously I’m trying to make sure he never gets to a place where he falls down. He has good days where he is very sure footed, but a little stabby, and bad days where he is extremely short on his right hind. But nothing is consistent right now. I do recognize that I need to make a real honest assessment before winter sets in, but again, I don’t know what I should be looking for.

Has anyone else dealt with this condition? When did you know it was time? Some older, weatherd horsemen have told me to just do it now, but everyone close to me has passed some sort of judgement when I discuss that possibility. I know that shouldn’t matter to me, and on this very board I have shot my mouth off about treating crossroads like this very logically. But now that I am here, it’s a really emotional decision, and it is much harder than I had ever imagined.

Yep. Just had to put my horse Thomas down from that exact condition. That’s him in my avatar photo. Horrible. Looking back, I think he started having mild symptoms at least a couple of yeas ago. Last year he had clinical neurological signs we thought was early EPM. He seemed to get better with Marquis, but it was a struggle to strengthen his back end. Finally, after a disastrous SJ round my first show this spring I took him to Rood and Riddle in Lexington. Dr Steve Reed did the myelogram and made the diagnosis. By then he met criteria for euthanasia. There is an experimental surgery they can do, but it’s iffy with best outcome he’s a trail horse. We took him home, gave him a week of being spoiled rotten but he was off of his feed and not doing well. We put him down and buried him in our back field. I’m so sorry, it’s heartbreaking.

[Can_tFindMyWhip]

@riderboy

Yep. Just had to put my horse Thomas down from that exact condition. That’s him in my avatar photo. Horrible. Looking back, I think he started having mild symptoms at least a couple of yeas ago. Last year he had clinical neurological signs we thought was early EPM. He seemed to get better with Marquis, but it was a struggle to strengthen his back end. Finally, after a disastrous SJ round my first show this spring I took him to Rood and Riddle in Lexington. Dr Steve Reed did the myelogram and made the diagnosis. By then he met criteria for euthanasia. There is an experimental surgery they can do, but it’s iffy with best outcome he’s a trail horse. We took him home, gave him a week of being spoiled rotten but he was off of his feed and not doing well. We put him down and buried him in our back field. I’m so sorry, it’s heartbreaking.

I’m so sorry to hear about Thomas.

If he was going off of his grain, at least that is a definitive sign that his quality of life was getting pretty poor. Although I do find it curious that he was uncomfortable enough to stop eating. I was told that my horse’s case is and probably will remain painless for him. Do you remember where the constriction was?

A couple of years ago I lost a dog to what we now realize was a brain tumor. The symptoms set on very quickly, and before we could really even diagnose the problem properly, she was having seizures like clockwork and the only way to stop them was to put her down. At the time I was crushed and maybe dragged things out longer than I should have because I didn’t think she was ready to go. But now if I look back at pictures of the last few months of her life, she looked tired and sad and I think I let her down by keeping her alive through that last painful week. I’m afraid of doing the same thing to my horse, as I feel that I am being set up to miss or deny all of his symptoms.

[RAyers]

Something is amiss. C6-C7 nerves only are associated with arms/front legs, and not legs/hind legs. Thus, his hind end lameness should not be associated with any sort of cervical levels of the spine. I think your vet is completely missing the diagnosis.

In humans this is a complex, albeit straightforward, fix focusing on decompression of the roots at the foramen. Unless there is an osteophyte, facet joint arthritis should only result in a “stiff neck” and not neuropathy.

How was the diagnosis accomplished? Was it MRI? CT? X-ray? Those are the only valid methodologies for such a diagnosis.

It seems to me that C6-C7 diagnosis is a diagnosis du jour as vets don’t actually have the capability to do anything about spine in horses so it is easier to pawn off the real issues to a fake diagnosis. Has the horse been tested for EPM or other neurologic conditions?

[Can_tFindMyWhip]

@RAyers

Something is amiss. C6-C7 nerves only are associated with arms/front legs, and not legs/hind legs. Thus, his hind end lameness should not be associated with any sort of cervical levels of the spine. I think your vet is completely missing the diagnosis.

In humans this is a complex, albeit straightforward, fix focusing on decompression of the roots at the foramen. Unless there is an osteophyte, facet joint arthritis should only result in a “stiff neck” and not neuropathy.

How was the diagnosis accomplished? Was it MRI? CT? X-ray? Those are the only valid methodologies for such a diagnosis.

It seems to me that C6-C7 diagnosis is a diagnosis du jour as vets don’t actually have the capability to do anything about spine in horses so it is easier to pawn off the real issues to a fake diagnosis. Has the horse been tested for EPM or other neurologic conditions?

He was diagnosed with an X-ray at Penn Vet New Bolton. While he was there we also did the spinal tap and it was determined that he does not have EPM.

I would describe the impingement as being caused by an osteophyte although I do not see that specific term used in the summary that was given to me. My understanding is that its not the nerves being constricted, its the fluid in the spinal column. So not enough spinal fluid is getting to his hind end to control his hind legs.

[kcmel]

I’m also surprised his neck isn’t stiff. NBC isn’t the end all and be all. They weren’t able to diagnose a stifle injury with my horse. Did you do a bone scan or block the stifle?

[Applecore]

@RAyers

Something is amiss. C6-C7 nerves only are associated with arms/front legs, and not legs/hind legs. Thus, his hind end lameness should not be associated with any sort of cervical levels of the spine. I think your vet is completely missing the diagnosis.

This is absolutely not true. Yes, the nerves that exit the spine in the caudal cervical region innervate the forelimbs. If you have lower motor neuron signs (eg flaccid paralysis) to the forelimbs, that localizes the deficits the the C6-C7 and/or the spinal nerves after exiting the spinal canal. However, the spinal cord tracts that carry information to the hind limbs of course also run through the spinal cord all the way down. The way the spinal cord is organized the farthest back tracts are on the outside of the spinal cord, so if the cord is compressed you actually damage the more distant tracts (outside) first. You will get upper motor neuron signs (ataxia, spasticity) to the hindlimbs, typically of at least one grade higher than upper motor neuron signs to the forelimbs when there is compression of the spinal cord in the neck region. We see this in Wobbler’s and neck arthritis cases, and farther back IVDD in the thoracolumbar spine of dogs causes hindlimb ataxia for similar reasons.

(source: I’m a DVM with a PhD in neuroscience)
(also, you’re at one of the top equine hospitals in the country, New Bolton, so you definitely have some good veterinarians on the case :). Fair to ask them how they ruled out the stifle though (or any other questions you have!)).

[riderboy]

@Applecore

This is absolutely not true. Yes, the nerves that exit the spine in the caudal cervical region innervate the forelimbs. If you have lower motor neuron signs (eg flaccid paralysis) to the forelimbs, that localizes the deficits the the C6-C7 and/or the spinal nerves after exiting the spinal canal. However, the spinal cord tracts that carry information to the hind limbs of course also run through the spinal cord all the way down. The way the spinal cord is organized the farthest back tracts are on the outside of the spinal cord, so if the cord is compressed you actually damage the more distant tracts (outside) first. You will get upper motor neuron signs (ataxia, spasticity) to the hindlimbs, typically of at least one grade higher than upper motor neuron signs to the forelimbs when there is compression of the spinal cord in the neck region. We see this in Wobbler’s and neck arthritis cases, and farther back IVDD in the thoracolumbar spine of dogs causes hindlimb ataxia for similar reasons.

(source: I’m a DVM with a PhD in neuroscience)
(also, you’re at one of the top equine hospitals in the country, New Bolton, so you definitely have some good veterinarians on the case :). Fair to ask them how they ruled out the stifle though (or any other questions you have!)).

Mine was a C6-7 cord compression as well. Here’s the report from Dr Reed at Rood and Riddle;
https://dl-mail.aolmail.com/ws/download/mailboxes/@.id==VjN-TaX1oh10L4AmXmqlXM26Wkh1WBGwgf6eQov0xPPpaG8qr4epExYNngrxyGkEgXkPyqtsdt-jko-uK0ko8KHOrw/messages/@.id==AK0bftxglRYHXQ0_YA7gmNE3wXw/content/parts/@.id==2/raw?appid=aolwebmail&ymreqid=e9acdba2-32e9-3002-2ffa-71001e010000&token=cqNK3SZSzYamV_E1eSQype22xIHCOKFPLF5wNgLNBr3-6cwgfEOB9FWdylrJtfAas5D8l7too8cq6Jt5mii0Wiqvh6kTFg2eCvHIaQSBeQ_Kq2x236OSj64rSSjwoc6v

[riderboy]

Mine was a C6-7 cord compression as well. Thomas was ataxic predominately in his hind limbs but was symptomatic in all four.

[Can_tFindMyWhip]

@kcmel

I’m also surprised his neck isn’t stiff. NBC isn’t the end all and be all. They weren’t able to diagnose a stifle injury with my horse. Did you do a bone scan or block the stifle?

At 21 years of age, he was in really great shape. There are younger horses with more flexible necks I am sure, but given the life he has had, the range of motion in his neck hasn’t concerned any vet, acupuncturist or bodyworker that has seen him. In fact my massage person was pretty adamant that the diagnosis was wrong so I showed her the x-rays because I consider her a friend. In the last month or so I have noticed that he doesn’t want to bend his neck to the left much, but he can still get his nose to his belly on the right. He also quit cribbing a year ago in June, but at the time I thought that he was finally happy enough with his life and the new barn we were at, that his anxiety and subsided and he didn’t feel the need to do it anymore. But knowing what we know now, it is likely that the motion was bothering his neck. So is that enough???

This whole saga started back in January where he slipped in some mud and I believe that he did genuinely strain his stifle. We followed the recommended rehab by a vet I’ve been using for many years. After 6 weeks, he was 90% sound. At 8 weeks he took a step backwards. At 10 weeks I was riding him and he fell down on his face. I chalked it up to bad footing because it had rained recently. During all this time my vet had no interest in coming back to see my horse and kept telling me to be patient, the horse is old and will take some time to heal. He even suggested that the horse had reinjured the same leg and I should do 8-12 more weeks of our original rehab for the stifle strain. I thought it was odd, as this horse has never ever been lame, and the likelihood that he would injure himself back to back like this didn’t make sense. But he was a professional so I followed his suggestions anyway and saw no improvement. And actually, by May he looked just as hitchy in his left hind as he did in his right.

I was disappointed in my vet’s lack of interest so I got a second opinion. It took me a couple of weeks to get this new vet out, so she came in the middle of June. I was still thinking hind end lameness, but it took her 2 minuets to say “You need to get this horse’s neck x-rayed and you need to hope that this is EPM.” She said that the lameness is more worse at the walk than it is at a jog, and his stride length on his right hind matched his left hind. She considers those to be classic neurological symptoms. She did flex his hocks and stifles just to be sure, and there was no change in his gait afterwards.

I am not questioning the diagnosis, that’s not the question I am asking here. If New Bolton isn’t good enough, I can’t imagine where else you would expect me to go. I am not loading this horse back on a trailer and taking him to Kentucky, I don’t believe that it is safe to take him that far.

[riderboy]

@Applecore

This is absolutely not true. Yes, the nerves that exit the spine in the caudal cervical region innervate the forelimbs. If you have lower motor neuron signs (eg flaccid paralysis) to the forelimbs, that localizes the deficits the the C6-C7 and/or the spinal nerves after exiting the spinal canal. However, the spinal cord tracts that carry information to the hind limbs of course also run through the spinal cord all the way down. The way the spinal cord is organized the farthest back tracts are on the outside of the spinal cord, so if the cord is compressed you actually damage the more distant tracts (outside) first. You will get upper motor neuron signs (ataxia, spasticity) to the hindlimbs, typically of at least one grade higher than upper motor neuron signs to the forelimbs when there is compression of the spinal cord in the neck region. We see this in Wobbler’s and neck arthritis cases, and farther back IVDD in the thoracolumbar spine of dogs causes hindlimb ataxia for similar reasons.

(source: I’m a DVM with a PhD in neuroscience)
(also, you’re at one of the top equine hospitals in the country, New Bolton, so you definitely have some good veterinarians on the case :). Fair to ask them how they ruled out the stifle though (or any other questions you have!)).

Yep. I’m an MD although not a neurologist! Thanks for the great explanation of the pathophysiology. Dr Steve Reed at Rood and Riddle is one of the foremost equine neurologists in the country if not the world. He was an incredibly kind man when he went over the findings with me. Thomas had no neck stiffness, but looking back other symptoms that I dismissed or attributed to other causes. Truly devastating news.

[kcmel]

Thanks OP for the clarification. It sounds very similar to what happened with my neuro horse in having to get a second opinion. And I wasn’t trying to criticize NBC (I am fortunate to have them in my backyard), just pointing out that they can and have made mistakes (like every other vet clinic in the world). But it sounds like you are confident in his diagnosis.

Forgot to mention in my previous post that like BFNE we did some acupuncture and it seemed to help. I know a good vet if you are local; shoot me a PM.

[riderboy]

@Applecore; Is this what is commonly called Wobbler’s Syndrome?

[Applecore]

@riderboy

@Applecore; Is this what is commonly called Wobbler’s Syndrome?

Without commenting specifically on this case - the term “cervical myelopathy” (used in the title here) would cover any condition that caused spinal cord damage in the cervical (neck) region.

Cases similar to the one here could be due to an osteophyte (proliferative bone secondary to arthritic changes) that compresses the spinal cord. This is a long term degenerative (i.e. ‘wear and tear’) type injury, like other sources of arthritis. And like other types of arthritis, tends to present in older horses.

Wobbler’s - the official medical term is ‘cervical vertebral instability’ - is a developmental or congenital (present from a young age) condition where the vertebrae are unstable in how they line up in the neck, causing the spinal cord to be damaged or ‘kinked’ as it proceeds between vertebrae - sometimes only in certain head positions, sometimes in all positions.

Because they both are compressive lesions of the spinal cord in the same area of the cord (neck), the clinical signs (hind limb ataxia +/- forelimb ataxia) are very similar, but the actual disease process is different. Radiographs or other imaging is needed to diagnose either.

[riderboy]

Thanks. It was indeed a much more insidious and slowly progressive process for my horse. I’m really, really amazed at how well he was able to compensate. Such unbelievable heart. In the end, even that was just not enough.

[caryledee]

@riderboy

Thanks. It was indeed a much more insidious and slowly progressive process for my horse. I’m really, really amazed at how well he was able to compensate. Such unbelievable heart. In the end, even that was just not enough.

I am so sorry! I followed your videos and you had such a wonderful bond. Did Thomas have the malformation at C6-C7 (now called ECVM?) Mine was diagnosed with it several years ago. He is still pasture sound but has been retired since the diagnosis.

[riderboy]

@caryledee

I am so sorry! I followed your videos and you had such a wonderful bond. Did Thomas have the malformation at C6-C7 (now called ECVM?) Mine was diagnosed with it several years ago. He is still pasture sound but has been retired since the diagnosis.

Yes, C6-7. I confused Wobblers with ECVM but AC got me straightened out! I’m slowly starting to look at horses, but for awhile my interest in riding died with him.

[visorvet]

@RAyers

Something is amiss. C6-C7 nerves only are associated with arms/front legs, and not legs/hind legs. Thus, his hind end lameness should not be associated with any sort of cervical levels of the spine. I think your vet is completely missing the diagnosis.

Sympathies on the recent diagnosis, OP.

Applecore has already done an excellent job of rebutting some errors of fact in RAyers’ post, but I wanted to add that (a) neck stiffness does not always accompany cervical arthritis causing spinal cord compression, and (b) owners sometimes fail to recognize reduced neck mobility even when it is present. In older horses the cord compression is often caused by bony remodeling, and in other cases synovial effusion (increased fluid volume in the neck joint) is a contributing factor. This is why neck injections can sometimes reduce cord compression and improve ataxia, as well as improve neck pain and stiffness - they can’t reverse the bony change but they can dial back some inflammation and fluid production.

X-rays are often suggestive rather than conclusive for diagnosis of spinal cord compression unless combined with myelography. 3D imaging such as MRI/CT is superior but also more expensive, and can be associated with increased risk related to recovery if the procedure is done under general anesthesia. Most units cannot get as far down the neck as C6-C7, though the robotic system at NBC may very well be capable of this!