Low grade wobbler / CVSM - prognosis?

[flippa_t]

My 5yr old warmblood has just been diagnosed as a low grade CVSM / wobbler, with "mild to moderate enlargement of C5-6 and C6-C7" (shown on x-ray). The x-ray didn't show really significant narrowing of the spinal column, but given the enlargement this was presumed to be the case. He can't have a CT myelogram as he is too big to fit into the machine (17.2hh), and it is suspected that there will not be a clear image of C6-7 at the base of his neck. I'm not putting him through a GA if its unlikely to give us any new information.

He shoes neurological symptoms - a lack of coordination (especially in canter), struggles with hills, trips and stumbles and very weak behind, and had a neurological assessment at the RVC. He has been graded 1-2 out of 5.

He has had C6-7 medicated with steroids, followed by 2 weeks off and I need to bring him back into work for reassessment in a few weeks.

So my question is (as the vets are vague) .... what prognosis is he likely to have? He was bought as a 3 year old to produce for dressage, but has done very little as he is big (17.2hh) so I have mainly hacked and done ground work, with minimal school work when the weather was very bad. He has also had various silly field injuries (not neck though) so had a fair bit of time off with intermittent work. The vets think his case is purely developmental as he grew quickly and is very big.

Does anyone have any experience of the steroid injections improving it? And how long did it last?

Is he likely to be able to have any competitive career? And if not, how quickly would you expect him to go down hill? Would he be safe to continue hacking / low level? I've heard that many top dressage horses are wobblers... if that's the case then is there a chance for us after all or am I clutching at straws?

Thanks!
I'm trying to prepare myself for the worst as he's the sweetest, nicest youngster I've ever met, so I need to do what is right for him.

 

[AmyMay]

Bump

 

[ycbm]

I think the information you, and all of us probably, are lacking is whether the majority of high performing wobblers are the kind born with the C3/4 problem or the kind with the C6/7 problem.

Certainly there are a lot of high performing dressage wobblers with the huge floating trot which is characteristic of the C3/4 disease. Mine had it and was a fabulous mover until he was 10 and C4 cracked. The C3/4 is neurological only in impact.

The problem with the C6/7 abnormality is that it often (usually? always? ) goes with asymmetry of the attachments of the front legs to the shoulders. That creates a physical instability which isn't present in the C3/4 wobblers.

I think you might need to seek more information from your vet, but I wouldn't necessarily expect them to know the answers.

I wouldn't knowingly ride a wobbler, I think the risks are too high of a fall in riding a horse which quite literally doesn't know where its feet are landing.

I hope you get a good outcome from the steroids.
.

 

[flippa_t]

I think the information you, and all of us probably, are lacking is whether the majority of high performing wobblers are the kind born with the C3/4 problem or the kind with the C6/7 problem.

Certainly there are a lot of high performing dressage wobblers with the huge floating trot which is characteristic of the C3/4 disease. Mine had it and was a fabulous mover until he was 10 and C4 cracked. The C3/4 is neurological only in impact.

The problem with the C6/7 abnormality is that it often (usually? always? ) goes with asymmetry of the attachments of the front legs to the shoulders. That creates a physical instability which isn't present in the C3/4 wobblers.

I think you might need to seek more information from your vet, but I wouldn't necessarily expect them to know the answers.

I wouldn't knowingly ride a wobbler, I think the risks are too high of a fall in riding a horse which quite literally doesn't know where its feet are landing.

I hope you get a good outcome from the steroids.
.

Thank you for your reply and I'm sorry to hear about your horse!

It's really interesting re. C3/4 vs C6/7 - thank you! My boy is also a big mover, although it was the effect on his movement (especially canter) that was one of the key symptoms.

I agree re. riding, although as very mild at the moment and he's never fallen which makes it tempting to carry on, but I understand it will likely get worse (and I don't want to be onboard if he does fall ever). The vets want me to get on again and work him for a few weeks before they reassess.

 

[ycbm]

The vets want me to get on again and work him for a few weeks before they reassess.

Great, but it's not their neck at risk.

This one again is going to hinge for me around whether you have only instability of the back end through squeezing of the spinal cord, where I understand that the effect is back end only because those nerves are on the outside of the bundle. Or whether you also have mechanical instability of the front end through asymmetric vertebrae at C6 and/or 7.

Personally, in think I'd be working him in hand with some additional pole work, but you know the horse in front of you and whether he feels safe to ride.

I really hope it's "just" compression and that steroids can keep it at bay for both of you.
.

 

[millitiger]

I've had the misfortune of two horses with neurological symptoms caused by neck vertebrae issues.

First was a classic wobbler, likely born with the issue.
He was around 18hh, huge mover and I rode him until he was an 8yro and he evented and it never really caused him much issue, until one day it did.
It was always hindlimb for years, just that they were a bit 'floaty' but if you rode him in balance it was fine.
No-one could see it when I rode but you could see if you trotted him up.
Unfortunately his developed and then front limb started to be impacted at which point we went for all of the x-rays and he was retired with immediate effect
He did 2 years retired but I had him PTS as he deteriorated and I wanted to ensure he went while he was well and happy and not having to have him PTS because he was down and in distress and not able to get up etc.

Second horse was C6/C7, very likely caused by a heavy rotational fall under previous rider which they never rehabbed and treated him for
He was great for 2 years with me (I didn't know about the fall when I bought him), jumping 1.20m tracks and no signs at all, until overnight he went incredibly pottery in front (almost like laminitis).
He was PTS 2 days after diagnosis as it was so acute and unfortunately there wasn't even a way to get him comfortable to be a field pet.

Sorry my stories are pretty bleak- I don't know where you are but Chris Rea at Three Counties vets would be a super person for you/ your vet to speak to as he is very experienced in this area and with horse 1, he had said there was potential to treat with steroids to get another 12-18 months but we decided not much point to prolong it when there was no positive long term prognosis.

 

[flippa_t]

Thanks for sharing your experiences, and sorry they were sad ones.

Interesting that your vet said you'd only get another 12 - 18 mths if you had the steroid injection. Mine said I'd likely need it repeating, but not for how long it was likely to be an option for.

I think what I'm struggling with is whether I should call it a day and PTS a happy and otherwise well horse who at present only has very mild signs. If I knew he'd have a good quality of life for a few years and the onset of more serious issues would be gradual (and therefore not dangerous to him or me) then his current symptoms seem almost "too mild" to make such a big decision, and we may have a few years of fun before I need to.

However I'm a firm believer of a "week too early rather than a day too late" and would rather make that decision now if need be, rather than subject him to any misery and put myself (or the yard staff handling him) at any risk. I had hoped he may be able be a happy hack for someone even if he was unable to compete, but it doesn't sound like this is an option as I wouldn't want to put anyone else at risk.

 

[ycbm]

My experience of C3/4 is that there can be a sudden and dangerous change. I was in the middle of some 3 time tempi changes when I felt it. I jumped off and he was very unstable behind and I never rode again. C4 had actually cracked into pieces at the edge under the pressure of the misalignment.

I made the hard decision to PTS as I wasn't prepared to find him down and unable to get up, which was a real possibility.

I feel for you, it's tough to PTS a bright and otherwise healthy horse, but I'm with you on better a day/ week/ month too soon.
.

 

[poiuytrewq]

Mine was c6/7. He had it injected twice. The first he was amazing for a couple of weeks, to be honest that made it worse for me as I thought we had “fixed” him.
Tried injecting again and absolutely no change.

He’s now retired. Many people say I should still just hack him and he looks to good to be retired but to quote YCBM it’s not their neck on the line and hacking means roads which are hard to face plant.
Be careful! Sorry!

 

[Hormonal Filly]

Mine was c6/7. He had it injected twice. The first he was amazing for a couple of weeks, to be honest that made it worse for me as I thought we had “fixed” him.

I haven’t read all the replies.. but my little pony of a lifetime (14.2 but just awesome!) had it at C6/C7. Same as you, I didn’t CT because the vet said the X-rays were clear enough to see and it was impacting his spinal cord.

Same as above, he was injected and went amazing for 6 weeks. Then he seemed to rapidly go downhill.. the specialist didn’t want to re inject so soon and said if he did, it’s not something able to be done monthly. Bute didn’t touch it.

I decided to retire him over summer and put him down before winter.
He was 9, it broke me if I’m honest.

Sorry to not share a better outcome. BUT a friend had similar with a 5yo Warmblood. Injected, rehabbed and sold because she couldn’t event (disclosed all issues) New owner does dressage and a bit of everything, hasn’t had her neck re medicated and that was about 4 years ago now.

Same vet dealt with both horses, Richard Hepburn, he said sometimes it makes a huge difference and they don’t need re medicating, but sometimes it goes the other way.

I really hope yours is the latter!

 

[millitiger]

This was mine 2 weeks before our x-rays and retirement.
They are such generous animals, he would have kept performing for me with his ears pricked, however we had such a wonderful relationship I'd have felt I was letting him down to keep him in work (and potentially in danger of injury and stress) so he was retired straight away.
Funnily I never worried about my safety, only worried about him having a bad experience from the wobblers and I didn't want him to have an instant where he felt hurt or scared.

 

[Birker2020]

My 5yr old warmblood has just been diagnosed as a low grade CVSM / wobbler, with "mild to moderate enlargement of C5-6 and C6-C7" (shown on x-ray). The x-ray didn't show really significant narrowing of the spinal column, but given the enlargement this was presumed to be the case. He can't have a CT myelogram as he is too big to fit into the machine (17.2hh), and it is suspected that there will not be a clear image of C6-7 at the base of his neck. I'm not putting him through a GA if its unlikely to give us any new information.

He shoes neurological symptoms - a lack of coordination (especially in canter), struggles with hills, trips and stumbles and very weak behind, and had a neurological assessment at the RVC. He has been graded 1-2 out of 5.

He has had C6-7 medicated with steroids, followed by 2 weeks off and I need to bring him back into work for reassessment in a few weeks.

So my question is (as the vets are vague) .... what prognosis is he likely to have? He was bought as a 3 year old to produce for dressage, but has done very little as he is big (17.2hh) so I have mainly hacked and done ground work, with minimal school work when the weather was very bad. He has also had various silly field injuries (not neck though) so had a fair bit of time off with intermittent work. The vets think his case is purely developmental as he grew quickly and is very big.

Does anyone have any experience of the steroid injections improving it? And how long did it last?

Is he likely to be able to have any competitive career? And if not, how quickly would you expect him to go down hill? Would he be safe to continue hacking / low level? I've heard that many top dressage horses are wobblers... if that's the case then is there a chance for us after all or am I clutching at straws?

Thanks!
I'm trying to prepare myself for the worst as he's the sweetest, nicest youngster I've ever met, so I need to do what is right for him.

So sorry to hear this. I had to pts a lovely 10yr old gelding with wobblers, he had reared over whilst being brought in from the field and hurt his neck, I suspect he was yanked in the mouth whilst being led in his chifney. I'd ridden him after not realising and he'd been so ataxic I had to get off and call emergency vet.

He was pts as he was too badly compromised and dangerous to handle from the point of view of being ataxic but this was months later.

It completely destroyed me at the time especially as he was misdiagnosed as having EHV for weeks before he was correctly diagnosed. Sadly the original vets portable xray machine gave a false picture, it wasn't until he went for much stronger imaging technology at Philip Leverhulme hospital in Liverpool that it was discovered C4, C6 and C7 from memory. There was only a 17mm gap in the spinal column, and there should have been 52mm. The diagnosis provided a lot of answers, I'd suspected he may have been a wobbler for sometime as he had a lot of the symptoms like brushing his hind fetlocks together, his outside hind leg swinging wide on a tight circle, weird bunny hopping canter: reining back and directly into canter seemed to free his neck for a while. But as he was 99% of the time fine and the professionals told me to keep riding him I continued.

I suspect he had the condition a while, he'd had two previous male owners before me that had jumped him fox hunter classes but he'd been too strong for them, he was incredibly strong through his neck bizarrely. I don't know how I coped when they couldn't but it was probably because they were jumping more technical/higher tracks than me.

Before his fall being brought in from the field and his eventual diagnosis he'd been BSJA with me jumping BN and Disc. classes and we'd won a bit together but every now and he'd fail to pick up his hind legs through a fence, it was really bizarre. One day he fell directly on top of an oxer which was part of a double and I couldn't understand it as we'd been on a perfect stride and there was absolutely no reason why this had happened. Another time we had him on video and I can remember poring over the footage of him clearing the fence with his front end but dragging his back end behind him. But there were weeks and sometimes months between these incidents where he stabilised and appeared normal apart from the odd bunny hopping canter. Obviously I didn't know he had wobblers, I only thought he may have had it, I'd consulted the McTimoney chiropractor twice about the fetlocks rubbing together, the swinging of the outside leg on the circle, their attitude was "he must be ok if you compete him". The farrier or vet never saw any red flags, he was never consistently even slightly ataxic at this stage.

He never felt dangerous during any of that time apart from when he first fell over in the field when being brought in. I was convinced the y.o had been rough handling him, she was very much like this. I'd not been told he'd fallen and had gone for a hack with a friend. I'd just jumped on and gone over to the barn where my friend was and she'd been coming out of her stable so I'd had to rein back and I commented "Rommy feels a bit drunk, like hebeen on the gin". Just a passing flippant comment, never thought much of it at the time, just assumed it was a bit of a misstep. When things feel strange your brain comes up with what feel like logical answers. But as we got on the road 500 yards further on it became very evident there was an issue as he started dramatically swaying when walking. I jumped straight off and led him back, that in itself was a nightmare as he felt at this stage he could topple over, and it was downhill. I called the emergency vet. By the time the vet arrived the poor lad couldn't raise his head above chest height. It was the last time I rode him.

This was way back in 2004. First thing the vet said was "looks like he has wobblers". The y.o was a very good friend of the vet and I saw her whispering with him, I couldn't hear what was said but it was obvious I wasn't meant to. He came over to me and said he wasn't entirely sure it was wobblers now. It needed further investigation. He had steroids at the time, I had to raise his hay and feed and water off the floor. It's only looking back now I realise she'd obviously felt guilty about pulling him over in the field when he was brought in so didn't want it to appear to be her fault.

He stabilised with his ataxia but wasn't ridden again obviously. He went on to have two further ataxic episodes. The first one the vet came out and started diagnosing EHV, the whole yard was stabbed twice. Then May bank holiday he had another really bad ataxic episode in the stable. I insisted on a referral to hospital. It was evident at this stage it wasn't EHV. He was referred to Liverpool, had a horrendous journey up there with a so called 'professional transporter', fell off the ramp being unloaded, scrambled around trying to get up, was subjected to various neuro tests in front of students which I demanded were cut short, was xrayed and the horrific findings were explained to me. The consultant said he was too dangerous to keep as a field pet, there was nothing could be done to save him, despite me begging.

It was an incredibly sad and distressing time when he was pts 2 hrs after diagnosis. He was a lovely boy. He was and still is my heart horse.

Photo of me and my beloved Rommy on a fun ride.

 

[flippa_t]

Mine was c6/7. He had it injected twice. The first he was amazing for a couple of weeks, to be honest that made it worse for me as I thought we had “fixed” him.
Tried injecting again and absolutely no change.

He’s now retired. Many people say I should still just hack him and he looks to good to be retired but to quote YCBM it’s not their neck on the line and hacking means roads which are hard to face plant.
Be careful! Sorry!

Thank you, its useful to understand the experience that you had with the injection. The vet did warn me that if it works we wouldn't know how long it would last. I can completely understand that it made it worse for you - it just prolongs the agony and gives false hope when things like that don't work.

I definitely won't be taking any risks, he's a big horse that I don't want landing on top of me. At the moment he's never fallen or shown any indication of doing so, but it sounds like the low grade ataxia is only likely to get worse.

 

[Birker2020]

Thank you, its useful to understand the experience that you had with the injection. The vet did warn me that if it works we wouldn't know how long it would last. I can completely understand that it made it worse for you - it just prolongs the agony and gives false hope when things like that don't work.

I definitely won't be taking any risks, he's a big horse that I don't want landing on top of me. At the moment he's never fallen or shown any indication of doing so, but it sounds like the low grade ataxia is only likely to get worse.

There is a surgical option which you might like to consider and I think if you got referred here they may be able to tell you if it's feasible based on your horses xrays

Wobbler Diagnosis & Surgery | Rainbow Equine

Our experienced team have been at the forefront of recent advances in the diagnosis and treatment of Wobblers. Learn how we can care for your horse here.

www.rainbowequinehospital.co.uk

Don't want to give you false hope.
I think the age of your horse, the fact that he's already big and the amount affected might mean he's not suitable for surgery.

I believe they are way ahead of us in the states with this surgery and we ate somewhat behind, but this link provides more info

Equine Cervical Spinal Surgery Prognosis-Spinal Cord Compression

 

[flippa_t]

I haven’t read all the replies.. but my little pony of a lifetime (14.2 but just awesome!) had it at C6/C7. Same as you, I didn’t CT because the vet said the X-rays were clear enough to see and it was impacting his spinal cord.

Same as above, he was injected and went amazing for 6 weeks. Then he seemed to rapidly go downhill.. the specialist didn’t want to re inject so soon and said if he did, it’s not something able to be done monthly. Bute didn’t touch it.

I decided to retire him over summer and put him down before winter.
He was 9, it broke me if I’m honest.

Sorry to not share a better outcome. BUT a friend had similar with a 5yo Warmblood. Injected, rehabbed and sold because she couldn’t event (disclosed all issues) New owner does dressage and a bit of everything, hasn’t had her neck re medicated and that was about 4 years ago now.

Same vet dealt with both horses, Richard Hepburn, he said sometimes it makes a huge difference and they don’t need re medicating, but sometimes it goes the other way.

I really hope yours is the latter!

Thank you and sorry you did not have a happy outcome. It's helpful to understand that you had a similar experience to poiuytrewq with injections.

Your friend's warmblood gives me some hope though thank you - although there doesn't seem to be many positive stories. I wish things were more black and white with horses/veterinary issues. He's very mild at the moment so I don't want to PTS unnecessarily, but at the same time I'd rather do it sooner than later if he's going to deteriorate and become unhappy / unsafe.

 

[ycbm]

Even most vets in the US don't think that operation is ethical.

 

[flippa_t]

There is a surgical option which you might like to consider and I think if you got referred here they may be able to tell you if it's feasible based on your horses xrays

Wobbler Diagnosis & Surgery | Rainbow Equine

Our experienced team have been at the forefront of recent advances in the diagnosis and treatment of Wobblers. Learn how we can care for your horse here.

www.rainbowequinehospital.co.uk

Don't want to give you false hope.
I think the age of your horse, the fact that he's already big and the amount affected might mean he's not suitable for surgery.

I believe they are way ahead of us in the states with this surgery and we ate somewhat behind, but this link provides more info

You're right - the surgical option seems to be very common in the states.

The vet at the RVC said he would unlikely be a candidate due to his age and size though. They said if I wanted to pursue then they could fly a surgeon over from the US (which sounds very expensive), but that the chance of success would be low unfortunately and the rehab lengthy etc. Therefore sadly this isn't an option as I won't put him through major surgery and months of box rest/rehab with only a slim chance it will work.

 

[Birker2020]

https://beva.onlinelibrary.wiley.com/doi/10.1111/evj.13449

Research carried out on outcomes after surgery.

 

[Birker2020]

Even most vets in the US don't think that operation is ethical.

Well denerving horses feet for navicular and suspensories isn't ethical, and you could argue shaving spinal processes or snipping ligaments in horses with KS but they are common and favoured treatments and if they work are amazing.

 

[ycbm]

You're right - the surgical option seems to be very common in the states.

Michens Colorado vet advised her strongly against it on the grounds of what it puts the horse through, whether it works or not. Also from what I've read "works" is often defined as "safe to stay alive" not return of athletic function.

 

[ycbm]

Well denerving horses feet for navicular and suspensories isn't ethical, and you could argue shaving spinal processes or snipping ligaments in horses with KS but they are common and favoured treatments and if they work are amazing.

Just because we can doesn't mean we should.

 

[flippa_t]

https://beva.onlinelibrary.wiley.com/doi/10.1111/evj.13449

Research carried out on outcomes after surgery.

Thanks for sharing.

And thank you for sharing your experiences with Rommy above (sorry I replied out of order). Wobblers is something I haven't encountered before in all my years of horses so it is really helpful to understand everyone else's experiences with it, as sad as they are.

The compression of my horse's spinal column is marginal which I guess is why his symptoms are so mild at the moment. A crystal ball would be helpful to understand how much worse this may get as he continues to grow (although I wish he wouldn't get any bigger), and so subsequently how much worse the symptoms get.

 

[ycbm]

https://beva.onlinelibrary.wiley.com/doi/10.1111/evj.13449

Research carried out on outcomes after surgery.

Report does not appear to say whether any of the ten horses returned to any level of ridden work. Since almost all were still ataxic only to a lower level, it seems unlikely.

I question the ethics of owners who will put a horse through all that to become a paddock pet so they don't have to face having it PTS.

You can tell, can't you, I'm very against surgery to screw 2 of 7 vertebrae in a neck far more flexible than a human one into one fixed piece.
.

 

[flippa_t]

Michens Colorado vet advised her strongly against it on the grounds of what it puts the horse through, whether it works or not. Also from what I've read "works" is often defined as "safe to stay alive" not return of athletic function.

The definition of what "works" is a bug bear with mine. I have had 2 horses that had suspensory neuroectomy and fasciotomy. One was a huge success and competed to advanced dressage after (was novice pre- op), is still loving life and going on beach rides etc into his dotage. The other horse was signed off as a "success" by the vets after their final post op. check ups but had to be PTS less than 6 months later as he couldn't cope with any amount of work or stay sound.

Both horses would be included in the data / stats for "it worked", but only one was able to return to work post rehab let alone athletic function.

 

[ycbm]

Flippa I'm so sorry you're stuck in this bind of not knowing whether his condition will progress or not. I find that kind of uncertainty worst of all.

My understanding is that many will stay just as they are, many will stay as they are with continued treatment and many will get worse to the extent that PTS is inevitable.

I don't think there's any way of knowing which yours is and I really feel for you.
.

 

[flippa_t]

Flippa I'm so sorry you're stuck in this bond of not knowing whether his condition will progress or not. I find that kind of uncertainty worst of all.

My understanding is that many will stay just as they are, many will stay as they are with continued treatment and many will get worse to the extent that PTS is inevitable.

I don't think there's any way of knowing which yours is and I really feel for you.
.

Thank you - yes it is definitely the uncertainty that is the worst.

I suppose nothing with horses is ever certain though!

 

[Birker2020]

Michens Colorado vet advised her strongly against it on the grounds of what it puts the horse through, whether it works or not. Also from what I've read "works" is often defined as "safe to stay alive" not return of

Report does not appear to say whether any of the ten horses returned to any level of ridden work. Since almost all were still ataxic only to a lower level, it seems unlikely.

I question the ethics of owners who will put a horse through all that to become a paddock pet so they don't have to face having it PTS.

You can tell, can't you, I'm very against surgery to screw 2 of 7 vertebrae in a neck far more flexible than a human one into one fixed piece.
.

 

[poiuytrewq]

Thank you, its useful to understand the experience that you had with the injection. The vet did warn me that if it works we wouldn't know how long it would last. I can completely understand that it made it worse for you - it just prolongs the agony and gives false hope when things like that don't work.

I definitely won't be taking any risks, he's a big horse that I don't want landing on top of me. At the moment he's never fallen or shown any indication of doing so, but it sounds like the low grade ataxia is only likely to get worse.

I think it’s different with all horses. Don’t rule it out because your experience may be better than mine. We did lots of stuff. He had everything injected, x-rayed a bone scan
He had his back x-rayed and injected.
Everything we did have me hope. He is however still very much a happy horse. You’d never know he had an issue and is being a great companion.

 

[ycbm]

B, post 27, two YEARS of rehab and no indication of what pain the horse goes through in that time, to improve but not remove the ataxia.

I'm sorry but owners are putting horses through that either because they are worth a lot of money to breed or because they can't face their own pain in doing the right thing by their horse.
.

 

[flippa_t]

So to update ... we've seen a very very slight improvement in the neurological tests and grading, but still lots of signs on movement so the vets classify this as dynamic impingement of the spinal chord. In some ways this is worse as it means that he's most at risk when he's moving (and therefore if ridden). So we've come to the incredibly sad decision to PTS - devastated doesn't come close!