Disease processes of the cervical spinal cord and vertebral column and the pain and paresis produced by these disorders are a common cause of presentation to the veterinarian. Some causes of cervical pain are more common or unique to small breeds. Other disorders affect both large and small breed dogs but the clinical course, treatment and prognosis may vary between dogs of different sizes. Fortunately, by recognizing the clinical signs of cervical disease and developing a list of differential diagnoses, a diagnostic and treatment plan can often be formed to help relieve a patient of pain and regain the ability to walk.

Clinical signs of cervical disease

Clinical signs of cervical disease are often dramatic, resulting in severe pain and tetraparesis, but at other times a patient's symptoms can be frustratingly subtle. The first step in identifying a cervical spinal cord or vertebral column disorder is recognizing and localizing the source of the problem. Pet owners usually provide the first clue with their descriptions of their pet's behavior at home. Classic symptoms include a posture in which the patient's head is held low, either extended or retracted toward the shoulders. Often these patients will refuse to look up from the ground, have exaggerated eye movements in an attempt to examine their environment without moving the neck and have cervical musculature fasciculations or spasms. Other dramatic signs of cervical disease include tetraparesis from severe compression or intraparenchymal damage to the spinal cord. Unfortunately, cervical disorders do not always produce such easily recognized signs. Often a pet owner will only notice that their pet cries out in pain intermittently. Sometimes additional questioning about when the pain occurs can be helpful. Important observations from the owner that should raise suspicion of cervical disease include refusing to jump, difficulty flexing the neck to eat and drink from the ground, eating and drinking while laying down, refusing or hesitancy to shake the head and pain when giving medications or treats (because the neck is often extended during these activities). Compression of a cervical nerve root (root signature sign) often results in a posture in which the patient prefers to keep a thoracic limb flexed and held off the ground. Although most pet owners do not recognize this as a possible symptom of neck pain the presence of a root signature sign can be helpful in localizing the source of a patient's discomfort. Root signature pain, however, is less common in large dogs than small breeds. Still other patients have even more subtle signs. Although not specific to cervical disorders, symptoms such as decreased activity and inappetence are often the first and only signs present.

Neurologic examination in patients with suspected cervical disease should include all of the areas covered in the complete neurologic examination. These include observation of gait and mentation, assessment of postural reactions, segmental spinal cord reflex evaluation, sensory assessment, cranial nerve examination and palpation of the vertebral column, limb musculature and skull. Details on the neurologic examination and localization of neurologic symptoms can be found elsewhere in these proceedings.