Photo by Andrea Moulas

There are many causes of Deerhound Neck. This article takes another look at cervical facet joint arthrosis.

by John Dillberger, DVM, PhD

Reprinted from the January/February 2025 issue of The Claymore.

An SDCA member recently asked for my opinion about a Deerhound with a sudden onset of neck pain.  The dog in question is a 3-year-old male that was referred to a specialist by his primary veterinarian because he was not responding well to treatment.  The dog was having intermittent bouts of neck pain that improved when he was given Rimadyl (a NSAID anti-inflammatory drug) but which returned when treatment stopped.  The primary vet had recently tried adding a drug called gabapentin, which sometimes brings relief in cases of nerve-related pain, but this provided little extra pain relief. 

According to the primary vet, the dog’s only clinical sign was “stiffness of the neck.”  The dog was reluctant to move his neck, especially to bend it to the right.  He thought that the dog walked normally and showed no signs of impaired nervous system function in his forequarters.  X-rays of the neck taken by the primary vet showed possible calcification of the disc between the second and third vertebrae (C2 and C3) and maybe narrowing of the disc space between the third and fourth vertebrae (C3 and C4).  The primary vet was unsure because the dog was not sedated for the X-rays and was shaking a bit. 

At the specialist’s office, the owners said that the dog had good days and bad days and that he no longer wanted to exercise as usual.  When the specialist examined the dog, he felt the dog was mildly dehydrated and had a longer-than-normal capillary refill time.  A blood sample revealed a red blood cell-to-plasma ratio that was higher than, and a platelet count that was lower than, the laboratory reference ranges for these parameters.  However, the values were within the normal reference ranges for a Deerhound (Sheerer et al., 2013). 

The specialist gave the dog intravenous fluids to rehydrate it and then sedated him for spinal imaging by computed tomography (CT) and magnetic resonance imaging (MRI).  Images were taken before and after injection of contrast medium into the spinal canal to outline the spinal cord.  The digitized images were sent to a veterinary radiologist for analysis.  The radiologist noted the following abnormalities:

• The articular processes that form the facet joints between C2 and C3 were “bulbous in shape” and impinged on the spinal cord and the left and right nerve roots from above.  The nerve roots branch off the cord and exit the spinal canal between C2 and C3.
• The intervertebral disc between C2 and C3 impinged on the spinal cord and the left and right nerve roots from below.
• There was “multifocal, periarticular ossification” of the facet joints between vertebrae in the middle back.  Periarticular means around the joints, and ossification means formation of new bone.  Periarticular ossification is a sign that a joint is lax (not tight) and/or inflamed.

The radiologist’s diagnoses were “cervical spondylomyelopathy” and “articular facet hypertrophy and osteoarthritis” between C2 and C3.  He noted that the spinal cord and the left and right nerve roots were “impinged upon” both from above (by the articular facet hypertrophy) and from below (by the protruding disc), but he concluded that the dog’s neck pain was NOT due to this impingement.

I was surprised by the radiologist’s diagnosis of spondylomyelopathy.  This disorder is commonly called wobbler syndrome because affected dogs often have a wobbly gait.  They also may stumble when they walk, have scuffed feet, be weak overall, and have difficulty getting up from a lying position.  According to the Merck Veterinary Manual, mild cases of wobbler syndrome are characterized by a subtly unsteady gait in all limbs, often evident as a long, protracted stride in the pelvic limbs, with short-strided gait in the thoracic limbs (sometimes called a two-engine gait).  In severe cases, there is weakness (paresis) or paralysis of all limbs.  All of the symptoms of wobbler syndrome are caused by pressure damage to nerves either within the spinal cord itself or where they branch off and leave the cord. 

I very much doubt that this young male Deerhound had wobbler syndrome, partly because neck pain is not a prominent feature of this disorder and, more importantly, because this Deerhound had none of the clinical signs of wobbler syndrome.  I do agree with the radiologist that the impingement of the spinal cord and nerve roots was not causing this dog’s pain.  Instead, I think the pain was caused by the inflammation (osteoarthritis) in the facet joints between C2 and C3. 

The changes at the C2-C3 facet joints in this Deerhound match those described by German researchers in a 2003 paper (Kinzel et al.) in the Journal of the American Veterinary Medical Association.  The authors named this condition cervical facet joint arthrosis (CFJA).  I wrote about CFJA in my column in the May/June 2010 issue of the Claymore (it’s the third article so scroll down – Ed.) and it is worth repeating some of that information now.

The authors of the 2003 paper reviewed medical records from all Deerhounds seen between 1998 and 2002 at the veterinary college in Aachen, Germany.  Of the 14 Deerhounds seen during that 5-year period, nine had neck pain and were ultimately diagnosed with CFJA.  Eight of the Deerhounds with CFJA were males, and their average age was just over 4 years (range = 3 to 6 years).  The affected dogs had been in pain for 4 to 12 months before being referred to hospital at Aachen.  Although the authors do not say so, I assume that the ages given were the ages of the dogs when they were first seen at the authors’ hospital.  If so, then the average age at which neck pain began would have been closer to 3 years (range 2 to 5 years).

The average weight of Deerhounds diagnosed with CFJA was 87 pounds (range 70 to 101 pounds).  This is a typical weight range for adult male Deerhounds, and it suggests that larger-than-normal body size is not a risk factor for CFJA.

The authors also searched the medical records for dogs of other breeds seen over the same 5‑year period to see if CFJA had been diagnosed in any other breed.  They found no such cases – CFJA was diagnosed only in Deerhounds.  This raises the possibility of a heritable genetic risk factor for CFJA in our breed.  However, the authors reviewed pedigrees and found that affected dogs were unrelated for at least three generations.  Although this does not rule out a genetic component to CFJA, it suggests that heritability is low.

Before referral, all the Deerhounds had been treated with oral or injectable anti-inflammatory drugs (NSAIDs or corticosteroids) with little or no pain relief.  On examination, the predominant clinical sign was severe neck pain.  There was no evidence of impaired nerve function that might suggest damage to the spinal cord or spinal nerve roots.  In each Deerhound, X-rays consistently showed changes at C2-C3 that were consistent with facet joint arthrosis.  CT scans also showed changes in the facet joints between C2 and C3 in all dogs.  Changes were seen more readily on CT scans than on X-rays, and CT scans also revealed more subtle changes.

In each Deerhound where X-rays and CT scans suggested CFJA, the affected facet joint(s) were injected with a mixture of a corticosteroid and local anesthetic.  Facet joint injection was the only treatment any dog received.  Injection was done under general anesthesia using fluoroscopy to guide the needle into the joint space.  Post-treatment rest was not recommended; in fact, owners were instructed to exercise their dogs as soon as possible.  If facet joint injection stopped the pain, then the diagnosis of CFJA was considered confirmed. 

Eight Deerhounds showed substantial relief of neck pain within 2 days of treatment by joint injection, but one dog got no relief from either the first injection or a second injection one month later.  Seven of the dogs that responded to joint injections remained pain-free for longer than four months. In one dog that responded to joint injection, pain returned within a month, and the owner decided not to treat again.

The authors freely admit that their study does not address the underlying cause of CFJA in Deerhounds.  However, they do have a theory, which they explain like this:

…laxity of the capsular ligaments and tendons [of the facet joint] could be responsible for the degenerative changes we observed.  …high motility at C2 and C3 due to either congenital or acquired laxity of the facet joints could cause arthrosis, but no scientific proof of this can be found in the literature.  Neither the clinical data nor available imaging modalities of our series can prove or reject this hypothesis, because the motility of single spinal levels could not be determined.

If the authors are right that laxity of the facet joints at C2-C3 is an underlying cause of CFJA, then the fact that the disorder occurs more often in males may simply reflect the greater forces applied to those joints by the head, which is heavier in males than females.

With respect to the Deerhound with neck pain that led me to write this column, I can forgive the primary vet for being unaware of the paper about CFJA in Deerhounds.  But the specialist and the radiologist who evaluated the dog should have been aware of CFJA.  Likewise, the Merck Veterinary Manual should mention CFJA as a cause of neck pain in Deerhounds. 

To get an idea of how aware the veterinary community is of CFJA in Deerhounds, I googled “neck pain in Deerhounds.”  To my surprise (and dismay), the only veterinary medical “hit” that I got was for Parkside Veterinary Hospital in Fishers, Indiana!  The practice website has a large area detailing health problems for most breeds.  Although some of the Deerhound information is incorrect or out-of-date, the information about neck pain is accurate and includes CFJA as an important cause.

It is important that every SDCA member be aware that CFJA is an important cause of neck pain in Deerhounds.  Diagnosis requires X-rays and/or a CT scan of the neck done when the dog is sedated, which is relatively expensive.  Importantly, CFJA can be treated and in many cases (based on the 2003 paper) cured.   

References

Kinzel S, Hein S, Buecker A, Krombach GA, Kuepper W.  Diagnosis and treatment of arthrosis of cervical articular facet joints in Scottish Deerhounds: 9 cases (1998–2002).  J Am Vet Med Assoc 2003; 223: 1311–1315.

Sheerer KN, Couto CG, Marin LM, Zaldívar-Lopez MC, Iazbik JE, et al.  Haematological and biochemical values in North American Scottish deerhounds.  J Small Anim Pract 2013; 54 (7): 354-360.  https://doi.org/10.1111/jsap.12086.