Acupuncture for Neck Pain and Wobbler Syndrome
World Small Animal Veterinary Association World Congress Proceedings, 2015
S.H. Xie, DVM, PhD, MS
Chi Institute, Reddick, FL, USA

Acupuncture and herbal medicine have been used successfully for the treatment of neck pain and Wobbler syndrome.1,2 Wobbler syndrome is also called disc-associated Wobbler syndrome,3 caudal cervical vertebral instability and malformation,4 cervical spondylomyelopathy (CSM)5. It is a well-defined disorder of mostly large-breed dogs and young horses, characterized by a compressive cervical lesion affecting the spinal cord.6 Intervertebral disk disease (IVDD) is often a part of cervical spondylomyelopathy but can cause a compressive lesion from disk material on the spinal cord alone.7 Many dogs with CSM may have a dynamic component and therefore a worsening of clinical signs with neck position or movements.8 Therapeutic options include surgery, conventional medicine, and traditional Chinese veterinary medicine (TCVM). Surgical procedures, as one treatment option, are expensive, invasive, usually hold some element of risk and may or may not ameliorate clinical signs. Medical intervention, usually using corticosteroids, is another treatment option but does not correct structural problems and has risks associated with long-term use.9,10 This presentation will discuss the acupuncture points and herbal medicines that have been used in practice with retrospective study results.

Subjects

In this retrospective study, case files for nineteen animals (13 dogs and 6 horses) ranging in age from 4 months old to 14 years old were reviewed. Dog breeds included: 4 Doberman Pinschers, 2 German Shepherds, 2 Great Danes, 1 Greyhound, 1 Rottweiler, 1 Weimaraner, 1 Dalmatian and 1 Australian cattle dog. Horse breeds included 2 Thoroughbreds, 1 Standardbred, 1 Warmblood, 1 Andalusian, and 1 Saddlebred (Table 1*). Six dogs and 1 horse presented with at least one western medical diagnostic test, including radiographs, myelogram, and MRI. Twelve animals (7 dogs and 5 horses) presented with clinical signs typical of Wobbler's syndrome, including ataxia or/and hind-end weakness. Assessment of clinical signs of the animals varied based on degree of neurological dysfunction or pain measured on a 5-grade scale as follows, modified from Besalti and Ozak et al.8

TCVM Procedure

TCVM treatments including herbal medicines and acupuncture points were based on three major patterns of TCVM diagnosis:

 Local cervical Qi stagnation: mild neck pain on palpation/manipulation, or mild evidence of ataxia, possibly in only the hind limbs, and cervical stiffness; no evidence of abnormal radiographic findings; purple or pale-purple tongue, and wiry pulse

 Cervical Blood stagnation: obvious/severe evidence of ataxia of all 4 hind limbs (worse in hind limbs), neck pain on palpation/manipulations, and cervical stiffness; abnormal radiographic evidence (narrow IVD spaces, sclerosis of the demi-facets); purple tongue, wiry or fast pulse

 Kidney/Spleen Qi deficiency: general weakness, conscious proprioception deficits or paralysis, pale purple tongue, deep and weak pulse

 A combination of Qi deficiency and Yin deficiency: weakness, paresis or paralysis, panting, cool-seeking, hot ears, pale or red tongue, weak or fast pulse

 Kidney Jing deficiency: Wobbler syndrome occurs in young animals (less than 2 years old); often seen in Great Danes

Acupuncture

 Dry needle: Bai-hui, BL-23

 Electro-acupuncture (20 Hz for 5 to 10 minutes + 80–120 Hz for 15 to 20 minutes) at the following pairs of acupoints:

 Left GB-20 + right GB-21

 Right GB-20 + left GB-21

 Jing-jia-ji, bilateral

 ST-36 + GB-34

 GV-14 + GV-20 in dogs, or BL-10 + BL-11 in horses

 Aqua-acupuncture (vitamin B12) at Jing-jia-ji, BL-62, SI-3, KID-6

Herbal Medicine

Cervical formula was the basic formula for all patients.

Double P II was given orally for patients that had a neurological grade of 2 or higher.

Body Sore was given orally to patients with neck pain and used as needed.

After patients were able to walk, Double P II was discontinued. If Qi/Yang deficiency was present (rear weakness, cold back, pale and wet tongue, and deep/weak pulse) Bu Yang Huan Wu was given orally; or if Yin deficiency or Qi + Yin deficiency was present (cool-seeking, rear weakness, red/dry tongue, and fast/thin pulse), Hindquarter Formula was given orally. All these herbal medicines are made by Jing-tang Herbal. (Disclosure: Dr. Huisheng Xie is one of the owners of Jing-tang Herbal, Inc.)

Herbal Dosage

 Dog: 1 g per 10 kg body weight twice daily given orally for 1 to 4 months

 Horses: 15–30 grams twice daily given orally for the 1–3 months

Results

Of the 19 cases, 10 (52.6%) had complete clinical recovery, and 8 (42.1%) had a substantial improvement (improving one or more grades on the neurological scale). Only 1 of 19 cases (5.3%) had no improvement. All 18 cases that responded to TCVM were observed for at least 6 months and demonstrated signs of good quality of life clinically (including walking daily, normal urination and defecation, and good appetite).

Case Example

"Max," 10-year-old c/m canine Doberman Pinscher was presented to the neurology service of the local university small animal hospital for a 3-year history of progressive ataxia and quadriparesis with dramatic worsening over the previous 4 months. Reports from the rDVM in 2001 indicate "disk problems in the back" and prescribed 100 mg Deramaxx PRN which "Max" stayed on for over 3 years. Neurology service diagnosis for "Max" was: moderate dorsal and ventral dynamic extradural cord compression at C6–C7 with mild ligamentous hypertrophy dorsally; mild ventral extradural cord compression in the caudal thoracic spine; Wobbler's syndrome. The owner declined the ventral slot with decompression surgery; therefore, "Max" was referred to the acupuncture service on 4-5-2005.

First TCVM visit: Ataxia, weakness in hind end, difficulty rising, circumduction while walking, conscious proprioception deficits in all four limbs, decreased motor skills, disorientation. He also had a lick granuloma at R-lateral carpus at the SI meridian (around SI-4) (ulcerated and warm to the touch). His tongue was pale purple. His pulse was deep and weak. Sensitivity was found on BL-18/21/23 on palpation. His TCVM diagnosis was Kidney Qi deficiency with cervical Qi-Blood stagnation. Dry needle was inserted at Tian-men, BL-11/18/21/23/40, KID-3. Electroacupuncture (20 Hz/10 min, D/D 80–120 Hz/10 min) was stimulated at the following pairs of points: Jing-jia-ji C5/6, bilateral; Jing-jia-ji C6/7, bilateral; GB-21 + GB-20, bilateral; ST-36 + GB-34, bilateral. The following herbal medicines were also given: cervical formula - 8 capsules (0.5 g per capsule), PO BID; Double P #2 - 4 capsules (0.5 g per capsule), PO BID; Coptis (Huang Lian) powder - topical BID - very cold herb to cool the forced Heat and tastes very bitter to discourage licking behavior.

Case summary: After the 3rd treatment, "Max" was 95% improved and had no neurological deficit after 6 more monthly acupuncture treatments (on 5/17, 6/14, 7/21, 8/26, 9/20 and10/18, 2005) with herbal medications. He was then treated with acupuncture one session per 2 to 6 months or as needed. "Max" had no CP deficits but had a mild wide-based stance. He was clinically normal in terms of rising, walking and running. He ran with his horse friends every day and looked like a normal ambulating dog until June 20, 2009 at age of 14, when he passed away at the ICU because of congestive heart failure.

Conclusion

TCVM, including herbal medicine and acupuncture, offers a less-invasive alternative to surgery for the treatment of Wobbler syndrome, including cervical spondylomyelopathy and intervertebral disk disease, by providing the opportunity for complete resolution or significant improvement of clinical signs.

*VIN editor: Table 1 was not available at the time of publication.

References

1.  Xie H. TCVM for wobbler syndrome and myelopathy. In: Proceedings from the Annual Conference of the American Holistic Veterinary Medical Association; September 8–11, 2012; Birmingham, AL. 395–405.

2.  Xie H, Rimar T. Effect of a combination of acupuncture and herbal medicine on Wobbler syndrome in dogs and horses. In: Yang, Xie, eds. Traditional Chinese Veterinary Medicine - Empirical Techniques to Scientific Validation. Reddick, FL: Jing-tang Publishing; 2010:101–112.

3.  Shamir MH, Chai O, Loeb E. A method for intervertebral space distraction before stabilization combined with complete ventral slot for treatment of disc-associated wobbler syndrome in dogs. Vet Surg. 2008;37(2):186–192.

4.  Boudrieau RJ. Intraoperative use of ultrasonography during continuous dorsal laminectomy in 2 dogs with caudal cervical vertebral instability and malformation ('Wobbler syndrome'). Vet Surg. 2006;35(8):794–796.

5.  da Costa RC, Parent JM, Holmberg DL, Sinclair D, Monteith G. Outcome of medical and surgical treatment in dogs with cervical spondylomyelopathy: 104 cases (1988–2004). J Am Vet Med Assoc. 2008;233(8):1284–1290.

6.  Penderis J, Dennis R. Use of traction during magnetic resonance imaging of caudal cervical spondylomyelopathy ("Wobbler syndrome") in the dog. Vet Radiol Ultrasound. 2004;45(3):216–219.

7.  Besalti O, Pekcan Z, Siriny S. MRI findings in dogs with thoracolumbar intervertebral disk disease 69 cases (1997–2005). J Am Vet Med Assoc. 2006;228(6):902–908.

8.  Seim HB, Withrow SJ. Pathology and diagnostics of caudal cervical spondylomyelopathy with emphasis on Doberman Pinscher. J Am Animal Hosp Assoc. 1982;18:241–251.

9.  Slatter D. Textbook of Small Animal Surgery. Philadelphia, PA: Saunders; 2002:1180–1198.

10. Janssens LAA. Acupuncture for thoracolumbar and cervical disk disease. In: Schoen AM, ed. Veterinary Acupuncture - Ancient Art to Modern Medicine. 2nd ed. St Louis: Mosby-Year Book Inc; 2001:193–198.

  

Speaker Information
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S.H. Xie, DVM, PhD, MS
Chi Institute
Reddick, FL, USA


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