Signalment and Initial Presentation
Sally Barham, an 8-year-old spayed female English Mastiff weighing 158 lbs (71.7 kg), presented in April 2023 for evaluation of progressive mobility issues. Her owners reported difficulty rising from rest, hesitancy with stairs, reluctance entering or exiting a vehicle, and a recent episode of discomfort while attempting to lie down. Sally had been prescribed Carprofen and Gabapentin by her primary DVM, which provided mild short-term relief.
On neurological exam, conscious proprioception was delayed in the hind limbs, right greater than left. Mild mid-thoracic discomfort was elicited on palpation, and there was reluctance to bear full weight on the left forelimb. However, full passive range of motion was present in all joints. Survey spinal radiographs demonstrated extensive spondylosis deformans and intervertebral disc disease (IVDD) spanning T13 to L4, with marked calcification at L2-L3 and bridging osteophytes at L1-L2 and L3-L4. A presumptive diagnosis of thoracolumbar IVDD with radiculopathy was made.
Initial Treatment and Response
The initial treatment protocol included enforced rest, NSAID withdrawal with a 48-hour washout, and initiation of a tapering course of oral prednisone. Gabapentin (600 mg PO q8–12h) and sucralfate were prescribed concurrently to manage neuropathic pain and prevent GI side effects. Within one week, the owner noted a 40% improvement in mobility and comfort, and repeat neurological examination showed resolution of CP deficits. The prednisone taper was completed uneventfully, and Gabapentin was continued at a maintenance dose. A Traditional Chinese Veterinary Medicine (TCVM)-based disc support herbal formula was initiated empirically.
Reassessment and New Presentation: Suspected Cervical Involvement
In December 2023, Sally re-presented with acute decline similar to her initial signs. She was reluctant to go down stairs, had difficulty rising after urination, and lay with her head in a rigid, extended posture. Notably, she required assistance to stand and seemed unable to get comfortable in lateral recumbency. Her owner administered Carprofen prior to presentation.
Physical examination at this time was consistent with cervical pain. Palpation of the neck elicited guarded movement and discomfort, and she resisted extension and lateral flexion. Based on clinical signs and anatomical localization, a cervical spinal cord lesion was suspected. While thoracolumbar IVDD had been radiographically confirmed previously, this new presentation indicated a separate or additional lesion at the level of the cranial cervical spinal cord.
Targeted Manual Therapy and Herbal Intervention
Veterinary Medical Manipulation (VMM) was performed, including adjustments of the left dorsal atlas (C1) and right PSIS (posterior superior iliac spine). The patient demonstrated an immediate and marked clinical improvement. She was ambulatory without assistance post-treatment and voluntarily voided with normal posture. Head and neck positioning normalized. Gabapentin was prescribed on an as-needed basis, though her owner discontinued it within one week due to a lack of recurrence of clinical signs.
The patient was initiated on Cervical Formula (Jing Tang Herbal), an herbal compound traditionally indicated for cervical Qi and Blood stagnation. This formula, composed of herbs including Chuan Xiong, Dang Gui Wei, Pueraria, and Cinnamomum, is intended to address pain secondary to stagnation in the C1–T2 region. Clinical theory supports its use in cases involving cervical disc disease, Wobblers syndrome, and fibrocartilaginous embolism of the cervical spine.
Neuroanatomical Insight: Spinothalamic Tract Involvement
This case underscores a critical and often underappreciated neuroanatomical nuance: that hindlimb weakness may arise from lesions cranial to the thoracolumbar spine. The spinothalamic tracts, which convey superficial pain and temperature, are located in the lateral and ventrolateral funiculi of the spinal cord and are among the most superficially positioned white matter tracts. Compression of these tracts in the cervical spine—especially at C1–T2—may manifest with caudal signs such as hindlimb weakness or ataxia, mimicking a classic T3–L3 myelopathy. This may explain why Sally’s rear-limb symptoms improved more significantly following cervical adjustment and targeted herbal therapy than from prior anti-inflammatories or rest alone.
Long-Term Management and Outcomes
Sally continued to improve over the ensuing months. At her January 2024 recheck, she was back to normal activity and no longer receiving any pharmaceuticals. Her only ongoing intervention was Cervical Formula at a reduced dose. When this was discontinued temporarily in mid-2024, her clinical condition regressed by 10–20%, reinforcing the hypothesis that cervical pathology was a major contributor to her signs. She was restarted on the herbal with excellent results.
As of her most recent examination in January 2025 at 10 years of age, Sally remains clinically stable with no signs of ambulatory dysfunction, spinal pain, or neurologic deficits. Her quality of life is reported to be excellent, and she continues on a maintenance dose of the herbal compound. Despite radiographically evident thoracolumbar pathology, these findings are currently not clinically significant.
Clinical Relevance and Takeaways
This case illustrates the importance of integrative diagnostics and treatment strategies in veterinary neurology, particularly in geriatric large-breed dogs. Sally’s clinical improvement following cervical-focused therapy, despite significant thoracolumbar imaging abnormalities, highlights the need to correlate radiographic findings with clinical presentation. It also demonstrates the value of targeted herbal medicine and VMM in select cases where polypharmacy or long-term NSAID use may carry risks.
While Cervical Formula lacks formal clinical trials, it represents a promising adjunct or alternative in the management of cervical spinal pain, especially when informed by appropriate neuroanatomical localization. In Sally’s case, a total of three VMM sessions and one herbal formula were sufficient to restore and maintain full neurologic function for over two years.
Conclusion
Geriatric mobility issues in large-breed dogs often present a multifactorial diagnostic challenge. In this case, a thoughtful approach combining neuroanatomical reasoning, integrative therapy, and targeted manual manipulation produced an outcome that exceeded expectations. Sally’s story exemplifies the clinical value of a multimodal treatment paradigm grounded in both Western and Eastern medical frameworks.