Case Study: When Skipping Lameness Wasn’t Orthopaedic: Tethered Cord Syndrome

Signalment

Patient: 2-year-old Miniature Schnauzer

Presenting complaint: Gradual onset intermittent pelvic limb skipping lameness

Initial Presentation

This young Miniature Schnauzer presented with a gradual onset of intermittent bilateral pelvic limb skipping lameness, more pronounced on the right side. The gait abnormality was most evident when transitioning from walk to trot and worsened with exercise.

Despite this, the dog remained keen to sprint and engage in activity. On general assessment, the patient was noted to be globally hypermobile.

Alongside the physical concerns, there was a history of behavioural challenges from a young age, including reactivity toward both dogs and humans. These behaviours had been progressively worsening despite appropriate training interventions.

Over time, additional signs emerged:

• Biting at the back feet

• Increased sensitivity to handling, particularly of the limbs

• No changes in appetite or drinking

Initial Veterinary Work-Up

The dog was first assessed by the primary care veterinarian.

• Radiographs of the pelvis and stifles were unremarkable

• A trial of Apoquel was undertaken and the feet were deep-cleaned under sedation to rule out dermatological or allergic causes

No improvement in clinical signs was noted following these interventions, a referral to Orthopaedic specialist occurred. 

Orthopaedic Referral Findings

On referral, the patient was found to be in excellent lean body condition (BCS 2/5).

Gait assessment:

• Bilateral pelvic limb skipping lameness at walk and trot

  
  

Orthopaedic examination:

• Symmetrical pelvic limb muscle mass

• No joint effusion

• Stifles within normal limits (no patella luxation, cranial tibial thrust or pain)

• Hips with normal range of motion, no crepitus, Ortolani negative

• Mild pain response on bilateral iliopsoas stretch

  
  

Neurological assessment:

• Pelvic limb neurology within normal limits

• No lumbosacral pain on palpation

  
  

A contrast CT scan of the lumbosacral spine showed only mild disc bulging without cauda equina compression or displacement. Given the absence of pain on palpation and lack of neurological deficits, this was considered an incidental finding.

Initial Diagnosis and Management

At this stage, a suspected iliopsoas strain was diagnosed. A course of physiotherapy alongside a pain trial was initiated.

However, rather than improving, the patient’s condition progressively deteriorated.

Clinical Deterioration & Red Flags

During physiotherapy and conservative management, the following concerning signs developed:

• Increased biting at the hips and flank mid-walk

• Escalation of behavioural changes, including shadow chasing

• Increased intolerance of other dogs in the household

• Worsening skipping lameness

• Difficulty posturing to defecate, often lifting one pelvic limb

These signs suggested that the problem extended beyond a simple musculoskeletal injury.

Reframing the Problem: Neuropathic Pain?

A trial of gabapentin resulted in a marked improvement in comfort and behaviour. This positive response strongly suggested a neuropathic pain component.

Given the history, progression, behavioural changes, and response to medication, referral to a veterinary neurologist with expertise in Tethered Cord Syndrome (TCS) was sought by the owner.

Neurology Assessment & Advanced Imaging

A neurologist-guided pain trial resulted in significant but incomplete improvement. When medications were weaned, clinical signs rapidly returned,  including pain-related behaviours.

At this point, further diagnostics were pursued.

Dynamic MRI of the lumbosacral spine was performed in neutral, flexed, and extended positions to assess spinal cord movement, which confirmed findings consistent with Tethered Cord Syndrome.

In a normal dog, the spinal cord should move freely within the spinal canal when the spine bends and straightens. In this case, advanced imaging showed that the lower end of the spinal cord moved much less than expected during spinal flexion.

This restricted movement indicated that the spinal cord was abnormally tethered, placing it under tension during everyday activities such as walking, running, toileting, and postural changes. This helps explain the dog’s progressive pain, gait changes, and behavioural signs despite normal findings on earlier imaging.

Surgical Intervention & Outcome

Following diagnosis, detethering surgery was performed by a specialist veterinary neurologist. Post-surgical recovery and rehabilitation are ongoing, with notable improvements in pain levels, movement quality, and behaviour, a further blog to come on rehabilitation considerations in Tethered Cord Syndrome, both pre surgery and rehabilitation!

Key Takeaways 

• Skipping lameness is not always orthopaedic

• Behavioural changes can be an early sign of chronic pain, including neuropathic pain

• A normal CT, MRI or static imaging does not rule out neurological conditions, often dynamic imaging is needed. 

• Response to neuropathic pain medication can be a critical diagnostic clue

• Physiotherapists play a vital role in identifying cases that are not progressing as expected and advocating for further investigation

This case highlights the importance of listening to the whole dog, not just the imaging, especially in young, active patients with unexplained, progressive signs.