Here is the scene: You're evaluating a 10 year old MC Labrador retriever for a 6 month history of progressive difficulty walking. Signs were first noted in the pelvic limbs but have recently been noted in the thoracic limns. As an astute vet, you also discover that the dog has become hoarse, too. (Nice job!)

Physical examination: Unremarkable other that OA in the stifles from prior CCL injury and surgery .

Neurologic examination:
Mentation: BAR
Cranial nerves: Hoarse voice and harsh breathing consistent with laryngeal paralysis. Remaining cranial nerve examination normal.
Gait: ambulatory, slapping limb gait when walking, especially in the pelvic limbs. The dog appears to walk like he is wearing clown shoes.
Postural reactions: Absent paw replacement testing all four limbs

Reflexes: Absent femoral reflex (bilateral), reduced gastroc reflexes (bilateral), reduced distal withdrawal of all four limbs but most notable distal to the hock bilaterally, unable to obtain bicep reflexes (bilateral). Intact perineal, and reduced (but present) C. trunci throughout the entire TL region.
Palpation: Non painful spinal palpation, normal cervical ROM

Holy cow! What is this? (You might be wondering) This neurologic exam is all over the place!! I need help. (It's okay to stop here and call me or setup a consult.) However, since we're on a learning track today let's talk though this one together. I am willing to bet you can get this.

How to lesion localize this case if you lived inside of my brain:

First, we don't see any evidence of forebrain or brainstem disease, correct? (No CN deficits, no seizures, no mentation changes.) Okay, cross that off.
Secondly, all four limbs are involved. This cannot be T3-L3, or L4-S3 because ONLY the pelvic limbs would be affected. (See, we're getting somewhere!) Cross those off.
This leaves us C1-C5 or C6-T2 myelopathy, if this is spinal in origin. You might be tempted to say C6-T2 myelopathy because of the reflex deficits in the thoracic limbs but remember that we have reflex deficits in all four limbs and that just isn't possible with a C6-T2 myelopathy. You must have a lesion in the spinal cord plexus (C6-T2, L4-S3), or the nerve, or the neuromuscular junction to have a reflex deficit. Cross off C1-C5, and C6-T2.
Okay, big breath. This is NOT spinal cord in origin. It cannot be. It doesn't line up! We have ourselves a neuromuscular disease

What to do next, if you suspect neuromuscular disease

Neuropathy – reduced reflexes in multiple limbs, and/or limbs and head. Postural reactions may be reduced or absent. Pain is not noted on palpation. NO ataxia!
Junctionopathy – absent reflexes, non-ambulatory paresis or exercise induced non-ambulatory paresis. Depending on the severity, these animals may have a range reduced to absent postural reactions. (Myasthenia gravis is the exception. It is a junctionopathy but acts like a myopathy.)
Myopathy – Classically, these animals have a normal neurologic examination. (Think muscle disease, not neurologic disease) They are paretic (ranging from poorly ambulatory to ambulatory with fatigue) without any postural deficits or reflex deficits. Muscle pain, stiffness and pain on palpation may fool you into thinking they have spinal pain.

This case fits with a neuropathy, doesn't it? In fact, this is an example of a neuropathy. This dog has a neurodegenerative neuropathy common in Labrador retrievers. It is suspected to be genetic. The diagnosis is confirmed with muscle and nerve biopsy. (Yes, I can do these for you.)

Sadly, we do not have treatment available to reverse or slow down progression therefore treatment is supportive. Slings when needed, good solid footing such as rugs/carpet or yoga mats, and physical therapy are the mainstay of treatment. Supportive care with acupuncture has also been beneficial for some dogs.

Thanks for reading! Have a wonderful week and stay warm! I will be closed on January 28-29th. I appreciate your patience and look forward to connecting with you on Monday January 31st with any cases or questions you may have.