Dr. Marty Greer joins Laura Reeves to answer a listener question and break down one of the most serious and underdiagnosed neurological conditions affecting small breed dogs.

If you've never heard of syringomyelia, you're not alone — but if you breed Cavalier King Charles Spaniels, Brussels Griffons, Pomeranians or other small brachycephalic breeds, this episode could change how you think about your breeding program.

Dr. Marty Greer walks Laura through the difference between Chiari-like malformation and syringomyelia (SM), two conditions that often get lumped together but aren't quite the same thing. The short version: when the skull is too small for the cerebellum, fluid circulation gets disrupted and painful pockets of fluid can form along the spinal cord. The result is a dog in chronic, often invisible pain.

The symptoms are easy to miss. Phantom scratching near the neck, sleeping with the head elevated, flinching when picked up or eating from a floor-level bowl — all of these can look like something minor. In Cavaliers especially, an ear condition with overlapping symptoms makes diagnosis even trickier. Only an MRI gives you a definitive answer, and that's where things get complicated fast.

MRIs run anywhere from $1,500 to $3,000. Dogs need to be fully anesthetized. Cavaliers aren't the easiest anesthetic candidates for a variety of reasons. And even after all that investment, the genetics are multifactorial and polygenetic, meaning two "clear" dogs can still produce affected offspring.

The numbers are sobering. When screening efforts launched in the U.S., the breed incidence was estimated at 60 to 80 percent. Careful screening cut that roughly in half — but that still leaves the breed sitting around 35 to 40 percent affected, and only a fraction of dogs are ever screened.

Treatment options exist but aren't encouraging. Surgical intervention has a relapse rate of over 50 percent. Long-term management means gabapentin, steroids and other medications for the li