Radiographic and scintigraphic evaluation of spondylosis in the equine thoracolumbar spine: A retrospective study

Reasons for performing study: Clinical, radiographic and scintigraphic signs associated with spondylosis of the equine thoracolumbar spine have been poorly documented. Objectives: To establish an objective radiographic and scintigraphic grading system for spondylosis lesions; to estimate the prevalence of spondylosis in a population of horses with back pain; and to compare the results of radiography and scintigraphy Methods: Radiographic images of the thoracolumbar spine from 670 horses with clinical signs of back pain were graded. Scintigraphic images from horses with spondylosis lesions underwent subjective and objective analysis. Sensitivity and specificity of scintigraphy for detection of spondylosis relative to radiography for identification of spondylosis were calculated, and Chi‐squared analysis was performed to test for an association between location and severity of lesions. Results: Twenty‐three of 670 horses (3.4%) with back pain had radiographic evidence of spondylosis. Of these horses, 14 (61%) had more than one lesion and 44% (n = 22) of lesions occurred between T11‐T13 vertebral bodies. Only 33% (n = 28) of locations with radiographic changes had increased radiopharmaceutical uptake. Conclusion: Spondylosis occurs at a low prevalence in horses with back pain. It may be present alone or in association with other osseous abnormalities. The clinical significance of spondylosis needs further investigation. Potential relevance: Spondylosis is uncommon but may be a contributor to back pain in the horse.     

EFFECTS OF X‐RAY BEAM ANGLE AND GEOMETRIC DISTORTION ON WIDTH OF EQUINE THORACOLUMBAR INTERSPINOUS SPACES USING RADIOGRAPHY AND COMPUTED TOMOGRAPHY—A CADAVERIC STUDY

The widths of spaces between the thoracolumbar processi spinosi (interspinous spaces) are frequently assessed using radiography in sports horses; however effects of varying X‐ray beam angles and geometric distortion have not been previously described. The aim of this prospective, observational study was to determine whether X‐ray beam angle has an effect on apparent widths of interspinous spaces. Thoracolumbar spine specimens were collected from six equine cadavers and left‐right lateral radiographs and sagittal and dorsal reconstructed computed tomographic (CT) images were acquired. Sequential radiographs were acquired with each interspinous space in focus. Measurements were performed for each interspinous space in the focus position and up to eight angled positions as the interspinous space moved away from focus (±). Focus position measurements were compared to matching sagittal CT measurements. Effect of geometric distortion was evaluated by comparing the interspinous space in radiographs with sagittal and dorsal reconstructed CT images. A total of 49 interspinous spaces were sampled, yielding 274 measurements. X‐ray beam angle significantly affected measured width of interspinous spaces in position +3 (P = 0.038). Changes in width did not follow a consistent pattern. Interspinous space widths in focus position were significantly smaller in radiographs compared to matching reconstructed CT images for backs diagnosed with kissing spine syndrome (P < 0.001). Geometric distortion markedly affected appearance of interspinous space width between planes. In conclusion, X‐ray beam angle and geometric distortion influence radiographically measured widths of interspinous spaces in the equine thoracolumbar spine, and this should be taken into consideration when evaluating sport horses.     

The influence of head and neck position on kinematics of the back in riding horses at the walk and trot

REASONS FOR PERFORMING STUDY: A common opinion among riders and in the literature is that the positioning of the head and neck influences the back of the horse, but this has not yet been measured objectively. OBJECTIVES: To evaluate the effect of head and neck position on the kinematics of the back in riding horses. METHODS: Eight Warmblood riding horses in regular work were studied on a treadmill at walk and trot with the head and neck in 3 different predetermined positions achieved by side reins attached to the bit and to an anticast roller. The 3-dimensional movement of the thoracolumbar spine was measured from the position of skin-fixed markers recorded by infrared videocameras. RESULTS: Head and neck position influenced the movements of the back, especially at the walk. When the head was fixed in a high position at the walk, the flexion-extension movement and lateral bending of the lumbar back, as well as the axial rotation, were significantly reduced when compared to movements with the head free or in a low position. At walk, head and neck position also significantly influenced stride length, which was shortest with the head in a high position. At trot, the stride length was independent of head position. CONCLUSIONS: Restricting and restraining the position and movement of the head and neck alters the movement of the back and stride characteristics. With the head and neck in a high position stride length and flexion and extension of the caudal back were significantly reduced. POTENTIAL RELEVANCE: Use of side reins in training and rehabilitation programmes should be used with an understanding of the possible effects on the horse's back.     

Determination of the stiffness of the equine spine

REASONS FOR PERFORMING STUDY: Mechanical properties of the equine back are the bases for realistic modelling of the back, which is recognised as an important step towards improved understanding of the pathogenesis of equine back conditions. HYPOTHESIS: The stiffness of the equine back depends on the direction of the applied force and on the position of the spine. METHODS: Fourteen dissected spines were tested in a tensile testing machine. In 3 different positions, simulating dorsoventral, laterolateral and dorsoventral-30 degree rotated movement, force was applied on the dorsal spinous process of T12 to reach an excursion of 4 cm in each direction. The normal distribution of the stiffness coefficients was tested with a Kolmogorov-Smirnov test and the stiffness coefficients were compared with paired t tests. RESULTS: Mean +/- s.d. dorsoventral stiffness was 2093 +/- 611 N/m for the nonrotated spine and 2182 +/- 459 N/m for the 30 degree rotated spine. Mean laterolateral stiffness was significantly lower than dorsoventral stiffness at 1454 +/- 156 N/m. CONCLUSIONS: The stiffness of the spine depends on the direction of loading. POTENTIAL RELEVANCE: The stiffness of the spine under loading may be a relevant factor in the development of back disorders.     

Metastatic thyroid solid-follicular carcinoma in the cervical portion of the spine of a dog

A metastatic thyroid solid-follicular carcinoma in the cervical portion of the spine was responsible for severe tetraparesis in a dog. Myelography revealed an extradural compressive lesion dorsal and to the right of the midline of C3. Histologic examination was used to diagnose the mass as a solid-follicular thyroid carcinoma. The primary tumor was not evident on cervical palpation or radiography. A dorsal laminectomy centered over C3 was performed, and all visible tumor was removed from the spine. The owner declined any further treatment for the dog.     

Natural rigaidity of the horse's backbone

The functional anatomy of the thoracolumbar (TL) spine is considered in relation to the horse's ability to perform at speed and to jump. The morphological features quite clearly show the relative inflexibility of the equine back and this was confirmed by some experimental studies. Fresh post mortem specimens from 5 Thoroughbreds were used to estimate the limits of dorsoventral movement of the TL spine from mid-thoracic to the cranial lumbar (T10-L2). The individual spinous processes could be moved a mean 1.1-6.0 mm on maximum ventroflexion and 0.8-3.8 mm on dorsiflexion. The overall flexibility of the back was found to be 53.1 mm. Caudal to the mid-point of the back (T13) there was virtually no lateral or rotatory movement of the spine possible. The pathogenesis of some of the common causes of back trouble are discussed including the so-called vertebral subluxation and its treatment by chiropractic manipulation. From an anatomical viewpoint, this condition appears to be a misnomer and may simply be attributable to muscular imbalance leading to aspastic scoliosis.     

Endotracheal Tube Displacement During Cervical Manipulation in the Dog

A retrospective study was performed to identify positional changes of endotracheat tubes (ETT) during cervical spine radiography in 153 dogs. Three neck positions were identified: traction, hyperextension, and flexion. A properly placed ETT was defined as having the caudal tip of the tube located between the caudal half of the fourth cervical (C) vertebra (C₄) and the caudal half of C₇. In the traction position, before neck flexion and extension, the caudal tip of 13% of ETT were located caudal to C₇, and one tube was in the endobronchial position at the seventh thoracic (T) vertebra (T₇). In the hyperextended position, 60% of ETT moved cranially. The average distance moved was 0.6 vertebral spaces. In the flexed position, all ETT moved caudally. The average distance moved was 3.5 vertebral spaces, with 81.8% of ETT located caudal to C₇ and seven tubes in endobronchial positions. Endotracheal tube occlusion caused by kinking at the atlanto-occipital joint was seen in four dogs during flexion of the neck. Based on this study, ETT position should be monitored during cervical manipulation.     

Total body and regional measurements of bone mineral content and bone mineral density in pigs by dual energy X-ray absorptiometry.

Dual energy X-ray absorptiometry (DXA) was used to make total body and regional measurements of bone mineral content, bone mineral density, and bone area during the growth of pigs from 3 to 138 kg. In all, 1,053 total body scans were performed on 587 live pigs. Regional measurements consisted of the front legs, trunk, and back legs. In addition, bone mineral density readings were recorded for the head, pelvis, spine, and ribs. From about 5 to 75 kg, a greater percentage of the total body bone mineral content (BMC) was located in the trunk region. However, the percentage of BMC in the front and back legs continued to increase linearly whereas the percentage of BMC in the trunk region peaked at about 25 kg and then decreased logarithmically. Allometric analysis revealed that up to about 30 kg the BMC increased more rapidly in the trunk region compared to the front or back leg regions (P > 0.05), but after 30 kg the increase in BMC was more rapid in the leg regions (P < 0.05). Overall, the rate of increase in BMC in the back legs was slightly more than in the front legs (P > 0.05). Positive allometric growth of BMC was observed when compared with the increase in bone area for the same region. By far, the highest measured level of bone mineral density (BMD) was in the head region (P < 0.05), followed in order by the front legs, spine, back legs, pelvis, and ribs. Over the entire range of growth from 3 to 138 kg, the highest relative growth coefficient for the increase in BMD occurred in the pelvic and back leg regions and the lowest was in the ribs (P < 0.05). For pigs < 30 kg, the highest growth coefficient for BMD relative to BW was in the spine (P > 0.05). The growth coefficients for BMD in the back legs and total body increased in pigs > 30 kg and those of the front legs and trunk regions decreased.     

RADIOGRAPHIC SENSITIVITY AND NEGATIVE PREDICTIVE VALUE FOR ACUTE CANINE SPINAL TRAUMA

The objectives of this study were to establish the sensitivity and negative predictive value of radiography for acute spinal osseous lesions in the canine trauma patient, and to evaluate the interobserver variability in radiographic assessment of the spine in traumatized dogs. This was a retrospective multiple observer blinded study. The study population included 30 canine patients that presented following acute trauma, with clinical signs attributable to the spinal column. Radiography and computed tomography (CT) were performed in all cases. Radiographic interpretation was performed independently by four observers with different experience levels who were blinded to clinical information (other than trauma) and the CT results. CT studies were interpreted by a further three radiologists who formed a consensus opinion on the presence of specific osseous lesions. Using the CT results as a gold standard, the sensitivities and negative predictive values of radiography for specific osseous lesions were calculated. Interobserver agreement was also evaluated. Radiography was found to have only a moderate sensitivity for fractures (72%) and subluxations (77.5%). Low negative predictive values were found for the presence of vertebral canal narrowing (58%) and fracture fragments within the vertebral canal (51%). Interobserver agreement was only moderate to fair for most lesion types. In conclusion, radiography cannot be used to reliably rule out potentially unstable acute vertebral lesions in the canine trauma patient, and further imaging is therefore often indicated in the patient with a high risk of such injuries.     

Dorsolateral Subluxation of Hip Joints in Dogs Measured in a Weight-Bearing Position With Radiography and Computed Tomography

Objective —To develop a radiographic procedure to measure dorsolateral subluxation (DLS) of the femoral head in canine coxofemoral (hip) joints in a weight-bearing position. Study Design —DLS measured on a radiographic projection was compared with DLS measured on computed tomography (CT) images of hip joints in a weight-bearing position. Animals —A total of 24 dogs of varying ages were examined including Labrador retrievers, greyhounds, and Labrador-greyhound crossbreeds. Methods —Anesthetized dogs were placed in sternal recumbency in a kneeling position in a foam rubber mold. The stifles were flexed and adducted with the femora perpendicular to, and in contact with, the table. To test for DLS, dogs were imaged in this weight-bearing position (DLS test) with routine radiography and CT. For each hip, the DLS score was determined by measuring the percentage of the femoral head medial to the lateralmost point of the cranial acetabular rim on the dorsoventral radiographic projection and the lateralmost point of the central, dorsal acetabular rim on the CT image. Higher DLS scores indicated better coverage of the femoral head by the acetabulum. DLS scores were compared with the distraction index (DI) by grouping joints according to their probability of developing osteoarthritis (OA) as predicted by the DI. Results —The DLS score in the new position ranged from 29% to 71% for radiography and 15% to 59% for CT. Joints classified as OA unsusceptible had a mean score of 64%± 1.5% for radiography and 55%± 0.8% for CT (n = 10); hip joints having a high probability of developing OA had a score of 39%± 2.6% for radiography and 26%± 1.9% for CT (n = 8). When the DLS test was repeated on the same dogs at a different time, the intraclass correlation coefficient for the DLS score on the radiographs was 0.85 (left hip) and 0.89 (right hip). There was a strong correlation (r = .89 for both hips) between the DLS score measured on the weight-bearing radiograph and the CT image. A strong correlation also was observed between the DLS score and the DI (r = -.87). The DLS scores for OA unsusceptible joints and joints with a high probability of developing OA were significantly different (P < .05). Conclusions and Clinical Relevance —The DLS test can be performed with CT or routine radiography to measure variable amounts of DLS in weight-bearing hip joints oriented similarly to those of a standing dog. After additional long-term follow-up studies evaluating the development of OA and breed effects are performed, the DLS method may prove useful in studies of normal and abnormal hip joint development related to canine hip dysplasia.     

IMAGING FINDINGS IN DOGS WITH CAUDAL INTERVERTEBRAL DISC HERNIATION

The radiographic and magnetic resonance imaging (MRI) findings for four dogs with herniation of the Cd1–Cd2 intervertebral disc are described. All dogs were 7 years of age at the time of presentation, with one neutered male and three neutered females. Breeds included one Beagle, one Bassett hound, and two large, mixed breed dogs. All dogs had tail pain on manipulation, two had pain during defecation, and two maintained an abnormal tail position. Three dogs had radiographs in which mineralization within the disc space was apparent. Two of these dogs also had mineralization within the vertebral canal. Three dogs underwent MRI, which was characterized by varying degrees of disc herniation and nerve root compression at Cd1–Cd2. Mobility may be a factor predisposing to disc herniation in the cranial aspect of the caudal spine. We documented that caudal disc herniation does occur occasionally in dogs and that radiography and MRI may be used to identify this disease. Caudal intervertebral disc herniation should be considered as a differential for dogs with caudal vertebral pain, pain with tail manipulation, pain during defecation, or abnormal tail carriage.     

Transitioning to digital radiography

Objective – To describe the different forms of digital radiography (DR), image file formats, supporting equipment and services required for DR, storage of digital images, and teleradiology. Background – Purchasing a DR system is a major investment for a veterinary practice. Types of DR systems include computed radiography, charge coupled devices, and direct or indirect DR. Comparison of workflow for analog and DR is presented. Summary – On the surface, switching to DR involves the purchase of DR acquisition hardware. The X‐ray machine, table and grids used in analog radiography are the same for DR. Realistically, a considerable infrastructure supports the image acquisition hardware. This infrastructure includes monitors, computer workstations, a robust computer network and internet connection, a plan for storage and back up of images, and service contracts. Advantages of DR compared with analog radiography include improved image quality (when used properly), ease of use (more forgiving to the errors of radiographic technique), speed of making a complete study (important for critically ill patients), fewer repeat radiographs, less time looking for imaging studies, less physical storage space, and the ability to easily send images for consultation. Conclusions – With an understanding of the infrastructure requirements, capabilities and limitations of DR, an informed veterinary practice should be better able to make a sound decision about transitioning to DR.     

INFLUENCE Of PATIENT POSITIONING ON THE L5–L6 MID-LAMINAR DISTANCE

The aim of this project was to determine the effect of patient position on the L5-L6 mid-laminar distance (MLD). The lumbar area of 22 recently euthanatized dogs of various breeds was radiographed in three positions: lateral recumbency with the spine in neutral position, lateral recumbency with the spine flexed in a kyphotic position, and sternal recumbency with the spine flexed in a kyphotic position. Digital images of the radiographs were analyzed using a computer program that allowed measurement of the MLD between L5-L6 in the three positions. The L5 and L6 MLD was significantly larger in sternal recumbency with the spine flexed (142.3 units) than both in lateral recumbency with the spine flexed (138.7 units; P= 0.001) and lateral recumbency with the spine in the neutral position (135.8 units; P < or = 0.001). The MLD in lateral recumbency with the spine flexed was significantly larger than in lateral recumbency with the spine in neutral position (P = 0.005). Positioning a dog in sternal recumbency with the spine flexed produces a significantly larger MLD than in lateral recumbency with the spine flexed; this should simplify needle placement when performing a lumbar puncture.     

RADIOGRAPHIC GASTROINTESTINAL ANATOMY OF THE FOAL*

The purposes of this study were to evaluate a technique for contrast gastrointestinal (GI) radiography and to define the normal radiographic anatomy of the foal GI tract as demonstrated by survey and contrast radiography. GI studies were performed in five normal foals. Right lateral standing, right and left lateral recumbent, and ventrodorsal (dorsal recumbent) radiographs were evaluated. The recumbent lateral and ventrodorsal positions were preferred, although the right lateral standing position demonstrated most structures. Radiographic positions that clearly identified a specific GI region were determined. The dosage of contrast medium used (5 ml/kg of a 30% wt/vol barium suspension) was adequate to outline the GI tract. Transit times allowed evaluation of the large colon within eight hours.     

Relationship between scintigraphic and radiographic evaluations of spinous processes in the thoracolumbar spine in riding horses without clinical signs of back problems

REASONS FOR PERFORMING STUDY: Radiography and scintigraphy are used to aid diagnosis of the cause of back pain, but a large variation in appearance and radiopharmaceutical uptake in fully functioning horses make diagnosis difficult. OBJECTIVES: To describe the range of and compare scintigraphic and radiographic findings in the spinous processes of horses without clinical signs of back problems. METHODS: Thirty-three apparently normal riding horses underwent scintigraphic and radiographic examinations of the spinous processes in the thoracolumbar spine. Scintigraphic images were evaluated in a continuous blue, green and red colour scale, and the level of radiopharmaceutical uptake in the spinous processes from T10-L2 was graded into none, mild, moderate or severe increased radiopharmaceutical uptake. Structural changes along the borders of the spinous processes and the width of the interspinous spaces from T10-L2 were recorded. RESULTS: Only 7 horses had no scintigraphic or radiographic findings. Nine horses had no increased radiopharmaceutical uptake, 17 had no sclerosis, 21 had no radiolucencies and 11 had normal spacing of the spinous processes (>4 mm wide). The majority of findings in 26 horses were located from T13-18 and were mild. CONCLUSIONS: The findings of a wide spectrum of scintigraphic and radiographic changes leads to the conclusion that changes within this range found in affected horses cannot be interpreted as clinically significant. POTENTIAL RELEVANCE: To determine whether scintigraphy and/or radiography can be used to separate horses with back pain from horses without clinical signs, the results from this study should be compared to the scintigraphic and radiographic findings in horses with clinical signs.     

MAGNETIC RESONANCE IMAGING OF PRESUMPTIVE LUMBOSACRAL DISCOSPONDYLITIS IN A DOG

A three-year-old male Boxer dog had hyperesthesia, symmetrical epaxial, gluteal and hind limb muscular atrophy and rear limb ataxia. Neurological deficits included decreased conscious proprioception of the left hind limb, decreased withdrawal and increased patellar reflexes of both hind limbs. The dog had a urinary tract infection with positive culture for Staphylococcus intermedius. On survey radiography of the lumbosacral spine there was active bone proliferation spanning the L7 S1 intervertebral disc space with an epidural filling defect at the ventral aspect of the vertebral canal on epidurography, On magnetic resonance imaging (MRI), findings were similar to those described for human diskospondylitis including altered signal intensity and nonuniform contrast enhancement of the L7-S1 intervertebral disc, adjacent vertebral end plates and epidural and sublumbar soft tissues. Although skeletal radiography is usually sufficient to reach a diagnosis of discospondylitis, MRI of this patient made it possible to reach a presumptive diagnosia of discospondyltis prior to development of definitive radiographic abnormalties.     

COMPARISON OF RADIOGRAPHY AND COMPUTED TOMOGRAPHY FOR THE DIAGNOSIS OF CANINE NASAL ASPERGILLOSIS

To compare the radiographic and computed tomographic (CT) findings and to evaluate the sensitivity of radiography and CT for diagnosis of nasal aspergillosis in dogs, the radiographic and CT studies of 48 dogs with chronic nasal disease were reviewed separately. The radiographic and CT findings were recorded, and a diagnosis was made. The results obtained in the dogs with nasal aspergillosis (n = 25) were used. Based on definite aspergillosis as diagnosis, CT had a sensitivity of 88% and radiography of 72%. Considering definite and probable aspergillosis as equivalent, CT had a sensitivity of 92% and radiography of 84%. The sensitivity was higher in dogs with lesions affecting the entire nasal cavity and frontal sinus on at least one side (n = 20) with a sensitivity of 100% for CT and 90-95% for radiography than in dogs with lesions restricted to the nasal cavities (n = 5) where CT had a sensitivity of 60-80% and radiography of 0-40%. CT was superior to radiography for evaluation of the nasal cavities (mucosal thickening along the nasal bones, surrounding bone hyperostosis/lysis), frontal sinuses (mucosal thickening along the frontal bone, fluid/soft tissue, frontal bone hyperostosis/lysis), and differentiation between a cavitated-like or a mass-like process. This study suggests that CT is more sensitive than radiography for diagnosis of nasal aspergillosis in the dog because of a better demonstration of some changes suggestive of nasal aspergillosis. A diagnosis of a nasal aspergillosis restricted to the nasal cavities or associated with an FB is challenging, even with the use of CT.     

Correlation between radiographie and arthroscopic findings in the equine carpus

The radiographic and arthroscopic findings in 150 carpal joints in 114 lame horses were compared. Chip, slab, or sagittal fractures were identified in 130 (87%) joints. In 101 (78%) of these there was good agreement between radiographic and arthroscopic findings on the number and position of fractures. In 23 (18%) joints, chip fractures additional to those seen radiographically were found arthroscopically. In one joint a large chip fracture from the craniolateral aspect of the distal radius was identified only by arthroscopy, while in 6 joints fractures were identified only by radiography. Observed causes of lameness, other than intra-articular fractures, included degenerative joint disease, synovitis, ruptured intra-carpal ligaments, and haemarthrosis. Correlation between the radiographic and arthroscopic assessment of degenerative joint disease was poor. It was concluded that both radiography and arthroscopy should be used to obtain the most accurate assessment of the equine carpus.     

Thoracic vertebral chordoma in a domestic ferret (Mustela putorius furo).

A castrated adult male 1.0-kg domestic ferret (Mustela putorius furo) was referred for evaluation of a mass of >5 mo duration that was associated with the thoracic spine. The ferret had motor dysfunction and no conscious proprioception or pain perception in either hind limb. Segmental reflexes were present. Survey radiography, myelography, and magnetic resonance imaging showed a mass involving the ninth and 10 thoracic vertebrae and compressing the spinal cord. Decompressive surgery was performed, but clinical signs persisted. A diagnosis of chordoma was made using histopathology and immunohistochemistry. This is the first reported case of a chordoma involving the thoracic vertebrae in a domestic ferret.