Overriding vertebral spinous processes in the extinct horse, Equus occidentalis

Lumbar and thoracic vertebrae of the extinct horse, Equus occidentalis, were examined for gross and radiographic evidence of overriding spinous processes. Of 2,661 vertebrae examined, 580 had intact spinous processes. Thirty-six intact spinous processes, which appeared grossly similar to overriding spinous processes in the modern domestic horse, E caballus caballus, were radiographed. Of these 36 vertebrae, 2 had radiographic signs compatible with a radiographic diagnosis of overriding spinous processes, ie, radiographically observed lysis and/or sclerosis. Seemingly, weight bearing or other stresses imposed by human beings may not have induced the signs of overriding spinous processes.     

COMPARISON OF RADIOGRAPHIC AND SCINTIGRAPHIC FINDINGS OF THE SPINOUS PROCESSES IN THE EQUINE THORACOLUMBAR REGION

Back pain is common in horses, but there has been no large‐scale in‐depth study describing radiographic changes of the spinous processes, the relationship between radiographic and scintigraphic findings, and the effect of size, age, breed, or discipline. The objectives were to investigate the frequency of occurrence in horses with perceived back pain of: (1) radiographic alteration of the spinous process structure; (2) increased radiopharmaceutical uptake (IRU) in the spinous processes; and (3) to compare radiographic and scintigraphic findings; and to determine if there was breed, gender, age, bodyweight, height, or work discipline predisposition for close, impinging, or overriding spinous processes. Radiographic and scintigraphic images of the thoracolumbar spine of 604 horses were graded. A radiographic grade for each spinous process (T8–L6) was assigned (0–7). The maximum radiographic grade for each horse was defined as the highest grade assigned to any spinous process; the total radiographic grade was the sum of all grades for each horse. A scintigraphic grade for each spinous process was determined (0–3). The maximum scintigraphic grade for each horse was defined as the highest grade assigned to any spinous process; the total scintigraphic grade was the sum of all grades for each horse. Associations between radiology and scintigraphy and age, gender, breed, height, weight, and discipline were analyzed statistically. The severity of radiographic lesions of the spinous processes was associated with the severity of scintigraphic abnormalities. The caudal thoracic spine (T14–T17) was most frequently affected. There was a significant breed and age effect, with Thoroughbreds and older horses having higher total and maximum radiographic grades. The severity of the lesions of the spinous processes was significantly associated with the presence of osteoarthritis of the articular process joints. It was concluded that there is a wide range of radiographic abnormalities of the spinous processes seen in horses with or without back pain. There is an association between radiographic and scintigraphic grades of the spinous processes.     

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.     

Dorsal spinous process impingement syndrome ('kissing spine') in a cat: imaging appearance and surgical management

Spinal pain is an important clinical presentation in feline patients, but the underlying causes can often be difficult to elucidate. Dorsal spinous process impingement syndrome ('kissing spine' or in human patients 'Baastrup syndrome') is a significant cause of spinal pain in equine and human patients and radiographically is characterised by a close approximation of adjacent spinous processes with reactive bone sclerosis affecting these spinous processes. In this report we describe the first reported case of dorsal spinous process impingement syndrome in a cat causing spinal pain, and successful surgical management of the syndrome. The affected cat presented at 5 years of age for evaluation of a 7-month history of progressive thoracolumbar pain. Radiographs revealed close approximation of the dorsal spinous processes of the seventh, eighth and ninth thoracic vertebrae (T7, T8 and T9), with associated reactive bone sclerosis. Surgical resection of the T8 dorsal spinous process resulted in complete resolution of the clinical signs with no evidence of recurrence 9 months after surgery.     

THE EFFECTS OF ROTATION ON THE RADIOGRAPHIC APPEARANCE OF THE CANINE CARDIAC SILHOUETTE IN DORSAL RECUMBENCY

Cardiac mensuration was done on thoracic radiographs of Beagles to determine the effects of rotation on the cardiac silhouette in dorsal recumbency. As the thorax became more rotated, surfaces of the heart not normally seen were projected, making interpretation of cardiac changes unreliable. A positioning standard based on the relationship of the dorsal spinous processes to the vertebral body was developed. If the tips of the dorsal spinous processes were within the bounds of the vertebral bodies, the radiographs were suitable for cardiac interpretation. If the tips of the dorsal spinous processes were outside the bounds of the vertebral bodies, there was enough rotation to make interpretation unreliable. A microcomputer, digitizer pad, and a BASIC language program were used to input, store, and calculate the various cardiac mensuration parameters.     

Effect of Application of Polyvinilidine Plates on the Dorsal Spinous Processes of Dogs

Anecdotal comments in the literature suggest that spinous fracture many weeks after application of polyvinilidine plates to the dorsal spinous processes of dogs may be due to associated adverse vascular changes. This study was undertaken to evaluate that hypothesis. Large size Lubra plates were cut to the appropriate length and applied to the dorsal spines of vertebrae L3 and L4. Vertebrae L2 and L5 served as operated controls. Vertebrae L1 and L6 served as unoperated normals. Two dogs were euthanized 1 week postoperatively, and three dogs each at 4, 8, and 12 weeks. The effect of the plate on the dorsal spinous processes was evaluated using microangiography and correlated histology. There was no apparent change in vascular architecture associated with plate application, nor with surgery alone, at any time interval. There did appear to be a time dependent loss of bone associated with plate application, indicating a change in the relative balance of osteoblastic and osteoclastic activity, and altered bone turnover.     

The Use of Plastic Plates for Fixation of Spinal Fractures in the Dog

Plastic plates are a rapid and easy method to realign and stabilize the spinal column following a traumatic injury and may give greater bone-to-plate contact than metal plates. They distribute the pressure on the spinous processes over a larger surface area although plate slippage and spinous process fractures can occur as with any plate. Laminectomies should not be a routine procedure with plating but each patient should be evaluated individually and autogenous bone grafts may be used to advantage to promote fusion of vertebral bodies. In the two cases presented, the plastic plates achieved their purpose. However, it is essential that fusion of the vertebrae occurs before the plates slip or the spinous processes fracture.     

Histologic Evaluation of Response to Implantation of Polyvinilidine Plates in Dogs and Rats

The effect of implantation of polyvinilidine spinal plates was studied when placed on spinous processes of 11 mixed breed dogs and when placed within the thoracolumbar musculature of 12 male white rats. Specimens were also obtained from soft tissues adjacent to polyvinilidine plates 2 to 3 months after clinical surgery to repair spinal subluxations in three dogs. A similar pattern of dense, organized fibrous tissue interspersed with focal congregations of lymphocytes, plasma cells, and multinucleated giant cells was observed in the dog experiment, rat experiment, and in all clinical cases. Birefringent debris with polarization patterns identical to small slivers of polyvinilidine was associated with the observed reactions. It would appear that either a chemical or physical characteristic of the plates elicited this foreign body reaction. Grooving the inner surface of the plates, which is performed to increase the friction grip when applied to spinous processes, may make the surface texture of the plate more reactive or it may predispose the surface of the plate to minute fragmentation ("wear products").     

Modified Segmental Spinal Instrumentation in Repair of Spinal Fractures and Luxations in Dogs

A modified segmental spinal stabilization technique was used in four dogs weighing 10 to 56 kg with thoracolumbar and lumbosacral spinal fractures/luxations. A Steinmann pin was bent to encircle the dorsal spinous processes and was wired together with longitudinal pins to the cranial articular facets and dorsal spinous processes in the thoracolumbar application. The central pin was omitted, and the longitudinal pins were bent at a right angle and passed through the ilial wings in the lumbosacral application. Fracture fixation and stabilization were excellent in all dogs. One broken pin was detected in one dog after 18 months. No other complications due to the spinal instrumentation were observed. Neurologic recovery was excellent in two dogs, good in one dog, and fair in one dog.     

Radiographic Features of the Normal Equine Thoracolumbar Spine

The normal radiographic anatomy of the equine thoracolumbar (TL) spine is described from birth to maturity. Closure of the vertebral epiphyses was found to take place from 30 to 38 months of age. In a series of 110 normal horses, there were few incidental radiologic abnormalities seen apart from changes associated with crowding and overriding of the dorsal spinous processes. Sixty-six percent of horses were free from any detectable radiologic lesion, and an additional 12 percent showed only impingement of the dorsal tips of one or more summits. The remainder (22 percent) exhibited some evidence of overriding of the dorsal spinous processes, but in only 3 percent were the changes pronounced. This reduction or obliteration of the normal interspinous spaces occurred chiefly in the midback from T13 to T18 and was associated with pressure points between adjacent spines with local periosteal reaction and focal areas of radiolucency. The tips of the processes sometimes overlapped one another and became misshapen, presumably as a result of continued pressure from the adjacent impinging spines.     

Locking compression plate osteosynthesis of sacral fractures in three heifers

Objective: To describe a technique used for reduction and internal fixation of sacral fractures in cattle. Study Design: Case series. Animals: Three heifers aged 19–32 months with deformation of the tail head and tail paralysis attributable to a closed fracture of S5 or S4 and S5. Methods: Fractures were reduced and repaired under general anesthesia. A narrow, 6–10‐hole, locking compression plate (LCP) was placed on the spinous processes of S5 and the first coccygeal (Co1) using 5.0 mm locking head screws. Follow‐up inquiries were made by telephone (3/3), and cows were examined clinically and radiographically 2 (1 cow) to 9 (1cow) months postoperatively. Results: No complications were encountered. The range of movement of the tail improved so that soiling of the tail during defecation was no longer a problem. In all heifers, the normal top line was restored and there was no narrowing of the pelvic canal. Unassisted calving occurred in all heifers, and follow‐up radiographs for 2 cows showed complete fracture healing. Conclusion: LCP‐osteosynthesis of the spinous processes provided sufficient stability for internal fixation of sacral fractures. Marked improvement in tail function occurred postoperatively without decompression by laminectomy.     

Ultrasonographic evaluation of back lesions.

With progressive advances in ultrasonographic equipment, evaluation of a number of axial skeletal structures is now possible. Ultrasonography is presently the best technique for evaluation of the SSpL and lumbosacral intervertebral discs. It is a useful adjunct to radiography for assessment of spinous processes and AP injuries.     

Surgical resection of an osteoma of two thoracic spinous processes in a horse

This report describes the successful surgical removal of an osteoma of the thoracic dorsal spinous processes of a horse that presented with back pain. Osteomas of the spine are frequently reported in the literature in people, but have not been previously described in the horse.     

Distances between thoracic spinous processes in Warmblood foals: A radiographic study

Reason for performing study: The aetiological factors behind impinged or overriding of dorsal spinous processes (‘kissing spine syndrome’, KSS) are not clearly understood. Back conformation, breed, age, training and gender may play important roles in this condition. Radiographic changes vary and abnormalities are seen in many clinically normal horses, but the conclusion of previous studies in mature horses is that interspinous spaces <4 mm are considered too narrow and potentially indicative of KSS. Objectives: To evaluate whether narrowing of the interspinous space was present in a population of normal Warmblood foals. Materials and methods: The mean interspinous space width in the area of T10–L1 was measured on radiographs from 25 Warmblood foals aged 9–88 days. Results: Mean ± s.d. interspinous space width was found to be between 5.9 ± 1.2 and 8.9 ± 2.6 mm with the narrowest space in the area T16–T17 and the widest space in T10–T12. No interspinous spaces were <4 mm wide. Gender and location of the interspinous space significantly affected the width of the distance between the spinous processes. Conclusions and potential relevance: In this study none of the interspinous spaces were <4 mm and therefore none of the foals showed signs of impinged or overriding of dorsal spinous processes known as KSS based on the current definitions. Consequently, in this population, there did not appear to be a congenital narrowing of the interspinous space. However, long‐term follow‐up studies, including detailed information on imposed factors such as training, are needed in order to further elucidate a possible congenital component in the aetiology of KSS.     

Symposium on back problems in the horse. (3) Diseases of the horse's spine-"comparative aspects".

The structural differences in the spine of the horse and man are compared. These, together with the different uses to which the spine is put, explain the different patterns of disease. Impingement of the spinous processes is discussed in detail including surgical treatment. Comments are also made on sacroiliac strain and manipulation of the spine.     

Structure and Innervation of the Equine Supraspinous and Interspinous Ligaments

Pain related to the osseous thoracolumbar spine is common in the equine athlete, with minimal information available regarding soft tissue pathology. The aims of this study were to describe the anatomy of the equine SSL and ISL (supraspinous and interspinous ligaments) in detail and to assess the innervation of the ligaments and their myofascial attachments including the thoracolumbar fascia. Ten equine thoracolumbar spines (T15‐L1) were dissected to define structure and anatomy of the SSL, ISL and adjacent myofascial attachments. Morphological evaluation included histology, electron microscopy and immunohistochemistry (S100 and Substance P) of the SSL, ISL, adjacent fascial attachments, connective tissue and musculature. The anatomical study demonstrated that the SSL and ISL tissues merge with the adjacent myofascia. The ISL has a crossing fibre arrangement consisting of four ligamentous layers with adipose tissue axially. A high proportion of single nerve fibres were detected in the SSL (mean = 2.08 fibres/mm²) and ISL (mean = 0.75 fibres/mm²), with the larger nerves located between the ligamentous and muscular tissue. The oblique crossing arrangement of the fibres of the ISL likely functions to resist distractive and rotational forces, therefore stabilizing the equine thoracolumbar spine. The dense sensory innervation within the SSL and ISL could explain the severe pain experienced by some horses with impinging dorsal spinous processes. Documentation of the nervous supply of the soft tissues associated with the dorsal spinous processes is a key step towards improving our understanding of equine back pain.     

Fistulous withers in horses: 14 cases (1978-1987)

Over an 8-year period, 14 horses were admitted to the New York State College of Veterinary Medicine for evaluation of fistulous withers. Of the 14 horses, 11 were treated surgically and 3 were not treated. Surgical techniques involved radical excision of the affected soft tissue and spinous processes of affected vertebrae. Recurrence rate was 30%, and these horses required additional surgery to resolve the problem.     

Repair of transverse process fractures of multiple lumbar vertebrae in an adult dairy cow

Objective: To report lumbar vertebrae transverse process fracture repair using a narrow 3.5 mm limited contact dynamic compression plate (LC‐DCP) in an adult dairy cow. Study Design: Case report. Animals: A 3‐year‐old Holstein cow. Methods: Under general anesthesia, fractured left transverse processes of lumbar vertebrae 2–4 were repaired using internal fixation. A narrow 3.5 mm LC‐DCP was contoured and secured to the spinous process and the transverse process of each fractured vertebra. Results: Fractured transverse processes of the lumbar vertebrae were successfully repaired and the cow discharged 10 days after surgery. At 10 months after surgery, the cow was declared reserved champion at a regional show. Conclusion: A paramedian approach and muscle splitting can be used to repair multiple lumbar transverse process fractures using internal fixation with an excellent cosmetic outcome.     

SCINTIGRAPHIC EVALUATION OF THE THORACIC SPINE IN THE ASYMPTOMATIC RIDING HORSE

Scintigraphic evaluation of the spinous processes of the equine spine has been done by subjective evaluation of radiotracer uptake in clinically abnormal horses. To determine the range of variation in asymptomatic riding horses, 33 normal horses were examined. Two 60 degrees oblique views of the thoracic and lumbar spine were evaluated subjectively, and a semi quantitative method based on standardized regions of interest in each spinous process in T10-L3 was also applied. A ratio between each spinous process and a reference area (Rib 15 or 16) was calculated. The effects of two different color displays and a smoothing filter were assessed. The results of the subjective evaluation was compared to the calculated ratios, and the associations between age, gender, weight, height, use and increased radiotracer uptake, and ratios were analyzed. No significant association was found between age, gender, weight, height, use and increased radiotracer uptake, or ratio. One or more areas of increased radiotracer uptake between T13 and T18 were common in the asymptomatic riding horse, which may have implications for the interpretation of clinical patients. The blue, green and red color display had a higher sensitivity for detecting increased radiotracer uptake compared to the continuous grayscale. The smoothing filter used in this study had no effect on the detection of areas with increased radiotracer uptake. The association between the results of the subjective evaluation and the semi quantitative method was apparent when analyzed in T13-17. To evaluate if the semi quantitative method can replace the subjective evaluation, studies on clinically affected horses are necessary.