Endoscopic anatomy of the cervical vertebral canal in the horse: a cadaver study

Reason for performing study: Localisation of spinal cord compression in horses with cervical vertebral stenotic myelopathy is inexact. Vertebral canal endoscopy has been used in man to localise spinal cord lesions and has the potential to become a useful diagnostic technique in horses. Objective: To establish a surgical approach via the atlanto‐occipital space to the cervical vertebral canal in equine cadavers and describe the endoscopic anatomy of the cervical epidural and subarachnoid spaces. Methods: The cadavers of 25 mature horses were used to assess 3 surgical methods to approach the cervical vertebral canal, including 2 minimally invasive and one open technique. Once the approach had been made, a flexible videoendoscope was inserted into the epidural space (epiduroscopy) or the subarachnoid space (myeloscopy) and advanced caudally until the intervertebral space between C7 and T1 was reached. Results: The epidural and subarachnoid spaces could not be accessed reliably using the minimally invasive techniques. Furthermore, damage to the nervous tissues was a frequent complication with these procedures. The open approach allowed successful insertion of the videoendoscope into the epidural and subarachnoid spaces in all horses and no inadvertent damage was observed. Anatomical structures that could be seen in the epidural space included the dura mater, nerve roots, fat and the ventral internal vertebral venous plexus. In the subarachnoid space, the spinal cord, nerve roots, blood vessels, denticulate ligaments and external branch of the accessory nerve were seen. Conclusions: Using the open approach, epiduroscopy and myeloscopy over the entire length of the cervical vertebral canal are possible in the mature horse. Potential relevance: Cervical vertebral canal endoscopy may become a valuable tool to localise the site of spinal cord injury in horses with cervical vertebral stenotic myelopathy and could aid in the diagnosis of other diseases of the cervical spinal cord.     

Cervical vertebral canal endoscopy in the horse: intra- and post operative observations

Reasons for performing study: Despite modern medical diagnostic imaging, it is not possible to identify reliably the exact location of spinal cord compression in horses with cervical vertebral stenotic myelopathy (CVSM). Vertebral canal endoscopy has been successfully used in man and a technique for cervical vertebral canal endoscopy (CVCE) has been described in equine cadavers. Objective: To determine the feasibility and safety of CVCE in healthy mature horses. Methods: Six healthy mature horses were anaesthetised. A flexible videoendoscope was subsequently introduced via the atlanto‐occipital space into the epidural space (epiduroscopy, Horses 1–3) or the subarachnoid space (myeloscopy, Horses 4–6) and advanced to the 8th cervical nerve. Neurological examinations were performed after surgery and lumbosacral cerebrospinal fluid (CSF) analysed in horses that had undergone myeloscopy. Results: All procedures were completed successfully and all horses recovered from anaesthesia. Anatomical structures in the epidural space (including the dura mater, nerve roots, fat and blood vessels) and subarachnoid space (including the spinal cord, blood vessels, arachnoid trabeculations, nerve roots and the external branch of the accessory nerve) were identified. During epiduroscopy, a significant increase in mean arterial pressure was recognised, when repeated injections of electrolyte solution into the epidural space were performed. In one horse of the myeloscopy group, subarachnoid haemorrhage and air occurred, resulting in transient post operative ataxia and muscle fasciculations. No complications during or after myeloscopy were observed in the other horses. CSF analysis indicated mild inflammation on Day 7 with values approaching normal 21 days after surgery. Conclusions: Endoscopic examination of the epidural and subarachnoid space from the atlanto‐occipital space to the 8th cervical nerve is possible and can be safely performed in healthy horses. Potential relevance: Cervical vertebral canal endoscopy might allow accurate identification of the compression site in horses with CVSM and aid diagnosis of other lesions within the cervical vertebral canal.     

Gait abnormalities and ridden horse behaviour in a convenience sample of the United Kingdom ridden sports horse and leisure horse population

The objectives of this study were to compare horses’ gaits in hand and when ridden; to assess static and dynamic saddle fit for each horse and rider; to apply the Ridden Horse Pain Ethogram (RHpE) and relate the findings to gait abnormalities consistent with musculoskeletal pain, rider position and balance and saddle fit; and to document noseband use and its relationship with mouth opening during ridden exercise. Data were acquired prospectively from a convenience sample of horses believed by their owners to be working comfortably. All assessments were subjective. Gait in hand and when ridden were evaluated independently, by two assessors, and compared using McNemar’s test. Static tack fit and noseband type were recorded. Movement of the saddle during ridden exercise, rider position, balance and size relative to the saddle was documented. RHpE scores were based on assessment of video recordings. Multivariable Poisson regression analysis was used to determine factors which influenced the RHpE scores. Of 148 horses, 28.4% were lame in hand, whereas 62.2% were lame ridden (P<0.001). Sixty per cent of horses showed gait abnormalities in canter. The median RHpE score was 8/24 (interquartile range 5, 9; range 0, 15). There was a positive association between lameness and the RHpE score (P<0.001). Riding School horses had higher RHpE scores compared with General Purpose horses (P = 0.001). Saddles with tight tree points (P = 0.001) and riders seated at the back of the saddle rather than the middle (P = 0.001) were associated with higher RHpE scores. Horses wearing crank cavesson compared with cavesson nosebands had higher RHpE scores (P = 0.006). There was no difference in mouth opening, as defined by the RHpE, in horses with a noseband with the potential to restrict mouth opening, compared with a correctly fitted cavesson noseband, or no noseband. It was concluded that lameness or gait abnormalities in canter may be missed unless horses are assessed ridden.     

Cervical vertebral canal endoscopy in a horse with cervical vertebral stenotic myelopathy

A 3-year-old Thoroughbred gelding presented with a history of neurological signs, including incoordination in his hindlimbs, of about 7 months' duration. On initial examination, the horse exhibited ataxia and paresis in all limbs with more severe deficits in the hindlimbs. Cervical radiographs displayed severe osteoarthritis of the articular processes between C5 and C6. On subsequent cervical myelography the dorsal contrast column was reduced by 90% at the level of the intervertebral space between C5 and C6. Cervical vertebral canal endoscopy, including epidural (epiduroscopy) and subarachnoid endoscopy (myeloscopy), was performed under general anaesthesia. A substantial narrowing of the subarachnoid space at the level between C6 and C7 was seen during myeloscopy, while no compression was apparent between C5 and C6. Epiduroscopy showed no abnormalities. After completion of the procedure, the horse was subjected to euthanasia and the cervical spinal cord submitted for histopathological examination. Severe myelin and axon degeneration of the white matter was diagnosed at the level of the intervertebral space between C6 and C7, with Wallerian degeneration cranially and caudally, indicating chronic spinal cord compression at this site. Myeloscopy was successfully used to identify the site of spinal cord compression in a horse with cervical vertebral stenotic myelopathy, while myelography results were misleading.     

Desmectomy of a septic accessory ligament of the deep digital flexor tendon in the hindlimb of a horse under standing sedation

A horse presented with a discharging wound over the proximal aspect of the right metatarsal region. Examination, radiography and ultrasonography diagnosed a septic process within the accessory ligament of the deep digital flexor tendon (ALDDFT). Due to previous unsuccessful treatment with systemic antibiotics as well as financial restrictions, an ALDDFT desmectomy was performed with the patient under standing sedation and local analgesia. Histopathology confirmed the septic process within the affected structure. The patient made a rapid recovery and was discharged from the hospital 7 days post operatively and 2 years later was still in full work. This report describes the first case of infective hindlimb ALDDFT and the first desmectomy of this structure performed under standing sedation.     

A new approach for perineural injection of the lateral palmar nerve in the horse

OBJECTIVE: To evaluate the accuracy of a new technique for perineural injection of the lateral palmar nerve and to determine frequency of inadvertent injection into the carpal synovial sheath with this technique. STUDY DESIGN: Prospective experimental study. ANIMALS: Thirty equine cadaver forelimbs. METHODS: Each of 3 clinicians injected 0.5 mL of a 1% aqueous solution of new methylene blue as a marker at the medial aspect of the accessory carpal bone of 10 limbs. Immediately after each injection, the lateral palmar nerve was identified by dissection of and inspected for proximity of dye, and the carpal synovial sheath was inspected for the presence of dye. RESULTS: New methylene blue solution was observed to surround the nerve (29 limbs) or to lie within 2 mm of it (1 limb). Dye was not found in the carpal synovial sheath of any specimen. CONCLUSIONS: Using this technique, perineural injection of the lateral palmar nerve can be consistently achieved, and the carpal synovial sheath is unlikely to be penetrated by the needle during the procedure. CLINICAL RELEVANCE: The technique described provides an accurate and simple method for perineural injection of the lateral palmar nerve proximal to the origin of its deep branch. This technique can be used to anesthetize the lateral palmar nerve for diagnosis of pain originating in the palmaroproximal aspect of the metacarpus without risk of inadvertently desensitizing structures within the carpal synovial sheath.     

Traumatic neuroma of the medial palmar nerve as a possible cause of a severe gait abnormality in a Warmblood riding horse

This paper describes the history, examination and clinical findings in a riding horse with a gait abnormality. The lesion was localised to the carpal area of one of the forelimbs, but could not be properly characterised until post mortem examination, when a diagnosis of a traumatic neuroma of the medial palmar nerve could be reached. Thus, the most plausible explanation for the gait abnormality of the horse was found in the peripheral nervous system.     

The foot–surface interaction and its impact on musculoskeletal adaptation and injury risk in the horse

The equine limb has evolved for efficient locomotion and high‐speed performance, with adaptations of bone, tendon and muscle. However, the system lacks the ability seen in some species to dynamically adapt to different circumstances. The mechanical interaction of the limb and the ground is influenced by internal and external factors including fore–hind mass distribution, lead limb, moving on a curve, shoeing and surface properties. It is unclear which of the components of limb loading have the largest effect on injury and performance but peak load, impact and vibration all play a role. Factors related to the foot–ground interface that limit performance are poorly understood. Peak performance varies vastly between disciplines but at high speeds such as racing and polo, force and grip are key limits to performance.     

Use of ethanol in the treatment of distal tarsal joint osteoarthritis: 24 cases

Reasons for performing this study: Intra‐articular ethanol has been described to promote distal tarsal joint ankylosis. Its use and results in clinical cases affected by osteoarthritis (OA) have not been reported. Objectives: To describe and evaluate the results of treatment of distal tarsal joint OA by facilitated ankylosis stimulated by intra‐articular ethanol injection. Methods: Twenty‐four horses met the inclusion criteria of tarsometatarsal and centrodistal joint OA diagnosed by a positive response to intra‐articular analgesia, radiographic evaluation and recurrence of lameness ≤4 months after intra‐articular medication with a corticosteroid. Horses were sedated and, following a radiographic contrast study of the tarsometatarsal joint, medication with 2–4 ml of either 100% pure ethanol (G100) or a 70% ethanol (G70) solution was applied. Horses were classified as improved based on a 50% reduction from initial lameness grade combined with an increase in exercise level. Results: Of the 24 horses included in this study, 20 had the treatment performed bilaterally and 4 unilaterally. All horses were available for initial follow‐up examination and 21 for a second one 6–9 months after treatment. This represented a total of 44 treated limbs and 35 available for long‐term follow‐up. Of these, 21/35 (60%) were considered improved, which corresponds to 11/21 horses (52%). Of 21 horses, 4 (19%) deteriorated and 2 of these developed significant complications related to treatment. Conclusions: Distal tarsal joint ankylosis with ethanol should be considered a safe and economic treatment in cases of distal tarsal joint OA that fail to show long‐term improvement with intra‐articular corticosteroid treatment. Potential relevance: Ethanol should be considered in the treatment of certain cases of distal tarsal joint OA. The importance of performing an adequate radiographic contrast study of the tarsometatarsal joint prior to treatment is highlighted.     

Function of the ramus communicans of the medial and lateral palmar nerves of the horse

Reasons for performing study: The role of the communicating branch between the medial and lateral palmar nerves of horses (i.e. the ramus communicans) in conveying sensory impulses proximally should be determined to avoid errors in interpreting diagnostic anaesthesia of the palmar nerves. Hypothesis: Sensory nerve fibres in the ramus communicans of horses pass proximally from the lateral palmar nerve to merge with the medial palmar nerve, but not vice versa. Objective: To determine the direction of sensory impulses through the ramus communicans between lateral and medial palmar nerves. Methods: Pain in a thoracic foot was created with set‐screw pressure applied to either the medial or lateral aspect of the sole of each forelimb of 6 horses. The palmar nerve on the side of the sole in which pain was created was anaesthetised proximal to the ramus communicans with local anaesthetic. Lameness was evaluated objectively by using a wireless, inertial, sensor‐based, motion analysis system (Lameness Locator). Lameness was also evaluated subjectively by using a graded scoring system. Local anaesthetic was then administered adjacent to the ramus communicans to determine the effect of anaesthesia of the ramus communicans on residual lameness. Results: When pain originated from the medial or the lateral aspect of the sole, anaesthesia of the ipsilateral palmar nerve proximal to the ramus communicans did not entirely resolve lameness. Anaesthesia of the ramus communicans further attenuated or resolved lameness. Conclusions: Sensory fibres pass in both directions in the ramus communicans to connect the medial and lateral palmar nerves. Potential relevance: When administering a low palmar nerve block, both palmar nerves should be anaesthetised distal to the ramus communicans to avoid leaving nondesensitised sensory nerve fibres passing through this neural connection. Alternatively, local anaesthetic could also be deposited adjacent to the ramus communicans when anaesthetising the palmar nerves.     

Evidence of the development of ‘domain‐restricted’ expertise in the recognition of asymmetric motion characteristics of hindlimb lameness in the horse

Reasons for performing study: Visual assessment of horses' movements is subjective, affected by bias and dependent on the level of experience of the assessor. However, to date there are no data available on the ability of the human visual system to recognise (a)symmetry in moving objects. Objectives: To investigate, using visual lameness assessment, the limits of human perception and the ability of experienced and nonexperienced individuals to detect asymmetry in 2 moving objects simulating hindlimb lameness in the horse. Methods: Twelve experienced individuals (equine and small animal clinicians), and 24 nonexperienced individuals (undergraduate veterinary students) were presented with computer simulations showing 2 ‘tuber coxae markers’ created using data from both lame and nonperceptibly lame horses, as well as artificial data based on a sine wave. Individuals were asked to classify as symmetrical or asymmetrical, and then rank based on the grade of perceived asymmetry. Repeatability and learning effect were evaluated by repeating the tests on a subset of subjects. Results: The threshold for detection of movement asymmetry was found to be approximately 25% difference in amplitude between the 2 moving objects for all individuals. There was no significant difference between experienced and nonexperienced individuals in the ability to detect asymmetry in the simulations based on artificial data. However, the percentage of correct answers was higher for experienced compared to nonexperienced individuals for simulations based on data from real lame horses. Conclusions: There was a significant difference between experienced and nonexperienced individuals in the ability to identify asymmetric movement based on the pattern seen in a lame horse, as opposed to an artificial pattern for which all individuals showed similar performance. Potential relevance: The study provides the basis for the development of computer simulations that could aid in training veterinarians in the diagnosis of lameness and, even, the objective assessment of expertise in this field.