LA Axial Skeleton: Cervical/Thoracolumbar/Pelvis Flashcards
describe the common history with axial skeleton pathology
- lameness: asymmetry
- poor performance
- change in behavior: abnormal/dangerous behaviors, ridden and non-ridden
- neurologic signs/weakness
describe the poor performance observed in horses with axial skeleton pathology
- lack of push (won’t move forward)
- collection, contact with bit
- wont bend in one direction or sometimes both
- bucking, rearing
- lateral movement
- difficulty with hills
- giving out- stifle weakness (client tells you this)
describe the diagnostic approach to the axial skeleton
- static:
-musculoskeletal palpation
-functional exam - lameness exam
-flexion tests
-+/- ridden exam - neurologic exam! lost of overlat between neuro and painful
describe the functional exam of the axial skeleton
- sternal lift: belly tickles, normal horses should lift through back; if horse tries to kick or bite = problem maybe in back
- lumbosacral tuck: scratch at lumbosacral region and see if can lift butt through that region of their back
- hindlimb circles: more specific SI test: pick hindlimb up and circle it around to see if can hold in that position or make the circles
- cervical spine:
-baited stretches (cookie stretches): to evaluate neck movement; but if see snacks horses will override pain to get snak so also
-palpate individual facet joints
what are commonly affected structures in the cervical spine?
- articular facet joints!! first is between C2-C3
- intervertebral discs (live in facet joints)
- spinal cord
- nerve roots!!
- nuchal bursa
- muscles
what are 5 common cervical disease processes?
- cervical facet OA
-nerve root impingement - compressive myelopathy (Wobblers)
- nuchal bursitis
- subluxations/luxations/fractures
- intervertebral disc disease
describe cervical facet OA
clinical signs/history:
1. neck stiffness and pain
2. won’t move neck normally
3. forelimb lameness: decreased cranial phase of stride
-esp if OA further down in neck
4. explosive behavior if sudden pain
5. difficulty with collection, bit contact (dressage)
6. neurologic deficits
diagnostics:
1. radiographs: myelogram
2. nuclear scintigraphy
3. CT: +/- contrast to see if involvement of structures on spinal cord itself
4. ultrasound: can look at surface of joint
treatment:
1. medical:
-IA injections (facet joints; steroids or biologics)
-nerve root injections
-complementary therapie (acupunture, chiropractic, laser ECSWT)
-medications: gabapentin, CBD
2. surgical:
-vertebral fusion
-foraminotomy
describe nuchal bursitis
clinical signs:
1. swelling behind poll
- +/- drainage tract
2. pain on palpation
3. poor performance
4. change in head carriage
diagnostics:
1. radiographs
2. ultrasound
3. CT
4. other (sample drainage)
treatment:
infectious:
1. debridement/lavage
2. anti-inflam: NSAIDs, cryotherapy
3. antimicrobials: systemic or local
non-infectious:
1. debridement/lavage
2. anti-inflam: NSAIDs, corticosteroids (local), cryotherapy
3. ECSWT
describe subluxations/luxations/fractures
clinical signs/history:
1. trauma
2. juvenile: born abnormal, or baby got head stuck somewhere
3. neck pain
4. abnormal head/neck carriage
5. ataxia that develops to paresis that develops to paralysis
diagnostics:
1. radiographs: limited with what views can have; more options in babies bc smaller
2. CT
treatment:
1. surgical stabilization
2. conservative: NSAIDs, stall rest
3. euthanasia
describe intervertebral disc disease
can be cervical, thoracolumbar, or lumbosacral
probs underdiagnosed due to imaging limitations in horses, CT helps ID
describe pathology of the thoracolumbar spine
clinical signs/history:
1. poor performance
2. ridden behavior changes
diagnostics: even more limited!
can only rads and ultrasound unless minihorse bc can’t fit in CT
affected structures:
1. dorsal spinous processes
2. articular facet oints
3. IV discs
4. nerve roots
5. muscles: multifidus muscle atrophies with thoracolumbar pain!!!! ON EXAM!!
fractures/sublux can have pretty severe clinical signs in this region
describe dorsal impingement of spinous processes (kissing spine) treatments
medical:
1. methocarbamol
2. local injections: corticosteroid
3. alternative therapies: acupuncture, chiropractics, ECSWT
4. core strengthening exercises
surgical:
1. intraspinous ligament desmotomy
2. ostectomy
describe treatment of thoracolumbar facet OA
- methocarbamol
- IA injections: corticosteroids, orthobiologics
- alternative
- core strengthening
describe thoracolumbar fractures
- traumatic: cranial thoracic
- maladaptive remodeling: common in quarter horse racehorses in the caudal lumbar region
describe pathology of the sacroiliac region (pelvis)
clinical signs/history:
1. poor performance
2. difficulty cantering, maintaining lead
3. gluteal pain
4. difficulty holding up hind feet
what 3 joints are associated with the SI region?
- SI joint
- inter-transverse joint (IT joint): wing of sacrum interacts with last transverse process of lumbar vertebrae
- lumbosacral (LS) joints: articular facets and LS disc
these joints get OA changes like osteophytes!
describe diagnostics of the sacroiliac region
hard! giant glutes get in the way and lack of abnormalities on imaging does not mean horse not have pain! eliminate other causes and use functional exam
- nuclear scintigraphy: so much muscle can = false negative though
- ultrasound: transrectally, but can only see a little bit; transcutaneous very limited
describe treatment of pathology in the sacroiliac region
- methocarbamol
- periarticular injections: corticosteroids and orthobiologics
- alternative therapies
- exercise/core exercises/turnout
describe coccygeal vertebral fractures
clinical signs/history:
1. trauma
2. swelling
3. loss of function
diagnostics:
1. palpation
2. radiographs
3. ultrasound
describe degenerative conditions
only post mortem findings currently
- dorsal root ganglioneuritis: axial skeleton pain, progressive
- equine degenerative myeloencephalopathy: progressive ataxia and behavioral changes
