Cervical dz Flashcards
(12 cards)
What 2 articulations exist between adjacent vertebrae?
- articular process joints (APJs) or facet joints
- intervertebral joints
What is the exit point for spinal nerve roots?
- intervertebral foramen
What are the 3 manifestations of cervical dz?
- neck pain/dysfunction
- forelimb lameness
- ataxia: cervical stenotic myelopathy
Neck pain - presentation/CE
- reduced RoM during baited stretches
- changes in position or posture
- palpation findings: enlarged joints
- reduction in muscle mass
What is a good lateral neck flexion?
- head remaining vertical
- minimal twisting of the neck
Forelimb lameness caused by cerical dz - 2 main mechanisms
- a consequence of muscle dysfunction
– many cervical muscles are involved in protraction of the forelimb
– brachiocephalicus: changes in strength or function can cause asymmetry - radiculopathy - neuropathic pain
– compression of a spinal nerve root in the caudal cervical region (feeding brachial plexus)
– enlarged APJs are the culprit
How doe horses with a neck type lameness typically present?
- outside limb lame, often described as ‘hopping’ type
- hopping type = asymmetry in the movement of their poll is very early in the stride
Radiculopathy - normal vs moderate vs severe
Normal
- nice smooth homogenous grey of the articular process
- dorsal margins on the joint are smooth
- no irregular bone remodelling around the joint
- the joint is a normal size
- therefore, nice open intervertebral foramen
Moderate
- joint is slightly enlarged cf normal
- some bony remodelling around the caudal aspects of the articular processes
- joint has not only grown in size dorsally but also ventrally
- intervertebral foramen is becoming a bit closed and impinged
Severe
- articular processes even larger
- quite significant bony remodelling around the margins of the joint
- some bone lysis of the articular processes
- articular processes completely overlap and don’t see any intervertebral foramen at all
- can see abnormal lucencies in the joint space
CT - requirements
- large bore CT scanner
- GA
- often combined with pyelography
CT use
- only 3D imaging modality that can accommodate the equine neck
- vastly improves diagnostic accuracy, but have to take care not to over-interpret findings
Management
Mainstay is intra-articular meds with corticosteroid
- i.e. manage the same as other causes of joint dz
- can’t reverse bone remodelling but can alleviate pain and reduce associated soft tissue inflammation
- there are no landmarks on the surface and the target is deep beneath muscle
- injections performed under US guidance
Prognosis
Variable and often unpredictable
In general:
neck pain > radiculopathy > spinal ataxia
