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Guedes JRB, Vendruscolo CP, Tokawa PKA, Carvalho AM, Johnson PJ, Faleiros RR. The Detection of Thoracolumbar Spine Injuries in Horses with Chronic Laminitis Using a Novel Clinical-Assessment Protocol and Ultrasonographic Examination. Animals (Basel) 2024; 14:1364. [PMID: 38731368 PMCID: PMC11083038 DOI: 10.3390/ani14091364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/08/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
Postural adaptation is a prominent feature in horses affected by laminitis. Laminitis induces intense pain, especially in the forelimbs, prompting affected horses to assume a caudally displaced trunk posture, resulting in the hyperflexion of the thoracolumbar spine. This study assessed the nature and prevalence of thoracolumbar injuries in horses with chronic laminitis compared to horses without it. Sixty horses were used (thirty laminitic and thirty non-laminitic) of different athletic purposes and ages (2-20 years). The experimental protocol entailed a single assessment of horses' thoracolumbar spines, utilizing physical examination by MACCTORE, a scoring system developed specifically for this study. Additional evaluations included the Grimace Equine Pain Scale (HGS) and ultrasound exams. Statistical tests were used to compare values (Mann-Whitney or t-test) and lesions prevalences (Fisher) between groups (p < 0.05). The results showed a higher pain manifestation (HGS and heart rate, p < 0.0001) and thoracolumbar-spine-injury levels in chronic laminitis horses, both in MACCTORE clinical examinations (11.7 ± 4.8 vs. 4.2 ± 3.3, p < 0.0001) and general ultrasonographic indices (39.6 ± 12.0 vs. 20.7 ± 7.1, p < 0.0001), including specific examination approaches for various spinal elements. Horses with laminitis presented with a 14-fold higher prevalence of ultrasound-relevant lesions in the thoracolumbar spine (CI: 4.4 to 50.6, p < 0.0001) compared to controls. These findings constitute new evidence of an association between chronic laminitis and the presence of thoracolumbar spine injuries in horses, which may be confirmed by more sophisticated study designs.
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Affiliation(s)
- Julia R. B. Guedes
- The EQUINOVA Research Group, Department of Veterinary Medicine and Surgery, Veterinary School, Federal University of Minas Gerais (UFMG), Belo Horizonte 31270-901, Brazil; (A.M.C.); (R.R.F.)
| | - Cynthia P. Vendruscolo
- Department of Veterinary Medicine and Zootechnics School (FMVZ), University of São Paulo (USP), São Paulo 13635-900, Brazil; (C.P.V.); (P.K.A.T.)
| | - Paula K. A. Tokawa
- Department of Veterinary Medicine and Zootechnics School (FMVZ), University of São Paulo (USP), São Paulo 13635-900, Brazil; (C.P.V.); (P.K.A.T.)
| | - Armando M. Carvalho
- The EQUINOVA Research Group, Department of Veterinary Medicine and Surgery, Veterinary School, Federal University of Minas Gerais (UFMG), Belo Horizonte 31270-901, Brazil; (A.M.C.); (R.R.F.)
| | - Philip J. Johnson
- Equine Internal Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, MO 65211, USA;
| | - Rafael R. Faleiros
- The EQUINOVA Research Group, Department of Veterinary Medicine and Surgery, Veterinary School, Federal University of Minas Gerais (UFMG), Belo Horizonte 31270-901, Brazil; (A.M.C.); (R.R.F.)
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Domańska-Kruppa N, Wierzbicka M, Stefanik E. Advances in the Clinical Diagnostics to Equine Back Pain: A Review of Imaging and Functional Modalities. Animals (Basel) 2024; 14:698. [PMID: 38473083 DOI: 10.3390/ani14050698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 02/20/2024] [Accepted: 02/21/2024] [Indexed: 03/14/2024] Open
Abstract
Back pain is common in ridden horses. Back diseases in horses include Impinging Dorsal Spinous Processes, Ventral Spondylosis, Osteoarthritis of Articular Process, Intervertebral Discs Disease, Vertebral Fractures, Conformational Abnormalities, Desmopathy of the Supraspinous Ligament, Desmopathy of the Intraspinous Ligament, and Longissimus Muscle Strain. Back pain may also develop as a result of lameness (particularly hindlimb lameness). A poorly fitting saddle and an unbalanced rider are also considered important factors influencing the development of back pain in horses. The conventional diagnosis of equine back pain includes a clinical examination and diagnostic imaging examination using ultrasound, radiography, and thermography. Advanced diagnostic modalities of equine back pain involve the objectification of standard procedures through the use of algometers, a lameness locator, biometric mats, and the geometric morphometrics method. In addition to modern diagnostic methods, such as computed tomography and scintigraphy, advances in the diagnosis of equine back pain include the use of electromyography and functional electrical stimulation. The aim of this review article is to familiarize clinicians with the usefulness and capabilities of conventional diagnostic protocols and advanced diagnostic modalities. Although orthopedic examination and traditional diagnostic methods will remain the foundation of the diagnosis of back diseases, modern methods meet the growing expectations towards high-performance horses and allow for deeper diagnostics and objective monitoring of rehabilitation and training progress.
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Affiliation(s)
- Natalia Domańska-Kruppa
- Department of Large Animal Diseases and Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences, 02-787 Warsaw, Poland
| | - Małgorzata Wierzbicka
- Department of Large Animal Diseases and Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences, 02-787 Warsaw, Poland
| | - Elżbieta Stefanik
- Department of Large Animal Diseases and Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences, 02-787 Warsaw, Poland
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Scilimati N, Angeli G, Di Meo A, Dall’Aglio C, Pepe M, Beccati F. Post-Mortem Computed Tomographic Features of the Most Caudal Lumbar Vertebrae, Anatomical Variations and Acquired Osseous Pathological Changes, in a Mixed Population of Horses. Animals (Basel) 2023; 13:ani13040743. [PMID: 36830530 PMCID: PMC9951930 DOI: 10.3390/ani13040743] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
The radiographic, ultrasonographic, and scintigraphic findings of horses with thoracolumbosacral pain have been previously reported. In this study, the computed tomographic appearance of anatomical variations and pathological changes of the equine caudal lumbar region through a post-mortem examination were investigated. A total of 40 horses that had died or were submitted for euthanasia, for reasons unrelated to the study, were included in the study. From all the specimens, the modified vertebral system was adopted to evaluate and describe the four most caudal lumbar vertebrae, which were numbered from a caudal reference point (lumbosacral junction), with the segment number designated within parentheses (i.e., L(i)-L(iv)). Contact of the spinous processes was detected in 21 specimens (54%) and fusion in 6 specimens (15%). Lumbar spondylosis was seen in 17 specimens (42.5%), more commonly on the lateral aspect or on both ventral and lateral aspects in 12 specimens (71%). The presence of spondylosis was found more commonly in older horses (p < 0.001). There was no difference in bony density in specimens with spondylosis or spinous processes contact compared to specimens without. The highest prevalence of bony changes was found at L(ii)-L(i) intertransverse joints in 28 specimens (97%) on the left and in 22 specimens (96%) on the right side. Spondylolisthesis and partial fusion of the L(ii)-L(i) vertebral disc were found in association with degenerative pathologies. This study showed a high frequency of several anatomical variations and acquired osseous pathological changes in the most caudal lumbar vertebrae via a CT examination.
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Affiliation(s)
- Nicola Scilimati
- Veterinary Teaching Hospital, Department of Veterinary Medicine, University of Perugia, 06126 Perugia, PG, Italy
- Correspondence:
| | - Giovanni Angeli
- Veterinary Teaching Hospital, Department of Veterinary Medicine, University of Perugia, 06126 Perugia, PG, Italy
| | - Antonio Di Meo
- Veterinary Teaching Hospital, Department of Veterinary Medicine, University of Perugia, 06126 Perugia, PG, Italy
| | - Cecilia Dall’Aglio
- Veterinary Teaching Hospital, Department of Veterinary Medicine, University of Perugia, 06126 Perugia, PG, Italy
| | - Marco Pepe
- Veterinary Teaching Hospital, Department of Veterinary Medicine, University of Perugia, 06126 Perugia, PG, Italy
- Sport Horse Research Centre, Department of Veterinary Medicine, University of Perugia, 06126 Perugia, PG, Italy
| | - Francesca Beccati
- Veterinary Teaching Hospital, Department of Veterinary Medicine, University of Perugia, 06126 Perugia, PG, Italy
- Sport Horse Research Centre, Department of Veterinary Medicine, University of Perugia, 06126 Perugia, PG, Italy
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Vautravers G, Audigié F, Denoix JM. Prevalences of lumbosacral articulation anatomic variants identified on nuclear scintigraphy and transrectal ultrasonography of Selle Français Warmbloods, French Standardbred Trotters, and Thoroughbreds and agreement between results from the imaging modalities. J Am Vet Med Assoc 2022; 260:115-123. [PMID: 34843441 DOI: 10.2460/javma.20.08.0428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe scintigraphic and transrectal ultrasonographic anatomic variants of the lumbosacral (LS) articulation in horses and to determine the agreement between results obtained with each imaging modality. ANIMALS 243 horses (81 Selle Français Warmbloods, 81 French Standardbred Trotters, and 81 Thoroughbreds). PROCEDURES A retrospective search of clinical records was conducted to identify horses that had undergone nuclear scintigraphy and transrectal ultrasonography of the LS region of the vertebral column between January 2016 and December 2019. Scintigraphic images were evaluated by 2 observers blinded to the other's results for classification of LS articulation anatomic variants (scintigraphic type); intra- and interobserver agreement were determined. Ultrasonographic images were evaluated for classification of LS intervertebral symphysis anatomic variant (ultrasonographic grade) by 1 observer blinded to horses' identities and scintigraphic findings; agreement analysis was performed between scintigraphic type and ultrasonographic grade. Descriptive and statistical analyses were performed to describe distribution of anatomic variants. RESULTS The scintigraphic classification system (scintigraphic type) had excellent intra- and interobserver agreement. Agreement between results for scintigraphic type and ultrasonographic grade was moderate (κ = 0.61; 95% CI, 0.52 to 0.70). Anatomic variants of the LS articulation were observed in all groups. The distribution of variants differed significantly among breeds but not sexes. CLINICAL RELEVANCE Anatomic variations of the LS articulation in horses must be known to avoid misinterpreting them as clinically meaningful findings. Further research is needed to determine potential relationships between these anatomic variants and LS lesions, their clinical manifestations, and their influence on athletic performance.
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Beaumont A, Bertoni L, Denoix JM. Ultrasonographic diagnosis of equine thoracolumbar articular process joint lesions. EQUINE VET EDUC 2021. [DOI: 10.1111/eve.13551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- A. Beaumont
- Ecole Nationale Vétérinaire d’Alfort, CIRALE Maisons‐Alfort France
- INRAE Ecole Nationale Vétérinaire d’Alfort, BPLC Maisons‐Alfort France
| | - L. Bertoni
- Ecole Nationale Vétérinaire d’Alfort, CIRALE Maisons‐Alfort France
- INRAE Ecole Nationale Vétérinaire d’Alfort, BPLC Maisons‐Alfort France
| | - J. M. Denoix
- Ecole Nationale Vétérinaire d’Alfort, CIRALE Maisons‐Alfort France
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Vautravers G, Coudry V, Denoix J. Review of the use of transrectal ultrasonography for evaluation of the caudal lumbar – including lumbosacral – intervertebral discs and symphyses: Normal and abnormal ultrasonographic appearance. EQUINE VET EDUC 2020. [DOI: 10.1111/eve.13313] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- G. Vautravers
- CIRALE INRA USC 957 BPLC ENVA‐UPEC Normandie Equine Vallée Goustranville France
| | - V. Coudry
- CIRALE INRA USC 957 BPLC ENVA‐UPEC Normandie Equine Vallée Goustranville France
| | - J.‐M. Denoix
- CIRALE INRA USC 957 BPLC ENVA‐UPEC Normandie Equine Vallée Goustranville France
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Boado A, Nagy A, Dyson S. Ultrasonographic features associated with the lumbosacral or lumbar 5–6 symphyses in 64 horses with lumbosacral‐sacroiliac joint region pain (2012–2018). EQUINE VET EDUC 2019. [DOI: 10.1111/eve.13236] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- A. Boado
- Monte Hijedo 56 Boadilla del Monte Madrid Spain
| | - A. Nagy
- Centre for Equine Studies Animal Health Trust Newmarket Suffolk UK
| | - S. Dyson
- Centre for Equine Studies Animal Health Trust Newmarket Suffolk UK
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van Zadelhoff C, Ehrle A, Merle R, Jahn W, Lischer C. Thoracic processi spinosi findings agree among subjective, semiquantitative, and modified semiquantitative scintigraphic image evaluation methods and partially agree with clinical findings in horses with and without thoracolumbar pain. Vet Radiol Ultrasound 2018; 60:210-218. [PMID: 30394646 DOI: 10.1111/vru.12695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 08/07/2018] [Accepted: 08/14/2018] [Indexed: 11/29/2022] Open
Abstract
Impinging processi spinosi in the equine thoracic spine are a common cause of poor performance in the horse. A modified semiquantitative scintigraphic image analysis has been proposed for the evaluation of equine processi spinosi. This technique showed a high inter- and intraobserver agreement when compared to subjective and semiquantitative image analysis. The aim of this retrospective, method comparison study was to evaluate the agreement of the modified semiquantitative scintigraphic image assessment with previous methods of interpretation and to compare these scintigraphic evaluation techniques with radiographic and clinical findings. Two hundred twenty-three Warmblood horses that underwent scintigraphic, radiographic, and clinical examination of the thoracic spine were included in the study. Scintigraphic images were assessed using subjective, semiquantitative, and modified semiquantitative techniques. Radiographs were subjectively graded and horses were assigned to a group with or without thoracolumbar pain. Total radiographic and total scintigraphic grades were higher in horses with thoracolumbar pain (P < 0.05). Both the semiquantitative and the modified semiquantitative uptake ratios did not differ significantly in horses with or without thoracolumbar pain. The kappa agreement showed a substantial agreement between the modified semiquantitative scintigraphic and the semiquantitative scintigraphic evaluation techniques. The agreement between subjective scintigraphic and modified semiquantitative scintigraphic image evaluations was fair. There was a slight agreement between all scintigraphic techniques and radiographic findings. Limitations were the definition of thoracolumbar pain and the image analysis being restricted to the caudal thoracic processi spinosi. In conclusion, the modified semiquantitative scintigraphic image assessment obtained consistent results but did not perform better than previous evaluation methods. Further comparison to a defined diagnosis is warranted.
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Affiliation(s)
- Claudia van Zadelhoff
- Equine Clinic, Free University of Berlin, 14163, Berlin, Germany.,Pferdeklinik Bargteheide, 22941, Bargteheide, Germany.,University of Edinburgh, Royal (Dick) School of Veterinary Studies, Easter Bush Estate, Roslin, EH25 9RG, United Kingdom
| | - Anna Ehrle
- Equine Clinic, Free University of Berlin, 14163, Berlin, Germany
| | - Roswitha Merle
- Institute for Veterinary Epidemiology and Biostatistics, Free University of Berlin, 14163, Berlin, Germany
| | - Werner Jahn
- Pferdeklinik Bargteheide, 22941, Bargteheide, Germany
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Tallaj A, Coudry V, Denoix J. Transrectal ultrasonographic examination of the sacroiliac joints of the horse: Abnormal findings and lesions. EQUINE VET EDUC 2017. [DOI: 10.1111/eve.12858] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- A. Tallaj
- INRA USC BPLC 957 ENVA‐UPEC CIRALE Goustranville France
| | - V. Coudry
- INRA USC BPLC 957 ENVA‐UPEC CIRALE Goustranville France
| | - J.‐M. Denoix
- INRA USC BPLC 957 ENVA‐UPEC CIRALE Goustranville France
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Burns G, Dart A, Jeffcott L. Clinical progress in the diagnosis of thoracolumbar problems in horses. EQUINE VET EDUC 2016. [DOI: 10.1111/eve.12623] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- G. Burns
- Faculty of Veterinary Science; Research and Clinical Training Unit; University Teaching Hospital Camden; New South Wales Australia
| | - A. Dart
- Faculty of Veterinary Science; Research and Clinical Training Unit; University Teaching Hospital Camden; New South Wales Australia
| | - L. Jeffcott
- Faculty of Veterinary Science; Research and Clinical Training Unit; University Teaching Hospital Camden; New South Wales Australia
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Cousty M, Firidolfi C, Geffroy O, David F. Comparison of Medial and Lateral Ultrasound-Guided Approaches for Periarticular Injection of the Thoracolumbar Intervertebral Facet Joints in Horses. Vet Surg 2011; 40:494-9. [DOI: 10.1111/j.1532-950x.2011.00821.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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ETIENNE ANNELAURE, PEETERS DOMINIQUE, BUSONI VALERIA. ULTRASONOGRAPHIC PERCUTANEOUS ANATOMY OF THE CAUDAL LUMBAR REGION AND ULTRASOUND-GUIDED LUMBAR PUNCTURE IN THE DOG. Vet Radiol Ultrasound 2010; 51:527-32. [DOI: 10.1111/j.1740-8261.2010.01705.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Henson FMD, Lamas L, Knezevic S, Jeffcott LB. Ultrasonographic evaluation of the supraspinous ligament in a series of ridden and unridden horses and horses with unrelated back pathology. BMC Vet Res 2007; 3:3. [PMID: 17331234 PMCID: PMC1821016 DOI: 10.1186/1746-6148-3-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2006] [Accepted: 03/01/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Injury to the supraspinous ligament (SSL) is reported to cause back pain in the horse. The diagnosis is based on clinical examination and confirmed by ultrasonographic examination. The ultrasonographic appearance of the supraspinous ligament has been well described, but there are few studies that correlate ultrasonographic findings with clinical pain and/or pathology. This preliminary study aims to test the hypothesis that unridden horses (n = 13) have a significantly reduced frequency of occurrence of ultrasonographic changes of the SSL consistent with a diagnosis of desmitis when compared to ridden horses (n = 13) and those with clinical signs of back pain (n = 13). RESULTS The supraspinous ligament of all horses was imaged between T(thoracic)6-T18 and ultrasonographic appearance. There was an average of 2.08 abnormal images per horse from the whole group. The average number of abnormalities in unridden horses was 4.92, in ridden horses 2.92 and in horses with clinical back pain 4.69. No lesions were found between T6 and T10 and 68% of lesions were found between T14 and T17. No significant difference (p < 0.05) was found between the three groups in the number or location of abnormal images. CONCLUSION The main conclusion was that every horse in this study (n = 39) had at least one site of SSL desmitis (range 2 to 11). It was clear that ultrasonographically diagnosed SSL desmitis cannot be considered as prima facie evidence of clinically significant disease and further evidence is required for a definitive diagnosis.
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Affiliation(s)
- Frances MD Henson
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES, UK
| | - Luis Lamas
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES, UK
| | - Sabina Knezevic
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES, UK
| | - Leo B Jeffcott
- Faculty of Veterinary Science, University of Sydney, NSW 2006, Australia
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Abstract
Two horses with discospondylitis are described with emphasis on the imaging modalities used and their contribution to the final diagnosis and outcome. Radiographic findings were vertebral endplate lysis with sclerosis in both horses, with additional vertebral subluxation and ventral spondylosis in one horse. Ultrasonographic findings included vertebral malalignment and obliteration of the intervertebral disc by spondylotic bone in one horse and irregular endplates, a widened disc space, a hypoechoic paravertebral abscess and hypoechoic, atrophic adjacent musculature with loss of linear fiber pattern in the other horse. Bone scintigraphy excluded additional affected sites. A systematic approach is recommended when performing an ultrasound examination of the spine.
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Affiliation(s)
- Lynelle Sweers
- Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, Private Bag X04, Onderstepoort, South Africa.
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Laflin SL, Steyn PF, VanMetre DC, Uhrig JL, Callan RJ. Evaluation and treatment of decreased libido associated with painful lumbar lesions in two bulls. J Am Vet Med Assoc 2004; 224:565-70, 533. [PMID: 14989552 DOI: 10.2460/javma.2004.224.565] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Painful lesions of the vertebral column may cause decreased libido in bulls. Radiographic evaluation of vertebral skeletal problems in mature bulls is limited because of high body mass. Two breeding bulls with signs of decreased libido and spermatozoa production were evaluated. Initial systemic medical treatment for the conditions had not focused on localized lesions and was unsuccessful. Nuclear scintigraphy was performed in both bulls to determine the location of vertebral column lesions and facilitate localized treatment. Localized medical treatment was successful and resulted in decreased signs of pain and increased spermatozoa production in both bulls.
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Affiliation(s)
- Shelie L Laflin
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523-1620, USA
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