Diagnostic par imagerie des lésions de la région thoracolombaire chez le cheval

Abstract

<i>Diagnostic imaging of equine thoracolumbar disorders </i> Equine thoracolumbar conditions represent a major cause of poor performance and locomotor disorders in sports and race horses. Advances in diagnostic imaging during the last 15 years allow today to diagnose most equine back lesions in the standing sedated horse. Radiography is the first choice imaging modality due to its high diagnostic performance. Ultrasonography is a complementary modality to further investigate back soft tissues and the caudal lumbar area not evaluable radiographically in the standing horse. Bone scintigraphy is a more complex and expensive technique and is usually dedicated to complicated clinical cases. The most frequent injuries diagnosed using these 3 modalities are kissing spines, osteo-arthrosis of the synovial intervetebral joints, vertebral spondylosis and muscle injuries. Clinical significance of these lesions should be interpreted with care considering the clinical signs exhibited by the horse but also its sports or racing use.

Ultrasonographic diagnosis of equine thoracolumbar articular process joint lesions

“…When a sufficiently powerful generator is unavailable, the use of radiography is frequently restricted to imaging of the spinous processes (Vandeweerd, 2015). Conversely, ultrasonography is a more versatile diagnostic tool that can be used to detect soft tissue lesions (supraspinous ligament desmitis, thoracolumbar fasciitis, myositis), as well as APJ lesions, with a high sensitivity to detect bone remodelling and osteophyte formation (Audigié et al., 2013; Denoix, 1999). In addition, using ultrasonography, APJ lesions can be identified in the caudal lumbar region, an area where APJs are difficult to visualise on radiographs, even with high‐output x‐ray machines, because of the large muscle mass in this area and the projection of the tuber coxae (Cousty et al., 2010; Denoix, 1999; Denoix & Dyson, 2011).…”

“…In addition, ultrasonography is indicated to explore physical examination abnormalities such as paravertebral muscle atrophy, heat or induration identified by palpation, sensitivity and/or reduced range of motion during back mobilisation tests (Denoix, 1998a; Martin & Klide, 1999; Riccio et al., 2018). Finally, the ultrasonographic examination can be used in combination with radiography and bone scintigraphy to document and lateralise abnormal findings (Audigié et al., 2013). When the diagnosis is achieved, ultrasonography is useful to accurately guide periarticular injections (Fuglbjerg et al., 2009).…”

“…This is especially true when lesions involve the low mobile APJs or ‘facet joints’ made of several small articular surfaces covered by a thick layer of muscles. Radiography is the first‐choice imaging modality (Audigie et al., 2013) to explore the vertebral column from T1 to L4, but, because of the large muscle mass, complete radiographic assessment of the back is not easy in routine practice with a portable machine on a mature horse. High‐output x‐ray equipment, a focussed grid and computed or digital radiographic equipment are required, resulting in a high level of radiation exposure.…”