Management of equine ataxia caused by cervical vertebral stenotic myelopathy: A European perspective 2010–2015

Abstract

Summary The diagnosis and therapy of cervical vertebral stenotic myelopathy (CVSM) are challenging and have been most frequently described in racehorses. We aimed to analyse CVSM cases presented for diagnostic work‐up and treatment in a nonracing horse population. We hypothesised that our diagnostic work‐up protocol including clinical/orthopaedic/neurological/radiographic and myelographic examinations may provide practical reference points for in vivo diagnosis/prognosis and adequate CVSM management. Medical records from 2010 to 2015 were reviewed retrospectively. Cases were included if our standardised work‐up protocol was followed, there was no evidence of any infectious diseases causing the neurological signs, and native cervical radiographs and myelograms confirmed CVSM. Age/breed/sex/type of performance/degree of neurological deficits and number/sites/quality/therapy of stenosis were recorded. Sixty‐two horses met the inclusion criteria. The majority of the horses were aged 5–10 years (44%) or >10 years (35%); nine horses (15%) were 1–4 years and four <1 year (6%) old. Forty‐six horses were Warmbloods (73%), 10 ponies (16%) and six of other breeds (11%). Males were more affected (69%) than females (31%). Sixty‐one percent were pleasure‐horses, 26% were sport‐horses and no information was available for 13%. Most cases presented with mild–moderate neurological signs (grade 2/5 = 18%, grade 2–3/5 = 31%). On myelograms, 23 horses (37%) had single‐level, 22 (35%) had double‐level, and eight (13%) triple‐level stenosis, while nine cases (15%) did not have stenosis. Fifty horses (55%) showed dynamic and 41 (45%) static stenosis. Dynamic stenosis was more common (46%) than static (29%) stenosis and/or combined stenosis (25%). Stenoses were more frequently observed in the mid‐to‐caudal vertebrae. Static stenoses tended to be located more caudally. Based on our protocol, 15% of horses were subjected to euthanasia without therapy, 62% treated conservatively and 23% underwent cervical ventral interbody fusion. In conclusion, our diagnostic work‐up protocol provided practical reference points for in vivo diagnosis/prognosis and adequate management of CVSM in a nonracing horse population.

Survey of Risk Factors and Genetic Characterization of Ewe Neck in a World Population of Pura Raza Español Horses

“…The PRE stallion’s neck is usually more voluminous, and stallions are used for sport more often than PRE mares. Another cervical disease, stenotic myelopathy, has been studied previously and its prevalence was also higher in stallions than in females [ 34 ]. Age also was a relevant risk factor for Ewe Neck, with young horses (4–7 years old) showing higher percentages of those affected.…”

Outcome of Ventral Fusion of Two or Three Cervical Vertebrae with a Locking Compression Plate for the Treatment of Cervical Stenotic Myelopathy in Eight Horses

“…3 Similarly, another recent study found single-level stenosis in 37%, double-level stenosis in 35% and triple-level stenosis in 13% of their patients examined myelographically during the diagnostic work-up of suspected CVSM. 4 The most frequent combination of double-level stenosis is CV 3 to 4 and CV 5 to 6 followed by CV 3 to 4 and CV 4 to 5. 3 Additionally, recent studies emphasize the benefits of advanced imaging techniques such as computed tomography (CT) or magnetic resonance imaging over plain radiographs.…”

“…[1][2][3] Although CVSM is described in almost all horse breeds, Thoroughbreds, Warmbloods and Tennessee Walking Horses appear to be more frequently affected. 1,4 The diagnosis requires a detailed patient history, physical and neurological examination as well as diagnostic imaging. 5 Evaluation of plain radiographs in combination with calculation of the intra-and intervertebral minimal sagittal ratios or diameter can initially raise a valid suspicion of CVSM.…”

“…7 Dynamic lesions are observed more frequently than static lesions. 4 Specifically, spinal cord compression occurs most frequently at cervical vertebrae (CV) 3 and 4 (18-32%) 8 followed by CV 6 to 7 (17%) and CV 5 to 6 (14%). 3 Furthermore, multiple compressive lesions were found in 29% of horses diagnosed with CVSM in one study.…”

“…7 However, in the most recent case series 57% of all horses that had ventral cervical fusionwhich was mainly done using the KCC technique-were euthanatized because of either vertebral body fractures or implant migration. 4 Biomechanical in vitro studies indicated that locking compression plate (LCP) fixation results in similar or even superior biomechanical stability compared with KCC fixation for ventral cervical fusion of equine CV 4 and 5. 18,19 Multiple site ventral cervical fusion was not evaluated in these biomechanical studies.…”