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Vet Comp Orthop Traumatol 2019; 32(05): 383-388
DOI: 10.1055/s-0039-1691793
Original Research
Georg Thieme Verlag KG Stuttgart · New York

Ex Vivo Assessment of an Ultrasound-Guided Injection Technique of the Lumbosacral Disc in the Horse

Mickaël Robert 
1   Department of Equine Surgery, ONIRIS, Nantes Atlantic College of Veterinary Medicine, Food Science and Engineering, Nantes, France
,
Hadrien Manet
1   Department of Equine Surgery, ONIRIS, Nantes Atlantic College of Veterinary Medicine, Food Science and Engineering, Nantes, France
,
Guillaume Manneveau
1   Department of Equine Surgery, ONIRIS, Nantes Atlantic College of Veterinary Medicine, Food Science and Engineering, Nantes, France
,
Olivier Geffroy
1   Department of Equine Surgery, ONIRIS, Nantes Atlantic College of Veterinary Medicine, Food Science and Engineering, Nantes, France
› Author Affiliations Funding None.
Further Information

Publication History

05 September 2018

27 March 2019

Publication Date:
11 June 2019 (online)

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Abstract

Objectives The aim of this study was to describe an ultrasound-guided injection technique of the lumbosacral disc in horses through the cranial vertebral notch of the sacrum and to evaluate both accuracy and potential complications of the technique on equine cadavers.

Materials and Methods Twenty-four injections of the lumbosacral area were performed on 12 equine cadavers shortly after euthanasia under ultrasound guidance with the horse in recumbency using two different dyes (one colour for each side). The lumbosacral area was dissected in each horse and the accuracy of the technique, as well as its potential complications, was evaluated detecting the dyes and the structures that have been coloured.

Results The lumbosacral area was correctly reached in only 11/24 injections. However, this technique allowed a lumbosacral peridiscal injection in 7/12 horses. The main difficulty was reaching the ventral opening of the L6-S1 intervertebral foramen that is partially hidden by the iliac wing on ultrasound. Puncture of the vertebral canal has been observed in 11/24 cases. The L6 spinal nerve roots emerging through the intervertebral foramen could potentially be damaged when inserting the needle.

Clinical Significance The described ultrasound-guided technique allows peridiscal injection in the lumbosacral space in less than 60% of cases with potential sciatic nerve damage. Further investigations are warranted before using this technique in clinical practice in horses suffering from lumbosacral lesions.

Keywords

equine - lumbosacral joint - ultrasound - intervertebral disc - horses

Author Contribution

All authors contributed to conception of study, study design, acquisition of data, and data analysis and interpretation. All authors drafted, revised and approved the submitted manuscript.


Supplementary Material

 

  • References

  • 1 Denoix JM, Audigié F, Coudry V. Review of diagnosis and treatment of lumbosacral pain in sport and race horses. In: Proceedings of the 51st Annual Convention of the American Association of Equine Practitioners; December 3–7, 2005; Seattle, Washington; 2005: 366–373
    PubMedGoogle Scholar
  • 2 Head M. Ultrasonography of the pelvis. In: Kidd JA, Lu KG, Frazer ML. , eds. Atlas of Equine Ultrasonography. Oxford, UK: Wiley; 2014: 183-197
    CrossrefGoogle Scholar
  • 3 Dyson SJ. Lumbosacral and pelvic injuries in sports and pleasure horses. In: Ross MW, Dyson SJ. , eds. Diagnosis and Management of Lameness in the Horse. 2nd ed. Philadelphia, PA: Elsevier; 2011: 571-582
    Google Scholar
  • 4 Townsend HG, Leach DH, Fretz PB. Kinematics of the equine thoracolumbar spine. Equine Vet J 1983; 15 (02) 117-122
    CrossrefPubMedGoogle Scholar
  • 5 Denoix JM. Kinematics of the thoracolumbar spine in the horse during dorsoventral movements: a preliminary report. Paper presented at: Second International Conference on Equine Exercise Physiology; 1987 ; Davis, CA: ICEEP Publications
    PubMedGoogle Scholar
  • 6 Jeffcott LB, Dalin G. Natural rigidity of the horse's backbone. Equine Vet J 1980; 12 (03) 101-108
    CrossrefPubMedGoogle Scholar
  • 7 Denoix JM. Spinal biomechanics and functional anatomy. Vet Clin North Am Equine Pract 1999; 15 (01) 27-60
    CrossrefPubMedGoogle Scholar
  • 8 Denoix JM. Approche sémiologique des régions lombo-sacrale et sacro-iliaque chez le cheval. Prat Vet Eq 1992; 24 (13) 13-21
    PubMedGoogle Scholar
  • 9 Townsend HG, Leach DH. Relationship between intervertebral joint morphology and mobility in the equine thoracolumbar spine. Equine Vet J 1984; 16 (05) 461-465
    CrossrefPubMedGoogle Scholar
  • 10 Bergmann W, Bergknut N, Veraa S. , et al. Intervertebral disc degeneration in warmblood horses: morphology, grading, and distribution of lesions. Vet Pathol 2018; 55 (03) 442-452
    CrossrefPubMedGoogle Scholar
  • 11 Yovich JV, Powers BE, Stashak TS. Morphologic features of the cervical intervertebral disks and adjacent vertebral bodies of horses. Am J Vet Res 1985; 46 (11) 2372-2377
    PubMedGoogle Scholar
  • 12 Jeffcott LB. The normal anatomy of the osseous structures of the back and pelvis. In: Henson FMD. , ed. Equine Back Pathology. Ames, Iowa: Wiley-Blackwell; 2009: 3-15
    Google Scholar
  • 13 Denoix JM, Audigié F. Imaging of the musculoskeletal system in horses. In: K Hinchcliff AK, Geor RJ. , eds. Equine Sports Medicine and Surgery. London: Saunders; 2004: 161-187
    CrossrefGoogle Scholar
  • 14 Bergman EHJ, Puchalski SM, Denoix JM. How to Perform a Transrectal Ultrasound Examination of the Lumbosacral and Sacroiliac Joints. Proc Am Assoc Equine Pract: Nashville, TN; 2013
    PubMedGoogle Scholar
  • 15 Alexandre A, Meyer CM, Dauchel D. , et al. Prévalence et aspects cliniques des affections du disque lombo-sacré chez le cheval athlète. 44e Journées annuelles de L'Association Vétérinaire Equine Française: Reims, France; 2016
    PubMedGoogle Scholar
  • 16 Fölkel IM. Lumbar intervertebral disc disease (IVDD) in horses: a longitudinal ultrasonographic and histomorphological comparison: University of Utrecht; 2012
  • 17 Nagy A, Dyson S, Barr A. Ultrasonographic findings in the lumbosacral joint of 43 horses with no clinical signs of back pain or hindlimb lameness. Vet Radiol Ultrasound 2010; 51 (05) 533-539
    CrossrefPubMedGoogle Scholar
  • 18 Adams MA, Roughley PJ. What is intervertebral disc degeneration, and what causes it?. Spine 2006; 31 (18) 2151-2161
    CrossrefPubMedGoogle Scholar
  • 19 Buttermann GR. The effect of spinal steroid injections for degenerative disc disease. Spine J 2004; 4 (05) 495-505
    CrossrefPubMedGoogle Scholar
  • 20 Fayad F, Lefevre-Colau MM, Rannou F. , et al. Relation of inflammatory Modic changes to intradiscal steroid injection outcome in chronic low back pain. Eur Spine J 2007; 16 (07) 925-931
    CrossrefPubMedGoogle Scholar
  • 21 Buttermann GR. Intradiscal injection therapy for degenerative chronic discogenic low back pain with end plate Modic changes. Spine J 2012; 12 (02) 176 , discussion 177
    CrossrefPubMedGoogle Scholar
  • 22 Tuakli-Wosornu YA, Terry A, Boachie-Adjei K. , et al. Lumbar Intradiskal Platelet-Rich Plasma (PRP) Injections: a prospective, double-blind, randomized controlled study. PM R 2016; 8 (01) 1-10 , quiz 10
    CrossrefPubMedGoogle Scholar
  • 23 Levi D, Horn S, Tyszko S, Levin J, Hecht-Leavitt C, Walko E. Intradiscal platelet-rich plasma injection for chronic discogenic low back pain: preliminary results from a prospective trial. Pain Med 2016; 17 (06) 1010-1022
    PubMedGoogle Scholar
  • 24 König HEL. H. G. Veterinary Anatomy of Domestic Mammals. 6th ed. Stuttgart, Germany: Schattauer; 2014
    Google Scholar
  • 25 Peh W. Provocative discography: current status. Biomed Imaging Interv J 2005; 1 (01) e2
    PubMedGoogle Scholar
  • 26 Stack JD, Bergamino C, Sanders R. , et al. Comparison of two ultrasound-guided injection techniques targeting the sacroiliac joint region in equine cadavers. Vet Comp Orthop Traumatol 2016; 29 (05) 386-393
    Article in Thieme ConnectPubMedGoogle Scholar
  • 27 Cousty M, Rossier Y, David F. Ultrasound-guided periarticular injections of the sacroiliac region in horses: a cadaveric study. Equine Vet J 2008; 40 (02) 160-166
    CrossrefPubMedGoogle Scholar
  • 28 Stubbs NC, Hodges PW, Jeffcott LB, Cowin G, Hodgson DR, McGowan CM. Functional anatomy of the caudal thoracolumbar and lumbosacral spine in the horse. Equine Vet J Suppl 2006; (36) 393-399
    PubMedGoogle Scholar
  • 29 Whitcomb MB. Ultrasonography of the lumbosacral spine and pelvis. In: Henson FMD. , ed. Equine Back Pathology. Ames, Iowa: Wiley-Blackwell; 2009: 112-214
    Google Scholar
  • 30 Ghahreman A, Ferch R, Bogduk N. The efficacy of transforaminal injection of steroids for the treatment of lumbar radicular pain. Pain Med 2010; 11 (08) 1149-1168
    CrossrefPubMedGoogle Scholar
  • 31 Costanza AB, Abdi S. Epidural steroid injections. In: Smith HS. , ed. Current Therapy in Pain. Philadelphia, PA: Elsevier; 2009: 582-587
    CrossrefGoogle Scholar
  • 32 Barone RSP. Anatomie comparée des mammifères domestiques Tome.7–Neurologie. In: Barone R. , ed. Paris, France: Vigot; 2010: 838
    Google Scholar
  • 33 Natalini CC. Spinal anesthetics and analgesics in the horse. Vet Clin North Am Equine Pract 2010; 26 (03) 551-564
    CrossrefPubMedGoogle Scholar
  • 34 Wybier M, Gaudart S, Petrover D, Houdart E, Laredo JD. Paraplegia complicating selective steroid injections of the lumbar spine. Report of five cases and review of the literature. Eur Radiol 2010; 20 (01) 181-189
    CrossrefPubMedGoogle Scholar
  • 35 Espinosa P, Benoit P, Salazar I, de la Fuente J, Heiles P. Transrectal ultrasonography of equine lumbosacral nerves: pilot study in 28 healthy Warmblood horses. Vet Radiol Ultrasound 2017; 58 (02) 228-236
    CrossrefPubMedGoogle Scholar