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Topic:Vertebrae

The vertebrae in horses form a critical component of the equine skeletal system, providing structural support and facilitating movement. Horses possess a series of vertebrae categorized into five regions: cervical, thoracic, lumbar, sacral, and caudal. These vertebrae protect the spinal cord and serve as attachment points for muscles and ligaments, contributing to the horse's posture and locomotion. Variations in vertebral anatomy can influence a horse's performance and susceptibility to certain conditions. This page compiles peer-reviewed research studies and scholarly articles that explore the anatomy, biomechanics, and clinical implications of vertebral health in horses.
Adaptations in equine axial movement and muscle activity occur during induced fore- and hindlimb lameness: A kinematic and electromyographic evaluation during in-hand trot.
Equine veterinary journal    December 14, 2022   doi: 10.1111/evj.13906
Spoormakers TJP, St George L, Smit IH, Hobbs SJ, Brommer H, Clayton HM, Roy SH, Richards J, Serra Bragança FM.The inter-relationship between equine thoracolumbar motion and muscle activation during normal locomotion and lameness is poorly understood. Objective: To compare thoracolumbar and pelvic kinematics and longissimus dorsi (longissimus) activity of trotting horses between baseline and induced forelimb (iFL) and hindlimb (iHL) lameness. Methods: Controlled experimental cross-over study. Methods: Three-dimensional kinematic data from the thoracolumbar vertebrae and pelvis, and bilateral surface electromyography (sEMG) data from longissimus at T14 and L1, were collected synchronously from clinicall...
Age and sex correlate with bony changes and anatomic variations of the lumbosacroiliac region of the vertebral column in a mixed population of horses.
Journal of the American Veterinary Medical Association    November 8, 2022   Volume 261, Issue 2 258-265 doi: 10.2460/javma.22.07.0293
Scilimati N, Beccati F, Dall'Aglio C, Di Meo A, Pepe M.To provide a postmortem description of anatomic variations and changes of the lumbosacroiliac region in horses. The authors hypothesized that lesion severity would increase with age and body weight and correlate to anatomic variations. Lumbosacroiliac vertebral specimens from 38 horses (mean age, 16 years; range, 5 to 30 years) that died or were euthanized for reasons unrelated to the study between November 2019 and October 2021. The lumbosacroiliac region of the vertebral column was removed from each cadaver. After dissection, disarticulation, and boiling, the anatomic specimens were examined...
The effect of manually facilitated flexion of the thoracic spine on the interspinous space among horses with impinging dorsal spinous processes of the thoracic vertebrae.
Veterinary journal (London, England : 1997)    September 29, 2022   Volume 289 105909 doi: 10.1016/j.tvjl.2022.105909
O'Sullivan S, McGowan CM, Junnila J, Hyytiäinen HK.Impinging dorsal spinous processes (IDSP) are typically diagnosed and graded using radiography, during which the effect of the horses' thoracolumbar posture on the interspinous spaces is not commonly considered. Posture can be altered from a spontaneous, relatively extended, or lordotic, position by manual facilitation of thoracic flexion ('thoracic lift'). This study aimed to ascertain if the thoracic vertebral interspinous space distances were increased by using facilitated thoracic flexion to alter the posture in horses diagnosed with IDSP. Seven horses of mixed breed and sex, median age 9....
CT measures of osseous cervicothoracic intervertebral foramina are repeatable and associated with CT measures of adjacent articular processes in horses. Rovel T, Duchateau L, Saunders J, Vandenberghe F, Vanderperren K.Narrowing of the equine cervicothoracic intervertebral foramina (IF) has the potential to cause forelimb lameness and/or neck pain although limited information is available on CT of the IF. The aims of this retrospective, analytical study were to describe a protocol for quantifying CT cervicothoracic IF size; evaluate the repeatability of IF size measures; test associations between IF size and adjacent articular process (AP) size, ventral extent, and anatomic location; and determine the proportion of IF with narrowing. Computed tomographic images were acquired in 20 Warmblood horses that prese...
Cervical Vertebral Stenotic Myelopathy.
The Veterinary clinics of North America. Equine practice    August 12, 2022   Volume 38, Issue 2 225-248 doi: 10.1016/j.cveq.2022.05.002
Woodie B, Johnson AL, Grant B.Cervical vertebral stenotic myelopathy is a common cause of ataxia in horses secondary to spinal cord compression. Early articles describing this problem indicate genetic predisposition as a known risk factor. Further studies have shown the problem is a developmental abnormality which might have genetic predisposition and environmental influences.
A Systematic Review of Clinical Signs Associated With Degenerative Conditions and Morphological Variations of the Equine Caudal Neck.
Journal of equine veterinary science    July 2, 2022   Volume 116 104054 doi: 10.1016/j.jevs.2022.104054
Kernot N, Butler R, Randle H.Conditions of the equine caudal neck (C5-C7) are thought to be associated with various clinical signs. However, little investigation has been undertaken to isolate clinical indicators associated with specific conditions of the equine caudal cervical spine. This systematic review aimed to evaluate associations of clinical signs with anatomical malformation of caudal cervical vertebrae, spinal cord compression of the caudal cervical spine, and arthropathy of the caudal cervical articular process joints (APJs). A literature search was carried out using Google Scholar in accordance with PRISMA (Pr...
Investigation of a contributing factor for cervical vertebral stenotic myelopathy using computed tomography for measuring the cervical vertebral volume.
The Journal of veterinary medical science    June 8, 2022   Volume 84, Issue 8 1084-1087 doi: 10.1292/jvms.22-0188
Kondo T, Mashimo Y, Sato F, Tsuzuki N, Yamada K.Thoroughbred horses appear to be particularly predisposed to cervical vertebral stenotic myelopathy (CVSM), also known as wobbler syndrome. We hypothesized that variations in the cervical vertebral volumes can affect the dynamic instability of the cervical vertebrae. This observational study aimed to clarify whether cervical vertebral volume could be considered as a contributing factor in CVSM in Thoroughbred horses. Computed tomography (CT) was used to investigate a total of 21 male Thoroughbred horses (age range, 217-1,002 days; mean, 542.3 days). The study population comprised 17 CVSM horse...
The existence of intertransverse joints in young warmblood foals.
Journal of the American Veterinary Medical Association    April 27, 2022   Volume 260, Issue 10 1206-1210 doi: 10.2460/javma.22.02.0051
Spoormakers TJP, Bergmann W, Veraa S, van Weeren PR, Brommer H.To verify the existence of intertransverse joints (ITJs) in young foals. 11 warmblood foals. Postmortem examination of the lumbar area in foals < 200 days old using CT, MRI, dissection, and histomorphology. Data were analyzed with descriptive statistics. Age of foals varied between 1 and 200 days (median, 11 days). Ten foals had 6 lumbar (L) vertebrae, and 1 foal had 5. All 11 foals, irrespective of age, had ITJs between the first sacral and last lumbar vertebrae and between the last and second-to-last lumbar vertebrae. In 6 foals (all with 6 L vertebrae), ITJs also existed between the four...
Three-Dimensional Modeling and In Silico Kinematic Evaluation of Interspinous Ligament Desmotomy in Horses.
Frontiers in bioengineering and biotechnology    April 1, 2022   Volume 10 817300 doi: 10.3389/fbioe.2022.817300
Biedrzycki AH, Elane GL. Interspinous ligament desmotomy (ISLD) has been shown to improve the comfort of horses diagnosed with overriding dorsal spinous processes (DSP), but its effects on spine mobility are unknown. To objectively quantify the change in mobility of thoracic vertebrae following ISLD using CT and medical modeling software. Prospective cadaveric manipulation of seven equine thoracolumbar spines collected from T11-L1. Spines were collected from T11-L1 with the musculature intact. Flexion and extension phases were achieved with a ratchet device calibrated to 2000N. Bone volume CT scans were performed ...
Characteristic computed tomographic myelography findings in 23 Thoroughbred horses.
The Journal of veterinary medical science    February 23, 2022   Volume 84, Issue 4 525-532 doi: 10.1292/jvms.22-0036
Kondo T, Sato F, Tsuzuki N, Watanabe K, Horiuchi N, Kobayashi Y, Yamada K.The purpose of this observational study was to determine the characteristic computed tomographic (CT) myelography findings of cervical vertebral stenotic myelopathy (CVSM) lesions in Thoroughbred horses. A total of 23 Thoroughbred horses (age range, 155-717 days on CT examination; mean, 410.9 days) were analyzed. All 23 Thoroughbred horses underwent unenhanced radiography, radiographic myelography, and CT myelography. Unenhanced radiographs were observed the presence of cervical vertebral malalignment and osseous lesions. Radiographic myelograms were observed for signs of cervical spinal cord ...
An objective index for spinal cord compression on computed tomography in Thoroughbred horses.
Veterinary medicine and science    February 13, 2022   Volume 8, Issue 3 1072-1078 doi: 10.1002/vms3.767
Kondo T, Sato F, Tsuzuki N, Chen CJ, Yamada K.Computed tomographic myelography can be a useful tool for evaluating vertebral canal stenosis. However, an index of spinal cord compression is yet to be established. This observational descriptive study aimed to establish an index for spinal cord compression using computed tomography (CT). Twenty-three Thoroughbred horses (age, 155-717 days; weight, 205-523 kg) with suspected cervical vertebral malformation were subjected to computed tomographic myelography in dorsal recumbency using large-bore gantry CT to define the entire cervical vertebrae from C1 to C7. Subsequently, the height of the sp...
Osteochondrosis and other lesions in all intervertebral, articular process and rib joints from occiput to sacrum in pigs with poor back conformation, and relationship to juvenile kyphosis.
BMC veterinary research    January 18, 2022   Volume 18, Issue 1 44 doi: 10.1186/s12917-021-03091-6
Olstad K, Aasmundstad T, Kongsro J, Grindflek E.Computed tomography (CT) is used to evaluate body composition and limb osteochondrosis in selection of breeding boars. Pigs also develop heritably predisposed abnormal curvature of the spine including juvenile kyphosis. It has been suggested that osteochondrosis-like changes cause vertebral wedging and kyphosis, both of which are identifiable by CT. The aim of the current study was to examine the spine from occiput to sacrum to map changes and evaluate relationships, especially whether osteochondrosis caused juvenile kyphosis, in which case CT could be used in selection against it. Whole-body ...
Intervertebral disc degeneration in warmblood horses: Histological and biochemical characterization.
Veterinary pathology    January 4, 2022   Volume 59, Issue 2 284-298 doi: 10.1177/03009858211067463
Bergmann W, de Lest CV, Plomp S, Vernooij JCM, Wijnberg ID, Back W, Gröne A, Delany MW, Caliskan N, Tryfonidou MA, Grinwis GCM.Gross morphology of healthy and degenerated intervertebral discs (IVDs) is largely similar in horses as in dogs and humans. For further comparison, the biochemical composition and the histological and biochemical changes with age and degeneration were analyzed in 41 warmblood horses. From 33 horses, 139 discs and 2 fetal vertebral columns were evaluated and scored histologically. From 13 horses, 73 IVDs were assessed for hydration, DNA, glycosaminoglycans, total collagen, hydroxyl-lysyl-pyridinoline, hydroxylysine, and advanced glycation end-product (AGE) content. From 7 horses, 20 discs were ...
Computed tomographic myelography for assessment of the cervical spinal cord in ataxic warmblood horses: 26 cases (2015-2017).
Journal of the American Veterinary Medical Association    November 3, 2021   Volume 259, Issue 10 1188-1195 doi: 10.2460/javma.20.11.0614
Rovel T, Zimmerman M, Duchateau L, Adriaensen E, Mariën T, Saunders JH, Vanderperren K.To quantify the degree of dural compression and assess the association between site and direction of compression and articular process (AP) size and degree of dural compression with CT myelography. 26 client-oriented horses with ataxia. Spinal cord-to-dura and AP-to-cross-sectional area of the C6 body ratios (APBRs) were calculated for each noncompressive site and site that had > 50% compression of the subarachnoid space. Site of maximum compression had the largest spinal cord-to-dura ratio. Fisher exact test and linear regression analyses were used to assess the association between site an...
Computed tomographic examination of the articular process joints of the cervical spine in warmblood horses: 86 cases (2015-2017).
Journal of the American Veterinary Medical Association    November 3, 2021   Volume 259, Issue 10 1178-1187 doi: 10.2460/javma.20.03.0105
Rovel T, Zimmerman M, Duchateau L, Delesalle C, Adriaensen E, Mariën T, Saunders JH, Vanderperren K.To describe articular process joints (APJs) of the cervical spine in horses on the basis of CT and to determine whether abnormalities were associated with clinical signs. 86 client-owned warmblood horses. Horses that underwent CT of the cervical spine between January 2015 and January 2017 were eligible for study inclusion. Medical records were reviewed for age, body weight, breed, sex, history, clinical signs, and CT findings. Horses were divided into 3 case groups and 1 control group on the basis of clinical signs. 70 warmblood horses were cases, and 16 were controls. Abnormalities were more ...
3D kinematic of the thoracolumbar spine in Mangalarga Marchador horses performing the marcha batida gait and being led by hand-A preliminary report.
PloS one    July 6, 2021   Volume 16, Issue 7 e0253697 doi: 10.1371/journal.pone.0253697
Simonato SP, Bernardina GRD, Ferreira LCR, Silvatti AP, Barcelos KMC, da Fonseca BPA.This study aimed to provide a preliminary description of the sagittal and transverse plane kinematics of the thoracolumbar spine of Mangalarga Marchador (MM) horses performing the marcha batida gait, led in-hand. We evaluated the pattern of angular movement and the mean amplitude of six specific angles. An optoelectronic system was used for 3D kinematic analysis (19 cameras, 250 Hz). They were positioned around the horses and an acquisition volume of 16 × 4.8 × 3 meters was used. Eight retroreflective markers were fixed on the spine of the animals over thoracic vertebrae 8 (T8), 12 (T12), 15...
Postmortem diagnoses of spinal ataxia in 316 horses in California.
Journal of the American Veterinary Medical Association    June 2, 2021   Volume 258, Issue 12 1386-1393 doi: 10.2460/javma.258.12.1386
Hales EN, Aleman M, Marquardt SA, Katzman SA, Woolard KD, Miller AD, Finno CJ.To determine period prevalences of postmortem diagnoses for spinal cord or vertebral column lesions as underlying causes of ataxia (spinal ataxia) in horses. Methods: 2,861 client-owned horses (316 with ataxia [ataxic group] and 2,545 without ataxia [control group]). Methods: The medical records database of the University of California-Davis Veterinary Medical Teaching Hospital was searched to identify horses necropsied between January 1, 2005, and December 31, 2017. Results were compared between the ataxic and control groups and between various groups of horses in the ataxic group. Period pre...
Sudden death caused by spinal cord injury associated with vertebral fractures and fetlock failure in a Thoroughbred racehorse. Samol MA, Uzal FA, Blanchard PC, Arthur RM, Stover SM.The most prevalent causes of death in racehorses are musculoskeletal injuries, causing ~83% of deaths within the racing industry in California and elsewhere. The vast majority of these injuries have preexisting lesions that predispose to fatal injury. A 4-y-old Thoroughbred colt suffered an acute suspensory apparatus failure, including biaxial proximal sesamoid bone fractures of the right front fetlock, causing loss of support of the fetlock joint and consequent fall with fractures of the cervical and sacral spine. Cervical fracture caused spinal cord damage that resulted in sudden death. A pr...
A comparative study of breed differences in the anatomical configuration of the equine vertebral column.
Journal of anatomy    May 15, 2021   Volume 239, Issue 4 829-838 doi: 10.1111/joa.13456
Spoormakers TJP, Veraa S, Graat EAM, van Weeren PR, Brommer H.The importance of the equine thoracolumbar vertebral column in orthopaedic disorders is well recognized and diagnostic imaging becomes more feasible, but little is known about variations in the anatomical configuration within breeds. In this descriptive post-mortem study, anatomical variations in three widely differing breeds: Warmblood horses, Shetland ponies and semi-feral Konik horses are described. The caudal cervical (C), thoracic (T), lumbar (L) and sacral (S) regions of the vertebral column of 30 Warmblood horses, 29 Shetland ponies and 18 Konik horses were examined using computed tomog...
Outcomes after cervical vertebral interbody fusion using an interbody fusion device and polyaxial pedicle screw and rod construct in 10 horses (2015-2019).
Equine veterinary journal    May 3, 2021   Volume 54, Issue 2 347-358 doi: 10.1111/evj.13449
Pezzanite LM, Easley JT, Bayless R, Aldrich E, Nelson BB, Seim HB, Nout-Lomas YS.Further development of surgical techniques for equine cervical stabilisation is necessary to make the procedure less technically demanding, reduce complications and improve outcomes. Objective: To describe clinical outcomes and owner reports in horses undergoing placement of an interbody fusion device and polyaxial pedicle screw and rod construct for cervical vertebral fusion in horses with cervical vertebral compressive myelopathy. Methods: Retrospective case series. Methods: Data were retrieved from medical records of 10 horses undergoing cervical vertebral fusion (2015-2019). Records were e...
Differential Rotational Movement of the Thoracolumbosacral Spine in High-Level Dressage Horses Ridden in a Straight Line, in Sitting Trot and Seated Canter Compared to In-Hand Trot.
Animals : an open access journal from MDPI    March 20, 2021   Volume 11, Issue 3 888 doi: 10.3390/ani11030888
MacKechnie-Guire R, Pfau T.Assessing back dysfunction is a key part of the investigative process of "loss of athletic performance" in the horse and quantitative data may help veterinary decision making. Ranges of motion of differential translational and rotational movement between adjacent inertial measurement units attached to the skin over thoracic vertebrae 5, 13 and 18 (T5, T13, T18) lumbar vertebra 3 (L3) and tuber sacrale (TS) were measured in 10 dressage horses during trot in-hand and ridden in sitting trot/canter. Straight-line motion cycles were analysed using a general linear model (random factor: horse; fixed...
Ultrasound-guided erector spinae plane block in horses: a cadaver study.
Veterinary anaesthesia and analgesia    March 19, 2021   Volume 48, Issue 4 577-584 doi: 10.1016/j.vaa.2020.11.009
Delgado OBD, Louro LF, Rocchigiani G, Verin R, Humphreys W, Senior M, Campagna I.To describe dye distribution and spinal nerve involvement after a simulated erector spinae plane (ESP) block performed on fresh equine cadavers. Methods: Experimental cadaver study. Methods: A group of 11 adult equine cadavers. Methods: The spinal region surrounding the sixteenth thoracic vertebra (Th16) of one cadaver was removed and underwent magnetic resonance imaging. In 10 adult equine cadavers [body weight, 549 ± 58 kg (mean ± standard deviation)], 0.2 mL kg of a 50:1 2% lidocaine/dye solution was injected bilaterally (n = 20 injections) into the fascial plane between the transverse p...
Mesenchymal stem cell transplantation into the spinal cord of healthy adult horses undergoing cervical ventral interbody fusion.
Veterinary surgery : VS    March 11, 2021   Volume 50, Issue 5 1107-1116 doi: 10.1111/vsu.13611
François I, Lepage OM, Carpenter E, Desjardins I, De Guio C, Benedetti IC, Maddens S, Saulnier N, Grant BD.To determine the feasibility of umbilical cord-derived mesenchymal stem cell (UC-MSC) transplantation into the cervical spinal cord of horses by using fluoroscopy with or without endoscopic guidance and to evaluate the neurological signs and tissue reaction after injection. Methods: Experimental study. Methods: Eight healthy adult horses with no clinical signs of neurological disease. Methods: After cervical ventral interbody fusion (CVIF), ten million fluorescently labeled allogeneic UC-MSC were injected into the spinal cord under endoscopic and fluoroscopic guidance (n = 5) or fluoroscopic...
Ultrasonographic guidance for perineural injections of the cervical spinal nerves in horses.
Veterinary surgery : VS    March 10, 2021   Volume 50, Issue 4 816-822 doi: 10.1111/vsu.13610
Wood AD, Sinovich M, Prutton JSW, Parker RA.To evaluate the accuracy of ultrasonographic guidance for injection near the ventral rami of the cervical spinal nerves (VRCSN). Methods: Ex vivo study. Methods: Ten cadavers (n = 40 injections). Methods: Left and right VRCSN at C4/5 and C5/6 were infiltrated at the intervertebral foramen (IVF) under ultrasonographic guidance. A vertically orientated 3.5-MHz curvilinear probe was used to identify the craniocaudal midpoint of the articular process joint (APJ). The probe was moved ventrally until the IVF was identified. An 18-gauge 15-cm-long spinal needle was aimed immediately below the ventral...
Implications of the neuroanatomy of the equine thoracolumbar vertebral column with regional anaesthesia and complications following desmotomy of the interspinous ligament.
Equine veterinary journal    February 15, 2021   Volume 53, Issue 4 649-655 doi: 10.1111/evj.13402
Derham AM, Schumacher J, O' Leary JM, Kelly G, Hahn CN.Impinging/overriding dorsal spinous processes (DSPs) of the thoracolumbar vertebrae are a common cause of poor performance in horses. In the last five decades, numerous surgical treatments have been reported on, from transverse transection of the affected DSPs, and endoscopic resection of the affected DSPs, to transection of the interspinous ligament. Until recently, cosmetic outcomes have been reported as good to excellent in studies. However, a previously unreported complication of neurogenic atrophy of the contralateral epaxial muscle following desmotomy of the interspinous ligament has bee...
The Effect of a Physiotherapy Intervention on Thoracolumbar Posture in Horses.
Animals : an open access journal from MDPI    October 28, 2020   Volume 10, Issue 11 doi: 10.3390/ani10111977
Shakeshaft A, Tabor G.Dynamic mobilisation exercises (DME) are often used as part of a physiotherapy rehabilitation programme. Whilst immediate kinematic effects have been measured, the change in posture is anecdotally reported to have a longer duration. This study aimed to test the reliability of a simple objective measurement method, suitable for use in clinical practice, and to objectively measure equine thoracolumbar posture, before and after DME. A single investigator took triplicate measurements of the sagittal thoracolumbar shape using a flexicurve ruler (FCR) then triplicate measurements of the thoracolumba...
Cervical disc width index is a reliable parameter and consistent in young growing Dutch Warmblood horses. Veraa S, Scheffer CJW, Smeets DHM, de Bruin RB, Hoogendoorn AC, Vernooij JCM, Nielen M, Back W.Intervertebral disc disease, as well as the associated alteration of the radiographic intervertebral disc space width, has been reported in horses. Disc height index (DHI) has proven to be an accurate and objective parameter in other species but data related to this parameter are lacking in horses. Therefore, the aims of this retrospective longitudinal diagnostic accuracy study were (a) to evaluate the reliability of measurements within and between observers of the equine Disc Width Index (EDWI) as a parameter for radiographic equine cervical intervertebral disc space width, and (b) to evaluat...
Computed tomographic cervical myelography in horses: Technique and findings in 51 clinical cases.
Journal of veterinary internal medicine    July 24, 2020   Volume 34, Issue 5 2142-2151 doi: 10.1111/jvim.15848
Gough SL, Anderson JDC, Dixon JJ.Three-dimensional computed tomographic (CT) evaluation of the cervical vertebral column enables more accurate identification of osseous and soft tissue lesions than traditional latero-lateral radiography. However, examination of the complete cervical vertebral column has been limited by horse size, preventing evaluation of the caudal cervical vertebrae. Objective: To describe a technique to enable CT myelography of the complete cervical spine and describe the findings in 51 horses. Methods: Records of 51 horses presented for evaluation of cervical vertebral lesions. Methods: A retrospective re...
Effect of Caudal Traction on Mechanical Nociceptive Thresholds of Epaxial and Pelvic Musculature on a Group of Horses With Signs of Back Pain.
Journal of equine veterinary science    July 23, 2020   Volume 93 103197 doi: 10.1016/j.jevs.2020.103197
Long K, McGowan CM, Hyytiäinen HK.Direct muscular attachment from lumbar vertebrae to the caudal vertebrae of the tail suggests that caudal traction, also described as a tail pull, may affect lumbar vertebral segments and/or associated soft tissues in horses. Traction is a commonly used human manual therapy technique used for pain relief and anecdotally observed to relieve pain in horses. However, research is lacking validating the efficacy of manual caudal traction on the horse. The objective of this study was to determine if caudal traction has an effect on mechanical nociceptive thresholds (MNTs) in a group of horses with c...
Cervical Epidural and Subarachnoid Catheter Placement in Standing Adult Horses.
Frontiers in veterinary science    May 14, 2020   Volume 7 232 doi: 10.3389/fvets.2020.00232
Hurcombe SD, Morris TB, VanderBroek AR, Habecker P, Wulster K, Hopster K.Horses underwent either cervical epidural space (CES) catheterization or subarachnoid space (SAS) catheterization while restrained in stocks, under deep sedation (detomidine and morphine) and local anesthesia (mepivacaine 2%) block. Catheters were placed under ultrasound guidance with visualization of the dura, SAS, and spinal cord between the first (C1) and second (C2) cervical vertebrae. Following sedation and sterile skin preparation, operator 1 placed under ultrasound guidance, a 6- or 8-inch Tuohy needle with the bevel oriented caudally. For CES, a 6-inch Touhy needle was used with the ha...