A dorsal ultrasound-guided approach to perineural injection of the sixth and seventh cervical spinal nerves in horses is accurate and does not result in epidural placement.
Abstract: To determine the accuracy of a dorsal ultrasound-guided approach for perineural injection of the sixth and seventh cervical spinal nerves (CSNs) with the use of a clinically relevant volume of injectate (2 mL). We hypothesized that the majority of injections would result in identification of contrast solution in the intervertebral foramen (IVF) on CT and corresponding methylene blue dye staining of the CSN on postmortem evaluation, and distribution of injectate into the epidural space would not occur. Unassigned: 7 horses donated to the University of Pennsylvania New Bolton Center for euthanasia were utilized. A dorsal ultrasound-guided perineural injection of the right and left sixth and seventh CSNs with the use of methylene blue and iohexol (2-mL volume) was performed. Postmortem CT of C5-C7 was performed and evaluated for presence of contrast within the IVF and epidural space. The cervical region was frozen at -20 °C prior to performing serial transverse band saw sections to evaluate for presence of methylene blue in contact with or surrounding the sixth and seventh CSNs and epidural space. Unassigned: Contrast was identified on CT in the IVF in 22 of 24 injections (92%). Methylene blue was adjacent to or surrounding the sixth and seventh CSNs in 22 of 24 injections (92%). No dye or contrast was noted within the epidural space. Unassigned: This ultrasound-guided approach to caudal CSN perineural injection is highly accurate without high risk for epidural penetration. Unassigned: This approach should be considered for injection of the sixth and seventh CSNs for conservative management of cervical radiculopathy.
Publication Date: 2025-04-23 PubMed ID: 40267973DOI: 10.2460/javma.25.02.0101Google Scholar: Lookup
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Summary
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This research concludes that the dorsal ultrasound-guided approach for perineural injection of the sixth and seventh cervical spinal nerves in horses is precise and does not pose a high risk of epidural penetration. This method is suggested for conservative management of cervical radiculopathy.
Research Inquiry and Hypothesis
- The aim of the study was to evaluate the correctness of a dorsal ultrasound-guided approach for the perineural injection of the sixth and seventh cervical spinal nerves. The volume of the injectate used was clinically significant (2mL).
- The researchers hypothesized that most injections will show the contrast solution in the intervertebral foramen (IVF) when analyzed with CT and corresponding methylene blue dye staining of the CSN during post-mortem examination. They also assumed that the distribution of injectate into the epidural space wouldn’t happen.
Methodology
- Seven horses donated to the University of Pennsylvania New Bolton Center for euthanasia were used for the research.
- Perineural injection of the right and left sixth and seventh CSNs was carried out using a dorsal ultrasound guide, applying methylene blue and iohexol (2mL volume).
- Postmortem CT of C5-C7 areas was conducted and checked for the presence of contrast within the IVF and epidural space.
- The neck region was froze at -20 °C before performing serial transverse band saw sections to analyze for the presence of methylene blue either surrounding or in contact with the sixth and seventh CSNs and epidural space.
Results
- The CT images revealed the contrast within the IVF in 92% of the injections (22 out of 24 injections).
- Methylene blue was found either adjacent to or surrounding the sixth and seventh CSNs in 92% of the injections (22 out of 24 injections).
- There was no incidence of dye or contrast within the epidural space.
Conclusion
- The dorsal ultrasound-guided approach to perineural injection of the sixth and seventh cervical spinal nerves in horses showed high accuracy and did not pose any major risk of epidural penetration.
- As a result, this method is suggested for conservative treatment of cervical radiculopathy in horses.
Cite This Article
APA
Brown KA, Engiles JB, de Solis CN, Bills KW, Johnson AL, Davidson EJ.
(2025).
A dorsal ultrasound-guided approach to perineural injection of the sixth and seventh cervical spinal nerves in horses is accurate and does not result in epidural placement.
J Am Vet Med Assoc, 1-8.
https://doi.org/10.2460/javma.25.02.0101 Publication
Researcher Affiliations
- 1Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA.
- 1Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA.
- 2Department of Pathobiology, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA.
- 1Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA.
- 1Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA.
- 1Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA.
- 1Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA.
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