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The veterinary quarterly2024; 44(1); 1-5; doi: 10.1080/01652176.2024.2403456

Evaluation of the feasibility of equine in-vivo ultrasound technique for the medial branch of the dorsal ramus of the cervical spinal nerves.

Abstract: Ultrasound-guided local anaesthesia is commonly used in veterinary orthopaedics for horses. This study aimed to assess an ultrasound technique for the medial branch of the dorsal branch of the cervical spinal nerves (MB-DBCSNs) in horses and compare the performance of clinicians with different experience levels. Ten healthy, skeletally mature horses were examined using radiographic and ultrasound (US) techniques in the cervical area (C3-C7). Four operators with varying experience conducted US examinations using a 10 MHz linear and 6 MHz curvilinear transducer over ten training sessions. The number of cervical nerves visualized was recorded. A chi-square test was used to analyse the impact of training, anatomical location, and operator experience on the identification of facet joints. Operator agreement was evaluated with Cohen's K test. The operators assessed 80 MB-DBCSNs, with radiographs and identified 70 healthy and 10 pathological facet joints. Training significantly improved visualization success, reaching 90% in later sessions. Cranial facet joints (C3-C5) were more frequently visualized (81%) than caudal ones (C5-C7) were (59%). US performance was influenced by the operator's skill, and agreement among operators ranged from slight to fair. Overall, practice improved cervical nerve visualization , particularly for cranial nerves, but the technique requires a long learning curve because of low levels of operator agreement.
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Publication Date: 2024-09-13 PubMed ID: 39267500PubMed Central: PMC11404379DOI: 10.1080/01652176.2024.2403456Google Scholar: Lookup
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  • Journal Article

Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

Overview

  • This study evaluated the feasibility and reliability of an ultrasound technique to visualize the medial branch of the dorsal branch of the cervical spinal nerves (MB-DBCSNs) in horses.
  • The research compared how well different clinicians, with varying levels of experience, could identify these nerves through ultrasound after multiple training sessions.

Background

  • Ultrasound-guided local anesthesia is widely used in veterinary orthopedics for horses, especially for pain management in the cervical spine.
  • The medial branch of the dorsal branch of the cervical spinal nerves (MB-DBCSNs) is an important target for diagnostic and therapeutic procedures.
  • There is a need to assess how feasible and reliable ultrasound imaging is for identifying these nerves in vivo in horses.

Study Objectives

  • To develop and test an ultrasound technique for visualizing the MB-DBCSNs in horses between cervical vertebrae C3-C7.
  • To analyze the effect of operator experience and training on the ability to identify these nerves using ultrasound.
  • To compare visualization success rates between cranial (C3-C5) versus caudal (C5-C7) cervical regions.

Methods

  • Subjects: Ten healthy, skeletally mature horses.
  • Imaging Techniques:
    • Radiography was used as a reference standard to identify cervical facet joints (both healthy and pathological).
    • Ultrasound examinations targeted the MB-DBCSNs over ten training sessions.
  • Operators: Four clinicians with different ultrasound experience levels performed the examinations.
  • Ultrasound equipment:
    • 10 MHz linear transducer
    • 6 MHz curvilinear transducer
  • Data Recorded: Number of cervical nerves visualized by each operator per session.
  • Statistical Analysis:
    • Chi-square test used to assess the effect of training, anatomical location, and experience on visualization rates.
    • Cohen’s Kappa statistic evaluated inter-operator agreement.

Results

  • In total, 80 MB-DBCSNs were assessed across the horses, corresponding to 70 healthy and 10 pathological facet joints as confirmed by radiographs.
  • Training had a significant positive effect on successfully visualizing the nerves, with visualization success improving to 90% in the later sessions.
  • Visualization success varied by anatomical location:
    • Cranial segment (C3-C5) nerves were visualized 81% of the time.
    • Caudal segment (C5-C7) nerves were visualized less frequently at 59%.
  • Operator experience significantly influenced ultrasound performance:
    • More experienced operators had better visualization rates initially.
    • All operators improved with repeated training, though some variability remained.
  • The agreement between operators ranged from slight to fair, indicating variability in identification despite training.

Conclusions and Implications

  • Ultrasound visualization of the MB-DBCSNs in horses is feasible but challenging.
  • Repeated training sessions can significantly improve visualization success rates, especially for nerves located in the cranial cervical spine (C3-C5).
  • The technique demands a relatively long learning curve due to initially low inter-operator agreement and difficulty in consistently identifying caudal cervical nerves.
  • Clinicians seeking to use ultrasound-guided local anesthesia in this region should expect to invest time into training and should be aware of anatomical variations and technical challenges.
  • Further refinement of the technique and standardization of training protocols could improve reliability among different operators.

Cite This Article

APA
Nocera I, Di Franco C, Sorvillo B, Aliboni B, Bucchioni E, Sgorbini M, Sala G, Citi S. (2024). Evaluation of the feasibility of equine in-vivo ultrasound technique for the medial branch of the dorsal ramus of the cervical spinal nerves. Vet Q, 44(1), 1-5. https://doi.org/10.1080/01652176.2024.2403456

Publication

The veterinary quarterly
ISSN: 1875-5941
NlmUniqueID: 7909485
Country: England
Language: English
Volume: 44
Issue: 1
Pages: 1-5

Researcher Affiliations

Nocera, Irene
  • Sant'Anna School of Advanced Studies, Institute of Health Sciences, Pisa, Italy.
Di Franco, Chiara
  • Department of Veterinary Sciences, University of Pisa, Pisa, Italy.
  • Institute of Clinical Physiology, National Research Council, Pisa, Italy.
Sorvillo, Benedetta
  • Department of Veterinary Sciences, University of Pisa, Pisa, Italy.
Aliboni, Benedetta
  • Private Practitioner, Italy.
Bucchioni, Elena
  • Private Practitioner, Italy.
Sgorbini, Micaela
  • Department of Veterinary Sciences, University of Pisa, Pisa, Italy.
Sala, Giulia
  • Department of Veterinary Sciences, University of Pisa, Pisa, Italy.
Citi, Simonetta
  • Department of Veterinary Sciences, University of Pisa, Pisa, Italy.

MeSH Terms

  • Animals
  • Horses
  • Spinal Nerves / diagnostic imaging
  • Female
  • Feasibility Studies
  • Ultrasonography / veterinary
  • Ultrasonography / methods
  • Male
  • Cervical Vertebrae / diagnostic imaging
  • Ultrasonography, Interventional / veterinary
  • Ultrasonography, Interventional / methods

Conflict of Interest Statement

No potential conflict of interest was reported by the author(s).

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