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Home / Equine Research Bank / Vet Surg / Ultrasonographic guidance for perineural injections of the c...
Veterinary surgery : VS2021; 50(4); 816-822; doi: 10.1111/vsu.13610

Ultrasonographic guidance for perineural injections of the cervical spinal nerves in horses.

Abstract: 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 margin of the cranial articular process, where 1 mL of latex was injected. Cadavers were dissected, and the location of the latex was recorded relative to the ventral ramus, the spinal cord, and the vertebral artery. Results: Direct infiltration of the ventral ramus occurred in 73% (29/40) of injections; 15% (6/40) of injections were  0.5 cm (maximum 1.5 cm). Latex was located at a mean of 2.4 cm (range, 0.8-4) from the spinal cord and 0.9 cm (range, 0-1.5) from the vertebral artery. Conclusions: Ultrasonographic guidance of perineural injections of the caudal VRCSN was repeatable and accurate, with 88% of injections located within 0.5 cm of the ventral ramus. Iatrogenic damage was limited to one penetration into the vertebral artery. Conclusions: Ultrasonographic guidance of perineural injections of the caudal VRCSN may be considered by operators experienced in cervical APJ scanning in horses with suspected cervical spinal nerve compression.
© 2021 The American College of Veterinary Surgeons.
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Publication Date: 2021-03-10 PubMed ID: 33751588DOI: 10.1111/vsu.13610Google Scholar: Lookup
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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.

The research study was aimed at testing the precision of ultrasonographic guidance for injections targeting the ventral rami of cervical nerves in horses. This technique was found to be reliable and accurate, suggesting its potential use by veterinary professionals handling horses with suspected cervical spinal nerve compression.

Methodology

  • The study employed an ex vivo design and used ten horse cadavers, involving a total of 40 injections.
  • The left and right ventral rami of the cervical spinal nerves (VRCSN) at C4/5 and C5/6 were infiltrated at the intervertebral foramen (IVF) using ultrasonographic guidance.
  • A vertically aligned 3.5-MHz curvilinear probe identified the craniocaudal midpoint of the articular process joint (APJ). Moving the probe ventrally identified the IVF.
  • An 18-gauge 15-cm-long needle was aimed slightly beneath the ventral margin of the cranial articular process. Approximately 1 mL of latex was then injected.
  • The location of the latex was subsequently recorded, determining its relative positions to the ventral ramus, the spinal cord, and the vertebral artery.

Results

  • The results showed that the ventral ramus was directly infiltrated in 73% (29/40) of the injections.
  • Around 15% (6/40) of the injections ended up less than 0.5 cm from the ventral ramus.
  • About 13% (5/40) of the injections were more than 0.5 cm away (up to a maximum of 1.5 cm) from the ventral ramus.
  • The latex was found to be at an average of 2.4 cm (between 0.8 cm and 4 cm) from the spinal cord and 0.9 cm (ranging from 0 to 1.5 cm) from the vertebral artery.

Conclusions

  • The ultrasonographic guidance for perineural injections around the caudal VRCSN proved to be reliable and accurate, with 88% of injections located within 0.5 cm of the ventral ramus.
  • Any potential harm resulting from the procedure appeared minimal, with only one incident of penetration into the vertebral artery recorded.
  • The researchers concluded that qualified operators might consider employing this method for horses suffering from suspected cervical spinal nerve compression.

Cite This Article

APA
Wood AD, Sinovich M, Prutton JSW, Parker RA. (2021). Ultrasonographic guidance for perineural injections of the cervical spinal nerves in horses. Vet Surg, 50(4), 816-822. https://doi.org/10.1111/vsu.13610

Publication

Veterinary surgery : VS
ISSN: 1532-950X
NlmUniqueID: 8113214
Country: United States
Language: English
Volume: 50
Issue: 4
Pages: 816-822

Researcher Affiliations

Wood, Andrew Douglas
  • Liphook Equine Hospital, Hampshire, UK.
Sinovich, Matthew
  • Liphook Equine Hospital, Hampshire, UK.
Prutton, James Stephen Winter
  • Liphook Equine Hospital, Hampshire, UK.
Parker, Russell Alexander
  • Liphook Equine Hospital, Hampshire, UK.

MeSH Terms

  • Animals
  • Cadaver
  • Horses
  • Injections, Spinal / methods
  • Injections, Spinal / veterinary
  • Neck
  • Reproducibility of Results
  • Spinal Nerves / diagnostic imaging
  • Ultrasonography / veterinary

References

This article includes 21 references
  1. Dyson SJ. The cervical spine and soft tissues of the neck. 2010:606-616.
  2. Cohen SP, Hooten WM. Advances in the diagnosis and management of neck pain. Br Med J 2017; 358:1-19.
    doi: 10.1136/bmj.j3221google scholar: lookup
  3. Darby SA. Clinical Anatomy of the Spine, Spinal Cord, and ANS. 2013: 65-97.
    doi: 10.1016/b978-0-323-07954-9.00003-7google scholar: lookup
  4. Ehsanian R, Kennedy DJ, Schneider B. Cervical ultrasound utilization in selective cervical nerve root injection for the treatment of cervical radicular pain: a review. Curr Phys Med Rehabil Reports 2019;7:386-396.
    doi: 10.1007/s40141-019-00248-1google scholar: lookup
  5. Jaumard NV, Welch WC, Winkelstein BA. Spinal facet joint biomechanics and mechanotransduction in normal, injury and degenerative conditions. J Biomech Eng 2011;133:1-31.
    doi: 10.1115/1.4004493google scholar: lookup
  6. Moore BR, Holbrook TC, Stefanacci JD, Reed SM, Tate LP, Menard MC. Contrast enhanced computed tomography and myelography in six horses with cervical stenotic myelopathy. Equine Vet J 1992;24:197-202.
    doi: 10.1111/j.2042-3306.1992.tb02814.xgoogle scholar: lookup
  7. Ricardi G, Dyson SJ. Forelimb lameness associated with radiographic abnormalities of the cervical vertebrae. Equine Vet J 1993;25:422-426.
    doi: 10.1111/j.2042-3306.1993.tb02984.xgoogle scholar: lookup
  8. Marks D. Cervical nerve root impingement in a horse, treated by epidural injection of corticosteroids. J Equine Vet Sci 1999;19:399-401.
    doi: 10.1016/s0737-0806(99)80304-9google scholar: lookup
  9. Mattoon JS, Drost T, Grguric MR, Auld DM, Reed SM. Technique for equine cervical articular process joint injection. Vet Radiol Ultrasound 2004;45:238-240.
    doi: 10.1111/j.1740-8261.2004.04042.xgoogle scholar: lookup
  10. Purefoy Johnson J, Stack JD, Rowan C, Handel I, O'Leary JM. Ultrasound-guided approach to the cervical articular process joints in horses: a validation of the technique in cadavers. Vet Comp Orthop Traumatol 2017;30:165-171.
    doi: 10.3415/vcot-16-09-0139google scholar: lookup
  11. Nielsen JV, Berg LC, Thoefner MB, Thomsen PD. Accuracy of ultrasound-guided intra articular injection of cervical facet joints in horses: a cadaveric study. Equine Vet J 2010;35:657-661.
    doi: 10.2746/042516403775696366google scholar: lookup
  12. Touzot-Jourde G, Geffroy O, Tallaj A, Gauthier O, Denoix JM. Ultrasonography-guided perineural injection of the ramus ventralis of the 7 and 8th cervical nerves in horses: a cadaveric descriptive pilot study. Front Vet Sci 2020;7:1-8.
    doi: 10.3389/fvets.2020.00102google scholar: lookup
  13. Ok뫞jo GO, Talcott MR, Schmidt RE, Sharma A, Patel AA, Mackey RB, Guarino AH, Moran CJ, Riew KD. Perils of intravascular methylprednisolone injection into the vertebral artery: an animal study. J Bone Joint Surg 2008;90(9):1932-1938.
    doi: 10.2106/jbjs.g.01182google scholar: lookup
  14. Park KD, Lee WY, Nam SH, Kim M, Park Y. Ultrasound-guided selective nerve root block versus fluoroscopy-guided interlaminar epidural block for the treatment of radicular pain in the lower cervical spine: a retrospective comparative study. J Ultrasound 2019;22:167-177.
    doi: 10.1007/s40477-018-0344-zgoogle scholar: lookup
  15. McLean JP, Sigler JD, Plastaras CT, Garvan CW, Rittenberg JD. The rate of detection of intravascular injection in cervical transforaminal epidural steroid injections with and without digital subtraction angiography. Phys Med Rehabil 2009;1:636-642.
    doi: 10.1016/j.pmrj.2009.03.017google scholar: lookup
  16. Dahlgren N, Törnebrandt K. Neurological complications after anaesthesia. A follow-up of 18 000 spinal and epidural anaesthetics performed over three years. Acta Anaesthesiol Scand 1995;39:872-880.
    doi: 10.1111/j.1399-6576.1995.tb04190.xgoogle scholar: lookup
  17. Netravathi M, Taly AB, Sinha S, Bindu PS, Goel G. Accidental spinal cord injury during spinal anesthesia: a report. Ann Indian Acad Neurol 2010;13:297-298.
    doi: 10.4103/0972-2327.74200google scholar: lookup
  18. Radhakrishnan K, Litchy WJ, O'Fallon WM, Kurland LT. Epidemiology of cervical radiculopathy: a population-based study from Rochester, Minnesota, 1976 through 1990. Brain 1994;117:325-335.
    doi: 10.1093/brain/117.2.325google scholar: lookup
  19. Lee SH, Kim JM, Chan V, Kim HJ, Kim HI. Ultrasound-guided cervical periradicular steroid injection for cervical radicular pain: relevance of spread pattern and degree of penetration of contrast medium. Pain Med 2013;14:5-13.
    doi: 10.1111/pme.12010google scholar: lookup
  20. Birmingham SSW, Reed SM, Mattoon JS, Saville WJ. Qualitative assessment of corticosteroid cervical articular facet injection in symptomatic horses. Equine Vet Educ 2010;22:77-82.
    doi: 10.2746/095777309x477852google scholar: lookup
  21. Reed S. Neurologic exam. J Equine Vet Sci 2003;23(11):484-492.
    doi: 10.1016/j.jevs.2003.10.013google scholar: lookup

Citations

This article has been cited 2 times.
  1. Fouquet G, Abbas G, Johnson JP, Pompermayer E, Harel C, Aldous E, Puchalski S, David F. Ultrasound-guided injection technique of the equine cervical nerve roots. Front Vet Sci 2022;9:992208.
    doi: 10.3389/fvets.2022.992208pubmed: 36387391google scholar: lookup
  2. Nocera I, Di Franco C, Sorvillo B, Aliboni B, Bucchioni E, Sgorbini M, Sala G, Citi S. 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 2024 Dec;44(1):1-5.
    doi: 10.1080/01652176.2024.2403456pubmed: 39267500google scholar: lookup
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