Ultrasound-guided injection technique of the equine cervical nerve roots.
Abstract: Radiculopathy in horses is often a diagnosis of exclusion because of the non-specific clinical signs related to neck pain and possible forelimb lameness. There are no reported treatment options in the equine veterinary literature. The purpose of the study was to describe an ultrasound-guided injection of the cervical nerve root C3 to C8, to evaluate accuracy, time and safety and to anticipate possible complications on clinical cases. Under general anesthesia and with ultrasound guidance, five horses were injected from C3 to C8 with 1.5mL mix of contrast and latex. Immediately after euthanasia, the necks were taken for CT examination and then dissection was performed 3 days later. Data regarding the accuracy of injection, the presence of injectate in the nerve root, vertebral vessel or vertebral canal were recorded from both CT and dissection. The time of injection and ability to visualize the nerve root prior to injection were also recorded. Out of 60 intended injections, 55 (CT images) and 57 (dissection) led to injectate deposited within the target zone with direct contact between contrast/latex and cervical nerve roots noted in 76.4% and 73.7%, respectively. Presence of contrast/latex injectate within nerves (≤11%), vertebral vessels (<4%) and canal (<4%) were rarely encountered. No variation on success rate or safety noted based on the site of injection. The technique described has excellent accuracy, with injectate deposition in direct contact (≈75%) or close vicinity (≈25%) of C3-C8 cervical nerve roots. Injectate diffusion is likely to further improve success rate. Rare presence of injectate within nerve/sheath, vertebral vessels/canal along with diffusion warrants caution when performing this procedure in clinical cases.
Copyright © 2022 Fouquet, Abbas, Johnson, Pompermayer, Harel, Aldous, Puchalski and David.
Publication Date: 2022-10-26 PubMed ID: 36387391PubMed Central: PMC9644134DOI: 10.3389/fvets.2022.992208Google Scholar: Lookup
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- Journal Article
Summary
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This research article discusses a new method for injecting medicine into the nerve roots of horses using ultrasound for guidance. The study sought to test the accuracy, timing, safety, and potential complications of this treatment on clinical cases.
Study Objective and Methodology
The primary aim of this study was to introduce a new injection technique to address radiculopathy in horses, a condition typically diagnosed when there are non-specific signs of neck pain and possible lameness in the forelimbs – for which no treatment strategies are suggested in existing equine veterinary literature.
- The research involved injecting the cervical nerve roots from C3 to C8 using ultrasound guidance with a mix of contrast and latex.
- Five horses, subjected to general anesthesia, were part of the study.
- The study aimed to evaluate the accuracy, timing, safety, and possible complications of this technique.
- A CT examination was conducted on the horses’ necks immediately after euthanasia, and a dissection was performed three days later.
- The injection’s accuracy, the presence of the injected substance in the nerve root, vertebral vessel, or vertebral canal were assessed both by CT and dissection.
Results
The study showed promising results with the new ultrasound-guided cervical nerve root injection technique.
- Out of the 60 planned injections, 55 (CT images) and 57 (dissection) successfully led to the injectate being deposited within the target zone.
- On average, about 75% of the times, the injectate was found in direct contact with the cervical nerve roots, while it was in the close vicinity in about 25% of the cases.
- The study recorded a rare presence of injectate within nerve/sheath, vertebral vessels/canal, indicating that caution is necessary when delivering this treatment in clinical cases.
Conclusion
The study suggests that the new ultrasound-guided injection technique is highly accurate and successful in depositing the injectate in direct contact or close vicinity of the C3-C8 cervical nerve roots in horses. The diffusion of injectate is likely to improve the success rate further. The rare likelihood of the injectate diffusing into the nerve, vertebral vessels, or canal mandates caution when implementing this technique in real-world cases, thereby improving the overall safety and effectiveness of the treatment.
Cite This Article
APA
Fouquet G, Abbas G, Johnson JP, Pompermayer E, Harel C, Aldous E, Puchalski S, David F.
(2022).
Ultrasound-guided injection technique of the equine cervical nerve roots.
Front Vet Sci, 9, 992208.
https://doi.org/10.3389/fvets.2022.992208 Publication
Researcher Affiliations
- Equine Veterinary Medical Center, Member of Qatar Foundation, Doha, Qatar.
- Equine Veterinary Medical Center, Member of Qatar Foundation, Doha, Qatar.
- Equine Veterinary Medical Center, Member of Qatar Foundation, Doha, Qatar.
- Equine Veterinary Medical Center, Member of Qatar Foundation, Doha, Qatar.
- Equine Veterinary Medical Center, Member of Qatar Foundation, Doha, Qatar.
- Equine Veterinary Medical Center, Member of Qatar Foundation, Doha, Qatar.
- Puchalski Equine Diagnostic Imaging Inc., Petaluma, CA, United States.
- Equine Veterinary Medical Center, Member of Qatar Foundation, Doha, Qatar.
Conflict of Interest Statement
Author SP is employed by Puchalski Equine Inc. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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Citations
This article has been cited 4 times.- Mota LA, Calegari RP, Pinto AU, Sica P, Gomes MP, Baptista AS, Arthur V. Biofortification of Yeast with Selenomethionine in Corn Hydrolysate: Influence of Different Metabolic Pathways. Biol Trace Elem Res 2026 Jan 7;.
- Li L, Liu X, Liu T, Liu Y, Zhang Z. Application value of Ultrasound-Guided cervical nerve root block test before percutaneous nucleoplasty in the treatment of patients with cervical chest pain: A retrospective study. Eur Spine J 2025 Aug;34(8):3253-3261.
- Hamed MA, Hamouda H, Elmetwally M, Farrag F, Rizk MA, Abumandour MMA, Hegazy YM, Samy A. Comparative experimental anesthesia efficacy study of epidural injection at the sacrococcygeal space using ultrasound guidance versus blindness technique in Egyptian donkeys (Equus asinus). BMC Vet Res 2025 Feb 7;21(1):57.
- 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.
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