Percutaneous full endoscopic foraminotomy for treatment of cervical spinal nerve compression in horses using a uniportal approach: Feasibility study.

BACKGROUND: Cervical spinal nerve insult can be a sequel of osteoarthropathy in horses due to enlargement of the articular processes (AP). OBJECTIVES: To describe the percutaneous endoscopic cervical foraminotomy procedure in horses. STUDY DESIGN: Ex vivo experimental study and clinical case report. METHODS: The technique was performed in three equine cadavers and in two clinical cases with history of forelimb lameness located in the caudal cervical region. Briefly, the horse was positioned in lateral recumbency, with the affected AP joint uppermost. Under fluoroscopic guidance, the endoscopic instruments (Ø 6.9 mm, length 207 mm, 25° angle of vision) were positioned at the dorsal bony margin of the intervertebral foramen (IVF). The bone was freed from soft tissues and removed using diamond various burrs, hence widening the IVF. The bone drilling was continued until the medial cortical surface of the caudal AP was removed. Thereafter, the endoscope was removed and the skin portal was closed. RESULTS: The average of operation time in clinical cases was 98 ± 24 min. The horses recovered smoothly from the operation. At 12-month follow-up, the clinical signs had resolved completely without recurrence. MAIN LIMITATION: Small number of clinical cases and absence of post-mortem examination or histopathology performed in the cadaver study to assess possible iatrogenic injuries. CONCLUSION: Cervical spinal nerve decompression via minimal invasive foraminotomy is feasible in horses. More research is required before this procedure can be recommended in clinical cases.

The impact of different bone tracers and acquisition times on image quality of equine bone scintigraphy.

The impact of different acquisition times (AqT) and technetium-99 m-labeled (99m Tc) diphosphonates on the image quality of bone scintigraphy is poorly documented in horses. The aim of this prospective experimental study was to evaluate the impact of varying 99m Tc-disphosphonates and AqT on semiquantitative and qualitative image parameters of bone scintigraphy in horses. Twenty-four horses undergoing bone scintigraphy were divided equally and randomly into methylene- (MDP), hydroxymethylene- (HDP), and dicarboxypropane diphosphonate (DPD) groups. Lateral scintigraphic images of the antebrachium were obtained 3 h post 99m TC-diphosphonate injection using three AqT (60, 90, 120 s). The images were analyzed semiquantitatively using the bone-soft tissue ratio (B:ST), signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and image contrast. Furthermore, a blinded qualitative analysis was performed using a visual grading analysis. The results showed that DPD images had a significantly higher B:ST ratio than MDP images (P < .01) but not HDP images in all AqT (P > .08). However, DPD and HPD images acquired at 60 s had significantly higher CNR (P < .05) than those acquired at 90 and 120 s. The qualitative analysis revealed no significant differences between 99m Tc-diphosphonates at AqT 60 and 90 s. However, MDP images acquired at 120 s had significantly lower image quality compared to DPD and HDP (P = .01 and .03, respectively). In conclusion, the bone tracers affected the semiquantitative image parameters but not the qualitative analysis findings. Increasing AqT did not necessarily improve the image quality. Therefore, decreasing the AqT enabled a reduction in personnel radiation exposure.

Movement asymmetries in horses presented for prepurchase or lameness examination.

BACKGROUND: The increasing popularity of objective gait analysis makes application in prepurchase examinations (PPE) a logical next step. Therefore, there is a need to have more understanding of asymmetry during a PPE in horses described on clinical evaluation as subtly lame. OBJECTIVES: The objective of this study is to objectively compare asymmetry in horses raising minor vet concerns in a PPE and in horses raising major vet concerns with that found in horses presented with subtle single-limb lameness, and to investigate the effect of age/discipline on the clinicians' interpretation of asymmetry on the classification of minor vet concerns in a PPE. STUDY DESIGN: Clinical case-series. METHODS: Horses presented for PPE (n = 98) or subjectively evaluated as single limb low-grade (1-2/5) lame (n = 24, 13 forelimb lame, 11 hindlimb lame), from the patient population of a single clinic, were enrolled in the study provided that owners were willing to participate. Horses undergoing PPE were assigned a classification of having minor vet concerns (n = 84) or major vet concerns (n = 14) based on findings during the dynamic-orthopaedic part of the PPE. Lame horses were only included if pain-related lameness was confirmed by an objective improvement after diagnostic analgesia exceeding daily variation determined for equine symmetry parameters using optical motion capture. Clinical evaluation was performed by six different clinicians, each with ≥8 years of equine orthopaedic experience. Vertical movement symmetry was measured using optical motion capture, simultaneously with the orthopaedic examination. Data were analysed using previously described parameters and mixed model analysis and least squares means were used to calculate differences between groups. RESULTS: There was no effect of age or discipline on the levels of asymmetry within PPE horses raising minor vet concerns. MinDiff and RUD of the head discriminated between forelimb lame and PPE horses raising minor vet concerns; MinDiff, MaxDiff, RUD of the Pelvis, HHDswing and HHDstance did so for hindlimb lameness. Two lameness patterns differentiated both forelimb and hindlimb lame from PPE horses with minor vet concerns: RUD Poll + MinDiff Withers - RUD Pelvis and RUD Pelvis + RUD Poll - MinDiff Withers. Correcting for vertical range of motion enabled differentiation of PPE horses with minor vet concerns from PPE horses with major vet concerns. MAIN LIMITATIONS: Objective data only based on trot on soft surface, limited number of PPE horses with major vet concerns. CONCLUSIONS: Combinations of kinematic parameters discriminate between PPE horses with minor vet concerns and subtly lame horses, though overlap exists.

Visual lameness assessment in comparison to quantitative gait analysis data in horses.

BACKGROUND: Quantitative gait analysis offers objective information to support clinical decision-making during lameness workups including advantages in terms of documentation, communication, education, and avoidance of expectation bias. Nevertheless, hardly any data exist comparing outcome of subjective scoring with the output of objective gait analysis systems. OBJECTIVES: To investigate between- and within-veterinarian agreement on primary lame limb and lameness grade, and to determine relationships between subjective lameness grade and quantitative data, focusing on differences between (1) veterinarians, (2) live vs video assessment, (3) baseline assessment vs assessment following diagnostic analgesia. STUDY DESIGN: Clinical observational study. METHODS: Kinematic data were compared to subjective lameness assessment by clinicians with ≥8 years of orthopaedic experience. Subjective assessments and kinematic data for baseline trot-ups and response to 48 diagnostic analgesia interventions in 23 cases were included. Between and within-veterinarian agreement was investigated using Cohen's Kappa (κ). Asymmetry parameters for kinematic data ('forelimb lame pattern', 'hindlimb lame pattern', 'overall symmetry', 'vector sum head', 'pelvic sum') were determined, and used as outcome variables in mixed models; explanatory variables were subjective lameness grade and its interaction with (1) veterinarian, (2) live or video evaluation and (3) baseline or diagnostic analgesia assessment. RESULTS: Agreement on lame limb between live and video assessment was 'good' between and within veterinarians (median κ = 0.64 and κ = 0.53). There was a positive correlation between subjective scoring and measured asymmetry. The relationship between lameness grade and objective asymmetry differed slightly between (1) veterinarians (for all combined parameters, p-values between P < .001 and 0.04), (2) between live and video assessments ('forelimb lame pattern', 'overall symmetry', both P ≤ .001), and (3) between baseline and diagnostic analgesia assessment (all combined parameters, between P < .001 and .007). MAIN LIMITATIONS: Limited number of veterinarians (n = 4) and cases (n = 23), only straight-line soft surface data, different number of subjective assessments live vs from video. CONCLUSIONS: Overall, between- and within-veterinarian agreement on lame limb was 'good', whereas agreement on lameness grade was 'acceptable' to 'poor'. Quantitative data and subjective assessments correlated well, with minor though significant differences in the number of millimetres, equivalent to one lameness grade between veterinarians, and between assessment conditions. Differences between baseline assessment vs assessment following diagnostic analgesia suggest that addition of objective data can be beneficial to reduce expectation bias. The small differences between live and video assessments support the use of high-quality videos for documentation, communication, and education, thus, complementing objective gait analysis data.

Usefulness of Selected Acute-Phase Proteins in the Postsurgical Monitoring of Arthroscopy and Splint Bone Removal in Horses.

BACKGROUND: Arthroscopy and splint bone removal are the common orthopedic procedures in horses. Estimation of the dynamics of acute phase proteins in postoperative monitoring seems to be interesting diagnostic approach. The aim of the study was to investigate changes in the concentrations of plasma inflammatory markers-fibrinogen, haptoglobin, and protease inhibitors-following orthopedic surgery in horses. The study involved 114 horses, divided into two study groups undergoing: arthroscopy (41 horses) and splint bone removal (13 horses). The control group consisted of 60 healthy horses. The blood was collected before the surgery and 24, 48, 72 h, 5, 7, 10, 14 and 28 days after the surgery. Plasma fibrinogen, serum haptoglobin and proteinase inhibitors were measured. RESULTS: In non-complicated cases of arthroscopy and splint bone removal, fibrinogen and haptoglobin increased stepwise from 24 h, achieved the maximum level at 72 h and returned to preoperative levels after 10-14 days. In one complicated case after arthroscopy surgery the marked increase in fibrinogen and haptoglobin concentrations was observed 24 h earlier than standard parameters of inflammation Conclusion: The study shows the evolution of APPs after arthroscopy and splint bone removal in 28 days postsurgery period and in the case of one complicated case of arthroscopy.