Therapeutic Exercises for Equine Sacroiliac Joint Pain and Dysfunction.

This article provides the equine practitioner with a review of sacroiliac joint pain and dysfunction and outlines the importance of providing a specific prescription for a safe and effective therapeutic exercise program. The continuum of clinical dysfunction associated with the sacroiliac region is presented with prescribed interventions. The intent is to encourage the practitioner to perform a thorough assessment of the sacroiliac joint and the adjacent soft tissues and to use sound clinical reasoning to formulate a therapeutic exercise plan.

The relationship between urethral sphincter mechanism incompetency and lower back pain: Positing a novel treatment for urinary incontinence in dogs.

Background: In humans, multiple researchers have not only determined that there is a relationship between urinary incontinence (UI) and lower back pain (LBP), but that by treating the LBP, clinicians are able to improve or resolve the UI. Up until now, no equivalent canine research has investigated whether treatment of LBP can improve the clinical signs of acquired, non-neurologic UI in dogs. Aim: To determine if a relationship exists between LBP and urethral sphincter mechanism incompetence (USMI) in dogs. Methods: Review of medical records of all patients that presented to Points East West Veterinary Services with a history of naturally occurring acquired UI from May 2013 to December 2019. Thirty-nine patients treated for LBP using combined acupuncture and manual therapy, and 33/39 patients that also received concurrent photobiomodulation (PBM) therapy, qualified for this study. Results: Treated patients showed a statistically significant reduction in both the frequency (p < 0.01) and volume (p < 0.01) of UI episodes. Treatment responses ranged from no improvement, to complete resolution of the USMI clinical signs. Conclusion: The reduction of USMI clinical signs following LBP treatment suggests a relationship between these two conditions. Combined acupuncture, manual therapy, with or without PBM was shown to be an effective treatment for USMI. By corollary, USMI incontinence should be considered a potential pain symptom.

Effects of Low-Level Laser Therapy and Chiropractic Care on Back Pain in Quarter Horses.

Low-level laser therapy has been used clinically to treat musculoskeletal pain; however, there is limited evidence available to support its use in treating back pain in horses. The objective of this study was to evaluate the clinical effectiveness of low-level laser therapy and chiropractic care in treating thoracolumbar pain in competitive western performance horses. The subjects included 61 Quarter Horses actively involved in national western performance competitions judged to have back pain. A randomized, clinical trial was conducted by assigning affected horses to either laser therapy, chiropractic, or combined laser and chiropractic treatment groups. Outcome parameters included a visual analog scale (VAS) of perceived back pain and dysfunction and detailed spinal examinations evaluating pain, muscle tone, and stiffness. Mechanical nociceptive thresholds were measured along the dorsal trunk and values were compared before and after treatment. Repeated measures with post-hoc analysis were used to assess treatment group differences. Low-level laser therapy, as applied in this study, produced significant reductions in back pain, epaxial muscle hypertonicity, and trunk stiffness. Combined laser therapy and chiropractic care produced similar reductions, with additional significant decreases in the severity of epaxial muscle hypertonicity and trunk stiffness. Chiropractic treatment by itself did not produce any significant changes in back pain, muscle hypertonicity, or trunk stiffness; however, there were improvements in trunk and pelvic flexion reflexes. The combination of laser therapy and chiropractic care seemed to provide additive effects in treating back pain and trunk stiffness that were not present with chiropractic treatment alone. The results of this study support the concept that a multimodal approach of laser therapy and chiropractic care is beneficial in treating back pain in horses involved in active competition.

Thermographic assessment of saddles used in Mangalarga Marchador horses / Avaliação termográfica de selas utilizadas em cavalos da raça Mangalarga Marchador

Poor saddle-fitting is one of the main causes of back pain in horses. Mangalarga Marchador is a popular breed in Brazil, being used mainly for pleasure riding and sports. This study aimed to thermographically assess saddles used in horses of this breed. Thermographic images were obtained from 18 saddles of animals from different categories during a Mangalarga Marchador National Exposition. The evaluation was based on three parameters: contact area symmetry, dorsal midline interaction and total skin contact area (25%, 50%, 75% or 100%). Contact area asymmetry was observed in 83.3% of saddles. Dorsal midline interaction was observed with the same frequency. Only 22.2% of saddles assessed in the present study had panels with contact areas greater than 50%. Based on the results of this essay it can be concluded that thermography is a useful tool for the evaluation of saddle contact area with the back of horses and that there is a high frequency of fitting unconformities in saddles used in Mangalarga Marchador horses.(AU)

O ajuste inadequado da sela é um dos principais causadores de lombalgias em equinos. A raça Mangalarga Marchador está entre as mais populares do Brasil, sendo muito utilizada para cavalgadas e prática de esportes. O presente estudo teve como objetivo avaliar termograficamente as selas utilizadas em cavalos dessa raça. Para tal, foram realizadas imagens termográficas de 18 selas de animais de diversas categorias durante uma Exposição Nacional do Cavalo Mangalarga Marchador. A avaliação foi realizada baseando-se em três parâmetros: simetria da área de contato, interação com a linha média dorsal e área total de contato com a pele (25%, 50%, 75% ou 100%). Em 83,3% das selas avaliadas foi observada assimetria da área de contato. A interação com a linha média dorsal foi observada com a mesma frequência. Apenas 22,2% das selas avaliadas no presente estudo tinham suadouros com área de contato maior que 50%. Com base nos resultados obtidos neste trabalho, conclui-se que a termografia é uma ferramenta útil na avaliação do contato das selas com o dorso dos cavalos e que existe alta frequência de inconformidades no ajuste de selas utilizadas na raça Mangalarga Marchador.(AU)

Chiropractic abnormalities of the lumbar spine significantly associated with urinary incontinence and retention in dogs.

OBJECTIVES: To retrospectively summarise chiropractic findings in dogs presented in a veterinary practice with urinary incontinence and urinary retention over a 6-year period, and compare these to non-urinary patients presented during the same time period. METHODS: Twenty-two cases were included in the study. They all first underwent a standard clinical examination to rule out or treat other possible causes of their urinary problems. They then underwent chiropractic examination and hypomobility findings were recorded using Gonstead listings. Odds ratios (ORs) were calculated for the occurrence of chiropractic findings in urinary versus non-urinary patients for each vertebra in the lumbar, sacral and ilial regions. RESULTS: All patients had chiropractic findings in the lumbar region that differed from non-urinary patients. The urinary patients were significantly more likely to have chiropractic findings in L3 (OR=4 · 81; 95%CI: 2 · 02 to 11 · 44; P = 0 · 0004), L4 (OR=6 · 85; 95%CI: 2 · 63 to 17 · 84; P = 0 · 0001) and L5 (OR=3 · 98; 95%CI: 1 · 64 to 9 · 69; P = 0 · 0023). In addition, urinary patients were significantly less likely to have chiropractic findings associated with the ilium (OR=0 · 26; 95%CI: 0 · 11 to 0 · 66; P = 0 · 0043). CLINICAL SIGNIFICANCE: This is the first report of an association between chiropractic findings in the lumbar vertebrae and urinary incontinence and retention in dogs.

Lymphocytic ganglioneuritis secondary to intervertebral disc extrusion in a dog.

This study presents a case of lymphocytic ganglioneuritis in a dog secondary to intervertebral disc extrusion that mimicked a peripheral nerve sheath tumour on magnetic resonance imaging. A four-year-old spayed female dachshund with lumbar pain was imaged via magnetic resonance. A tubular, space-occupying, contrast-enhancing lesion was noted in the right intervertebral foramen at L6 to L7. This was presumed to represent focal enlargement of the right sixth lumbar spinal nerve. A right-sided haemilaminectomy was performed at L6 to L7 and material that grossly resembled extruded nucleus pulposus was removed. The right L6 dorsal root ganglion, dorsal nerve root and proximal spinal nerve were severely enlarged and a partial thickness biopsy was collected from the dorsal root ganglion. Results of histopathological examination of the submitted tissue samples were consistent with extruded disc material and lymphocytic ganglioneuritis. To the author's knowledge, this is the first published report of lymphocytic ganglioneuritis secondary to intervertebral disc disease in a dog.

Clinical exam protocol for the equine thoracolumbar spine / Protocolo de exame físico para a coluna toracolombar de equinos

Thoracolumbar injuries represent a challenge to the veterinarian that seeks to eliminate the pain, reinstitute the athletic use of the horse and minimize economic losses. The percentage of lost training days due to orthopedic conditions in race horses is of 72.1% and within those conditions is back pain, whicht represents from 4.35% to 20% of the lameness cases. The present study searched to establish a protocol based on score points for the thoracolumbar physical exam, by which it is able to determine the possible affected areas and the seriousness of the injuries. Along with the physical exam, it was performed an ultrasonographic exam of the thoracolumbar region to characterize and classify the injuries found, as to accompany its evolution after treatment. It was observed a clear reduction in the physical exam score sum in all animals between the exam days being that the exam of most of the animals presented a zero score at 60 days after the treatment. Relating the evolution of the clinical exam with the ultrasonography image tests, there was a positive association between the reduction score in the severity scale and the evolution of the ultrasonographic image of the evaluated structures. Thus, it can be concluded that gradation of the physical exam showed to be efficient and allowed the monitoring of the clinical evolution, as the answer of the injuries to the suggested treatment. Besides that, the results showed that 60 days is the ideal time for the first reevaluation of the animal after the treatment.

As enfermidades toracolombares representam um desafio ao veterinário, que busca eliminar a dor, restituir o uso atlético do cavalo e minimizar perdas econômicas. A porcentagem de dias de treino perdidos devido a afecções ortopédicas em cavalos de corrida é de 72,1% e dentro destas afecções estão as lombalgias, que representam de 4,35% a 20% dos casos de claudicação. O presente estudo procurou estabelecer um protocolo baseado em pontuação por escores para o exame físico da região toracolombar, por meio do qual se consiga determinar as possíveis regiões afetadas e a gravidade das lesões. Juntamente com o exame físico, foi realizada a ultrassonografia da região toracolombar, para caracterizar e classificar as lesões encontradas, assim como acompanhar sua evolução após o tratamento. Foi observada uma evidente redução na soma dos escores do exame físico em todos os animais entre os dias de exame, sendo que o exame da maioria dos animais apresentou escore zero aos 60 dias após o tratamento. Relacionando a evolução do exame clínico com os escores ultrassonográficos houve associação positiva entre a redução do escore na escala de severidade e a evolução da aparência ultrassonográfica das estruturas avaliadas. Sendo assim, pôde-se concluir que a gradação do exame físico se mostrou eficiente e permitiu o acompanhamento da evolução clínica, assim como da resposta das enfermidades ao tratamento proposto. Além disso, os resultados mostraram que 60 dias é o tempo ideal para a primeira reavaliação do animal após a realização do tratamento.

Endoscopic resection of dorsal spinous processes and interspinous ligament in ten horses.

OBJECTIVE: To describe endoscopic surgical subtotal resection of the dorsal spinous processes (DSP) and interspinous ligament in horses. STUDY DESIGN: Descriptive clinical study. ANIMALS: Adult horses (n=10) with back pain and impinging dorsal spinous processes METHODS: Diseased portions of DSP and interspinous ligament were resected by endoscopic surgery, using Destandau Endospine to create a surgical space and provide triangulation for the endoscope, suction cannula, and surgical instruments. Medical records of 10 horses with pain attributable to DSP pathology treated by endoscopic resection of DSP were reviewed to determine intra- and postoperative complications and outcome. RESULTS: Affected portions of DSP were successfully resected with minimal hemorrhage. Limited periosteal reaction was noticed after 3 months in 2 horses. Nine horses had no complications and returned to full work within 8 weeks; 1 developed a subcutaneous abscess, which was successfully managed, and returned to work after 3 months. Surgical resection improved presenting clinical signs and owner's complaint although 2 horses did not return to previous performance levels. CONCLUSION: Resection of DSP and interspinous ligament can be successfully performed endoscopically in horses. Hemorrhage was minimal but reduced visibility. Complications were minimal and most horses returned to work by 8 weeks. CLINICAL RELEVANCE: Endoscopic resection of DSP is a safe and reliable surgical procedure in horses.

Immunohistochemical demonstration of lumbar intervertebral disc innervation in the dog.

Low back pain is a common ailment in dogs, particularly in specific breeds such as the German shepherd dog. A number of structures such as facet joint capsules, ligaments, dorsal root ganglia, periosteum, vertebral endplates and meninges have been associated with this condition. Yet, in spite of all diagnostic efforts, the origin of pain remains obscure in a substantial proportion of all cases. A further structure often being involved in vertebral column disorders is the intervertebral disc. The presence of nerves, however, is a precondition for pain sensation and, consequently, structures lacking innervation can be left out of consideration as a cause for low back pain. Nerve fibres have been demonstrated at the periphery of the intervertebral disc in man, rabbit and rat. With regard to the dog, however, the extent of intervertebral disc innervation is still being disputed. The goal of the present study, therefore, was to substantiate and expand current knowledge of intervertebral disc innervation. Protein gene product (PGP) 9.5 was used for immunohistochemical examination of serial transversal and sagittal paraffin sections of lumbar discs from adult dogs. This general marker revealed nerve fibres to be confined to the periphery of the intervertebral discs. These results indicate that even limited pathological processes affecting the outer layers of the intervertebral disc are prone to cause low back pain.

Development and validation of a periarticular injection technique of the sacroiliac joint in horses.

REASONS FOR PERFORMING STUDY: Sacroiliac joint osteoarthritis has been recognised as a significant cause of poor performance in competition and racehorses. Reliable diagnostic tools are currently lacking. The diagnosis has been based typically on exclusion of other possible causes of poor performance, back pain and hindlimb lameness. OBJECTIVES: To develop a safe, reliable and minimally invasive periarticular or intra-articular injection technique of potential use for diagnosis and therapy of sacroiliac joint disease in horses. METHODS: Twenty-six horses were used to develop and assess a medial approach to the sacroiliac joint with a 15 gauge, 25 cm long spinal needle. In Part I, the cadaveric study, the spinal needle was introduced cranial to the contralateral tuber sacrale and advanced along the medial aspect of the ipsilateral iliac wing until the dorsal surface of the sacrum was encountered. One ml methylene blue (MB) was injected in both sacroiliac joint regions of the sacropelvic specimens. The location of MB-stained tissues relative to the sacroiliac joints was recorded after dissection and disarticulation of the sacroiliac joint. In Part II, the in vivo study, 18 horses were used to validate the in vivo application of the sacroiliac joint injection technique. Horses were restrained in stocks and sedated in preparation for needle placement. One ml MB was injected bilaterally prior to euthanasia. Stained tissues were identified and recorded at necropsy. Successful joint injections were characterised as having MB located intra-articularly or < or = 2 cm periarticularly from the sacroiliac joint margin and localised to the middle or caudal third of the sacroiliac joint. RESULTS: Intra-articular MB was not observed in any specimen. However, MB-stained tissue was identified periarticularly in all injection sites (n = 48). Based on the predetermined success criteria, 96% of the methylene blue depots were located at the middle or caudal third of the sacroiliac joint. Dye-stained tissue was located < or = 2 cm from the sacroiliac joint margins in 88% of the specimens. Median distance of the MB from the sacroiliac joint margins was 1.0 cm (range 0.2-3.8 cm). The overall success rate considering both location and distance of the MB-stained tissue relative to sacroiliac joint margins was 83% (40 of 48 joints). CONCLUSIONS: The injection technique provides a reliable, easy to perform and consistent access to the medial periarticular aspect of the sacroiliac joint. POTENTIAL RELEVANCE: The described injection technique has the potential for both diagnostic and therapeutic applications in the medical management of equine sacroiliac joint disease. Further investigation is necessary to evaluate clinical efficacy and potential adverse effects.

The lumbosacral junction in working german shepherd dogs -- neurological and radiological evaluation.

The clinical and radiological incidence of lumbosacral (LS) disease was studied on 57 German Shepherd dogs (GSDs) used in active service. The study included a clinical history, a neurological examination, and plain radiographs of the caudal lumbar vertebrae. The neurological examinations revealed lower back pain and/or neural deficits in 21 dogs, of which 14 had a history of pain or pelvic gait abnormalities. Radiographic findings were spondylosis at L7-S1, degeneration of L7-S1 disc, LS malalignment, transitional LS vertebrae and/or primary spinal canal stenosis in 15 dogs with neurological abnormalities and/or back pain and in 18 dogs with no clinical signs. No correlation between the neurological and the radiographic findings were found. This study demonstrates that even prominent radiographic LS abnormalities are of minimal value in the evaluation of LS disease in the GSD.

Evaluation and treatment of decreased libido associated with painful lumbar lesions in two bulls.

Painful lesions of the vertebral column may cause decreased libido in bulls. Radiographic evaluation of vertebral skeletal problems in mature bulls is limited because of high body mass. Two breeding bulls with signs of decreased libido and spermatozoa production were evaluated. Initial systemic medical treatment for the conditions had not focused on localized lesions and was unsuccessful. Nuclear scintigraphy was performed in both bulls to determine the location of vertebral column lesions and facilitate localized treatment. Localized medical treatment was successful and resulted in decreased signs of pain and increased spermatozoa production in both bulls.

Ultrasonographic abnormalities detected in the sacroiliac area in twenty cases of upper hindlimb lameness.

REASONS FOR PERFORMING STUDY: The pelvis is covered with extensive musculature and often presents a challenge in diagnostic imaging. Ultrasonography provides diagnostic information about soft tissue, articular cartilage and bone surfaces, although little information exists about the normal ultrasonographic appearance of the equine sacroiliac region. OBJECTIVES: To determine the clinical applicability of ultrasonographic examination in horses with sacroiliac pain. METHODS: Horses presented to the University of Minnesota Veterinary Teaching Hospital for hindlimb lameness were evaluated and lower limb lameness was ruled out with examination and local anaesthesia. Twenty cases were diagnosed with sacroiliac pain, characterised by response to palpation over the tuber sacrale. Seven of the 20 had visible asymmetry of the tuber sacrale. Ultrasonography was performed percutaneously and per rectum. Structures imaged were measured and compared to normal reference measurements. Other methods used to confirm diagnoses included thermography, scintigraphy and radiology. RESULTS: All 20 cases with sacroiliac pain showed ultrasonographic abnormalities of the sacroiliac area. Abnormalities were detected in the dorsal sacroiliac ligaments. Ligament size was significantly different from the normal ranges (P < 0.01). Malalignment of the sacroiliac area and sacral fractures were also imaged. CONCLUSIONS: Ultrasonography of the sacroiliac region aided diagnosis of ligament damage and displacement of bone surfaces; and may aid in monitoring the progression of healing. POTENTIAL RELEVANCE: Diagnostic ultrasound is readily available to most practitioners. Therefore the findings of this study show that diagnosis of sacroiliac injuries is possible in the field.

Association of cauda equina compression on magnetic resonance images and clinical signs in dogs with degenerative lumbosacral stenosis.

Magnetic resonance imaging (MRI) was used to examine the lumbosacral spine of 27 dogs with degenerative lumbosacral stenosis. Four normal dogs were also similarly imaged. Compression of the soft-tissue structures within the vertebral canal at the lumbosacral space was assessed in two ways: by measuring dorsoventral diameter on T1-weighted sagittal images and cross-sectional area on transverse images. The severity of the clinical signs was compared to the severity of cauda equina compression. No significant correlation was found. It is concluded that degree of compression as determined by MRI at time of presentation is independent of disease severity.