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Equine cervical vertebral stenotic myelopathy Accession# 139543

Equine cervical vertebral stenotic myelopathy Accession# 139543. Christina Copple, DVM Radiology Resident NCSU CVM. “heyoka” 1yr old Paint Gelding. Neurologic deficits – 1 wk Incoordination Ataxia Spasticity in forelimbs Lower motor neuron signs in hindlimbs

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Equine cervical vertebral stenotic myelopathy Accession# 139543

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  1. Equine cervical vertebral stenotic myelopathyAccession# 139543 Christina Copple, DVM Radiology Resident NCSU CVM

  2. “heyoka” 1yr old Paint Gelding • Neurologic deficits – 1 wk • Incoordination • Ataxia • Spasticity in forelimbs • Lower motor neuron signs in hindlimbs • Suspected cervical vertebral instability/malformation (“Wobblers Syndrome”)

  3. “Wobblers Syndrome” • Cervical vertebral stenotic myelopathy (CVSM) • Cervical vertebral malformation (CVM) • Cervical vertebral instability (CVI) • Equine sensory ataxia • Equine incoordination and spinal ataxia • Narrowing of cervical vertebral canal combined with malformation of cervical vertebrae • Anywhere from C1 to T1 • Stenosis  intermittent (dynamic) or continuous (static) compression of spinal cord  neurologic dz (ataxia & weakness) Equine Vet. Edu. (2003) 15(4) 212-223

  4. Cervical vertebral stenotic myelopathy • Young, well-fed, rapidly growing horses • Age of onset varies with type of stenosis • Young horses –dynamic lesions, acute onset ataxia or gait abnormalities, +/- trauma • Older horses – static lesions, chronic progressive ataxia or gait abnormalities • Most common in: • Thoroughbreds and Quarter Horses • Males • Most common noninfectious cause of equine spinal ataxia Equine Vet. Edu. (2003) 15(4) 212-223

  5. Pathogenesis of CVSM • Unknown though considered multifactorial • Genetic predisposition • Hormonal changes • Nutrition • Exercise • Trauma • Degenerative joint disease of articular process joints • Osteochondrosis lesions of articular processes  instability & malalignment of adjacent vertebrae  DJD of articular process joints & hypertrophy of soft tissue structures • Controversial role in young horses • Horses >4yrs old CVSM often associated with DJD of caudal cervical articular processes Equine Vet. Edu. (2003) 15(4) 212-223

  6. Normal Cervical Spine C5 C5 C6 C7 C6 C7 Articular Process DJD C5-C6 & C6-C7 C6 C7

  7. Malalignment at C7-T1 C7 T1

  8. 5 characteristic boney malformations that may be seen on lateral cervical radiographs • “Flare” or “ski jumps” of caudal vertebral epiphysis of vertebral body • Abnormal ossification of articular processes • Malalignment between adjacent vertebrae • Extension of dorsal laminae • DJD of articular process joints • Intravertebral sagittal ratio: <50% at C4-C6 or <52% at C7 • Sensitivity-87%, specificity-94%, PPV-95%, NPV-84% (Mayhew & Green 2000) Equine Vet. Edu. (2003) 15(4) 212-223 Equine Vet. Edu. (2005) 17(1) 34-38

  9. The fate of “Heyoka” C6 C7 C6 C7

  10. Additional imaging to consider • Cervical myelography – antemortem confirmation of compression • > 50% decrease in opposing dorsal and ventral aspects of subarachnoid space compared to mid-vertebral site cranial or caudal to lesion • 20% reduction of dural diameter at C6-C7 in neutral or flexed position – highly sensitive & specific for CVSM • Reduction in dorsal aspect of subarachnoid space to a thickness <2 mm • Failure of contrast medium to pass by a site of compression Equine Vet. Edu. (2005) 17(1) 34-38 Equine Vet. J. (2004) 36(1) 14-20

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