Anatomical variation of the spinous and transverse processes in the caudal cervical vertebrae and the first thoracic vertebra in horses

Congenital variants of the ventral laminae of the sixth and seventh cervical vertebrae are not associated with clinical signs or other radiological abnormalities of the cervicothoracic region in Warmblood horses

BACKGROUND

There is controversy about the clinical relevance of congenital variants of the ventral laminae of the sixth (C6) and seventh (C7) cervical vertebrae and their relationship with other radiological abnormalities.

OBJECTIVES

To document the prevalence of congenital variants of C6 and C7 and that of other radiological abnormalities from C6 to the second thoracic vertebra (T2).

STUDY DESIGN

Cross-sectional.

METHODS

The study included Warmblood horses ≥3 years of age undergoing clinical assessment at two referral institutions: 127 control horses and 96 cases (neurologic, neck pain or stiffness, or neck-related forelimb lameness). All horses underwent a standardised orthopaedic and neurologic examination. Lateral-lateral and lateral 45°-55° ventral-lateral dorsal (left to right and right to left) radiographic views of C5 to T2 were acquired and assessed blinded to the horse's clinical category using a predetermined grading system.

RESULTS

The ventral profile of C7 was abnormal in 54 horses (24.2%). Cases were less likely to have congenital variants than control horses, p = 0.0002, relative risk (RR): 0.63 (95% confidence intervals [CIs]: 0.4, 1.0). There was no association between the presence of a congenital variant of C7 and the presence of modelling of the articular processes (APs) of C6-C7, C7-T1 or T1-T2. Cases were more likely to have severe modelling of the APs at C6-C7, p = 0.01, RR: 1.94, CI: 1.1, 3.5 and C7-T1, p = 0.04, RR: 1.97, CI: 1.2, 3.2 compared with control horses.

MAIN LIMITATIONS

Radiographs were read by one assessor independently at each institution.

CONCLUSIONS

There was no association between the presence of congenital variants of C7 and any other radiological findings. Congenital variants occurred less frequently in cases compared with control horses. There was no association between the presence or absence of a congenital variant and the type of case.

Characterization and Association of the Missing Ventral Tubercle(s) from the Sixth Cervical Vertebra and Transpositions on the Ventral Surface of the Seventh Cervical Vertebra in Modern Equus ferus caballus

In recent years, equine complex vertebral malformation (ECVM) has been of concern in the equine community, with studies identifying numerous associative morphological variations. Here, we examine the morphological association between C6 and C7 for dependency in ECVM cases, where the partially absent ventral process of C6 transposes on the ventral surface of C7. A C6 ventral process presents two tubercles, one cranial (CrVT) and one caudal (CVT). In this study, the C6 osseous specimens (n = 85) demonstrated a partial or completely absent CVT (aCVT) graded 1-4 that often extended cranially creating a partially absent cranial ventral tubercle (aCrVT) graded 1-3. In the 85 C6 osseous specimens examined, the corresponding C7s demonstrated either a complete or incomplete transposition of the ventral process from C6 in 44/85, with 30/44 replicating a transverse foramen. A strong statistical dependency existed between C6 grade 4 aCVTs and grades 1-3 aCrVTs and C7 transpositions with replicated transverse foramen. Sidedness was also demonstrated, where a left sided absent C6 associated with transposition on the left ventral surface of C7. This likewise applied to right sidedness and most bilateral cases. These findings might benefit practitioners when radiographing the extent of the ECVM configuration in patients presenting caudal cervical pain.

Closure of the neuro-central synchondrosis and other physes in foal cervical spines

BACKGROUND

The neuro-central synchondrosis (NCS) is a physis responsible for the growth of the dorsal third of the vertebral body and neural arches. When the NCS of pigs is tethered to model scoliosis, stenosis also ensues. It is necessary to describe the NCS for future evaluation of its potential role in equine spinal cord compression and ataxia (wobbler syndrome).

OBJECTIVES

To describe the NCS, including when it and other physes closed in computed tomographic (CT) scans of the cervical spine of foals, due to its potential role in vertebral stenosis.

STUDY DESIGN

Post-mortem cohort study.

METHODS

The cervical spine of 35 cases, comprising both sexes and miscellaneous breeds from 153 gestational days to 438 days old, was examined with CT and physes scored from 6: fully open to 0: fully closed. The dorsal physis, physis of the dens and mid-NCS were scored separately, whereas the cranial and caudal NCS portions were scored together with the respective cranial and caudal vertebral body physes.

RESULTS

The NCS was a pair of thin physes located in a predominantly dorsal plane between the vertebral body and neural arches. The mid-NCS was closed in C1 from 115 days of age, and in C2-C7 from 38 days of age. The dorsal physis closed later than the NCS in C1, and earlier than the NCS in C2-C7. The dens physis was closed from 227 days of age. The cranial and caudal physes were closing, but not closed from different ages in the different vertebrae of the oldest cases.

MAIN LIMITATIONS

Hospital population.

CONCLUSIONS

The NCS was a thin physis that contributed mainly to height-wise growth, but also width- and length-wise growth of the vertebral body and neural arches. The mid-NCS was closed in all cervical vertebrae from 115 days of age. The NCS warrants further investigation in the pathogenesis of vertebral stenosis.

Historic Horse Family Displaying Malformations of the Cervicothoracic Junction and Their Connection to Modern German Warmblood Horses

Malformations of the equine cervicothoracic junction affect the C6 and C7 cervical vertebrae, the T1 thoracic vertebra and in variable extent the first and second sternal ribs. To date, the clinical impact of this malformation, its prevalence and mode of inheritance in equine populations are not yet determined. We examined five skeletons for signs of malformation of the cervicothoracic junction, including three skeletons from widely used Thoroughbred stallions affected with the malformation and two skeletons serving as a comparison. The three affected historical horses were the Thoroughbred stallions Der Loewe XX, Birkhahn XX and their common great grandsire Dark Ronald XX. Malformations of C6 and C7 showed a large variation between the three stallions, as Dark Ronald XX, Der Loewe XX and Birkhahn XX were affected uni-laterally at C6 and C7, uni-laterally at C6 and bi-laterally at C6 and C7, respectively, with varying grades. In order to evaluate whether or not these malformations are incidental, we took a random sample of 20 living German Warmblood horses, which are distant descendants of these stallions. This sample consisted of ten controls and ten horses with malformations of C6/C7. Blood proportions of the historical sires in the modern Warmblood horses ranged from 0.10 to 6.25%. The contribution to inbreeding in each individual horse of our selected horse group by those sires was expressed as a percentage of the total inbreeding coefficient and ranged from 0.01 to 17.96%, demonstrating their influence on the modern Warmblood. In the present study, we were able to describe the variability of the malformation of C6/C7 within a horse family including historic and modern horses. Additionally, we detected variations appearing in connection with malformations of the cervicothoracic junction that have not been described in the literature yet. This is the first time that the malformations of C6 and C7 have been described within a familial context, providing hints on inheritance in Thoroughbreds and Warmbloods. It is worthwhile to carry out further studies in a larger setting to gain more comprehensive insights into the inheritance of the malformation and the role of important ancestors.

Characterization of the Caudal Ventral Tubercle in the Sixth Cervical Vertebra in Modern Equus ferus caballus

This study examined the anomalous variations of the ventral process of C6 in modern E. ferus caballus. The aim was to provide an incremental grading protocol measuring the absence of the caudal ventral tubercle (CVT) in this ventral process. The findings revealed the most prevalent absent CVT (aCVT) was left unilateral (n = 35), with bilateral (n = 29) and right unilateral (n = 12). Grading was determined in equal increments of absence 1/4, 2/4, 3/4, with 4/4 representing a complete aCVT in 56/76, with a significance of p = 0.0013. This also applied to bilateral specimens. In those C6 osseous specimens displaying a 4/4 grade aCVT, 41/56 had a partial absence of the caudal aspect of the cranial ventral tubercle (CrVT). Here, grading absent CrVTs (aCrVT) followed similarly to aCVTs, though 4/4 was not observed. The significance between 4/4 grade aCVTs and the presentation of an aCrVT was left p = 0.00001 and right p = 0.00018. In bilateral specimens, C6 morphologically resembled C5, implying a homeotic transformation that limited the attachment sites for the cranial and thoracal longus colli muscle. This potentially diminishes function and caudal cervical stability. Therefore, it is recommended that further studies examine the morphological extent of this equine complex vertebral malformation (ECVM) as well as its interrelationships and genetic code/blueprint.

Morphology of the Ventral Process of the Sixth Cervical Vertebra in Extinct and Extant Equus: Functional Implications

In this study, we examined the ventral process of C6 in extinct and extant Equus (sister taxa to Equus ferus caballus only) with the purpose of describing normal morphology and identifying anomalous variations relevant to recent studies describing a congenital malformation in E. ferus caballus. Overall, 83 specimens from 9 museums and 3 research/educational facilities were examined, totalling 71 extinct specimens from 12 species and 12 extant specimens from 5 species. The lateral view revealed that a large convexity exists in the ventral process between the cranial ventral tubercle (CrVT) and the caudal ventral tubercle (CVT) in the earliest ancestor, Hyracotherium grangeri, from 55 mya, which receded throughout the millennia to become a smaller convexity in E. ferus caballus and the sister taxa. The CrVT is visibly shorter and narrower than the CVT, with a constricted section directly ventral to the transverse process, essentially demarcating the CrVT and CVT. No congenital malformations were evident. As the ventral process of C6 is an integral component for muscle attachment in supporting the head/neck during posture and locomotion, this would indicate that the caudal module in the cervical column might be compromised when a partial or complete absence of the CVT is detected via radiographs in modern E. ferus caballus.

A systematic review of clinical signs associated with degenerative conditions and morphological variations of the equine caudal neck

Conditions of the equine caudal neck (C5-C7) are thought to be associated with various clinical signs. However, little investigation has been undertaken to isolate clinical indicators associated with specific conditions of the equine caudal cervical spine. This systematic review aimed to evaluate associations of clinical signs with anatomical malformation of caudal cervical vertebrae, spinal cord compression of the caudal cervical spine, and arthropathy of the caudal cervical articular process joints (APJs). A literature search was carried out using Google Scholar in accordance with PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Studies were selected for inclusion in this systematic review according to a set of inclusion criteria, resulting in a small group of eligible studies (n=12) that addressed clinical signs associated with caudal cervical spine conditions in horses. The results of the included studies indicate that there are grounds for further investigation of clinical presentations of specific conditions of the equine caudal neck such as anatomical variations, myelopathy, and alteration to the APJs.

Equine Cervical Pain and Dysfunction: Pathology, Diagnosis and Treatment

Simple Summary

Neck pain and dysfunction in the horse is becoming an increasingly important topic among riders, trainers and veterinarians. Some horses may present for a subtle performance decline, while others may show dramatic, dangerous behavior. It is important to recognize how to carefully evaluate the horse in an effort to understand the different types of pain that may be contributing to the different behaviors. The musculoskeletal and nervous systems may both play a role in the development of clinical signs. Recognizing that there are many diagnostic options as well as several treatments choices is important. This synopsis covers the disease processes that may contribute to the development of neck pain and dysfunction in the horse, as well as several possible diagnostic and treatment options.

Abstract

Interest in the cervical spine as a cause of pain or dysfunction is increasingly becoming the focus of many equine practitioners. Many affected horses are presented for poor performance, while others will present with dramatic, sometimes dangerous behavior. Understanding and distinguishing the different types of neck pain is a starting point to comprehending how the clinical presentations can vary so greatly. There are many steps needed to systematically evaluate the various tissues of the cervical spine to determine which components are contributing to cervical pain and dysfunction. Osseous structures, soft tissues and the central and the peripheral nervous system may all play a role in these various clinical presentations. After completing the clinical evaluation, several imaging modalities may be implemented to help determine the underlying pathologic processes. There are multiple treatment options available and each must be carefully chosen for an individual horse. Provided is a synopsis of the current knowledge as to different disease processes that can result in cervical pain and dysfunction, diagnostic approaches and treatment strategies. Improving the knowledge in these areas will ideally help to return horses to a state of well-being that can be maintained over time and through the rigors of their job or athletic endeavors.

Cervical disc width index is a reliable parameter and consistent in young growing Dutch Warmblood horses

Intervertebral disc disease, as well as the associated alteration of the radiographic intervertebral disc space width, has been reported in horses. Disc height index (DHI) has proven to be an accurate and objective parameter in other species but data related to this parameter are lacking in horses. Therefore, the aims of this retrospective longitudinal diagnostic accuracy study were (a) to evaluate the reliability of measurements within and between observers of the equine Disc Width Index (EDWI) as a parameter for radiographic equine cervical intervertebral disc space width, and (b) to evaluate the sequential development of the EDWI over time. For this, EDWI from all intervertebral disc spaces between second cervical (C) to first thoracic (Th) vertebrae were obtained in a group of 39 Dutch Warmblood horses at 1, 5, and 18 months of age, by one European College of Veterinary Diagnostic Imaging (ECVDI) board-certified veterinary radiologist (S.V.) and two veterinary students. Bland-Altmann plots and intraclass Correlation Coefficient revealed a good intra- and interobserver agreement. A linear mixed-effect model did reveal that mean EDWI increases significantly toward the caudal cervical spine, but did not differ significantly for a certain location over time or between sexes. Spearman's rank test did show a significant correlation between the vertebral alignment angle induced by different head-neck positions and a normalized EDWI (ρ = 0.33, P < .0001). Student's t-test revealed that the presence of C6-C7 transposition of the transverse processes did not influence EDWI significantly. It was concluded that EDWI represents a reliable parameter for equine cervical radiographic intervertebral disc space width. Practical implementation of EDWI warrants monitoring in a group of adult horses while maintaining a standardized head-neck position.

Radiographic findings and anatomical variations of the caudal cervical area in horses with neck pain and ataxia: case-control study on 116 horses

BACKGROUND

Abnormalities of the ventral lamina of the sixth cervical vertebra (AVL-C6) are thought to exert abnormal stress on the articular process joints (APJs) of the cervicothoracic junction. The aim of the study was to investigate the association between AVL-C6 and radiographic findings in the caudal cervical area and between clinical signs of neck pain and ataxia and radiographic findings.

METHODS

Medical records of horses subjected to cervical radiography were reviewed. Horses were classified into those with neck pain (group C), those with ataxia (group A) and healthy horses (group H). Presence of AVL-C6 and increased size, dysplasia, remodelling, fragmentation and osteochondral fragment at the APJs (C5-T1) were recorded. Univariable logistic regression analysis was performed to identify the associations between explanatory and dependent variables. Variables with P<0.2 were included in the multivariable analysis.

RESULTS

One hundred and sixteen horses were included (44 in group C, 29 in group A, 66 in group H); 24 of 116 horses had radiographic AVL-C6. Age, AVL-C6 and overall/C6-C7 increase in size remained in the final models.

CONCLUSIONS

The presence of AVL-C6 and moderate/severe increase in size of the caudal cervical APJs increase the odds of showing neck pain and, if severe, ataxia.

A Radiographic Technique for Assessment of Morphologic Variations of the Equine Caudal Cervical Spine

Equine Caudal Cervical Morphologic Variation (ECCMV) is a congenital malformation of the caudal cervical spine distinct from the more commonly recognized Cervical Vertebral Stenotic Myelopathy (CVSM). The most common presentation of ECCMV is recognized on the sixth cervical vertebra (C6). In "normal" presentations, the transverse processes on the left and right sides have a caudal lamina projecting ventrally below the caudal vertebral body in a heel shape. With ECCMV, variations occur to the structure of the caudal ventral lamina on one or both sides of C6 and may include the seventh cervical (C7) and first thoracic (T1) vertebrae and ribs, in varying configurations. Whereas the prevalence of ECCMV is not known, it has been recognized for many years and has been reported to occur with relatively high frequency within multiple populations of domesticated horses. To date, there is no documented link between the occurrence of ECCMV and clinical signs. However, based on retrospective studies, multiple authors have recognized the potential impact on performance that this condition may have. Establishing a reliable radiographic protocol for the consistent diagnosis of ECCMV would allow quantitative, scientific evaluation of the problem and support clinicians working in this field. We present a radiographic technique, which has been illustrated by diagnosis of ECCMV in three horses and confirmation of the diagnoses in two cases via postmortem examination.

Caudal cervical vertebral morphological variation is not associated with clinical signs in Warmblood horses

BACKGROUND

Variation in equine caudal cervical spine morphology at C6 and C7 has high prevalence in Warmblood horses and is suspected to be associated with pain in a large mixed-breed group of horses. At present no data exist on the relationship between radiographic phenotype and clinical presentation in Warmblood horses in a case-control study.

OBJECTIVES

To establish the frequency of radiographically visible morphologic variation in a large group of Warmblood horses with clinical signs and compare this with a group without clinical signs. We hypothesised that occurrence of morphologic variation in the case group would not differ from the control group, indicating there is no association between clinical signs and morphologic variation.

STUDY DESIGN

Retrospective case-control.

METHODS

Radiographic presence or absence of morphologic variation of cervical vertebrae C6 and C7 was recorded in case (n = 245) and control horses (n = 132). Case and control groups were compared by univariable Pearson's Chi-square and multivariable logistic regression for measurement variables age, sex, breed, degenerative joint disease and morphologic variation at C6 and C7. Odds ratio and confidence intervals were obtained. A P≤0.05 was considered statistically significant.

RESULTS

Morphologic variation at C6 and C7 (n = 108/377 = 28.6%; Cases 58/245 = 23.7%; Control 50/132 = 38%) was less frequent in horses with clinical signs in univariable testing (OR 0.48, 95% CI 0.3-0.8, P = 0.001). Age, sex, breed and degenerative joint disease were not retained in the final multivariable logistic regression step whereas morphologic variation remained significantly less present in horses with clinical signs.

MAIN LIMITATIONS

Possible demographic differences between equine clinics.

CONCLUSIONS

Morphologic variation in the caudal cervical spine was detected more frequently in horses without clinical signs. Therefore, radiographic presence of such variation does not necessarily implicate the presence of clinical signs.

PREVALENCE OF ANATOMICAL VARIATION OF THE SIXTH CERVICAL VERTEBRA AND ASSOCIATION WITH VERTEBRAL CANAL STENOSIS AND ARTICULAR PROCESS OSTEOARTHRITIS IN THE HORSE

The sixth cervical vertebra (C6) has unique morphology due to a ventral extension from the transverse process known as the ventral lamina. Little information was found regarding the prevalence and clinical relevance of morphologic variations. Aims of this observational, retrospective study were to characterize C6 morphologic variations in a large sample of horses. Cervical radiographic studies of 100 horses were retrieved. Data recorded were signalment, clinical history, morphology of the C6 ventral lamina, presence of articular process osteoarthritis, and presence of static vertebral canal stenosis. Morphologic variations were found in C6 vertebrae for 24/100 horses, with symmetric absence of the ventral lamina in nine horses and asymmetric absence in 15. Anomalous C6 vertebrae were more common in Warmbloods, with 19/55 Warmbloods in the population being affected (P = 0.006). No association was found with sex. There was no significant difference in the mean of the intravertebral sagittal ratios between horses with normal or anomalous C6 vertebrae; however there was a significantly greater proportion of horses with anomalous C6 vertebrae that had an intravertebral sagittal ratio of less than 0.5 at C6 (P = 0.047). There was no association between the morphology of C6 and articular process osteoarthritis. Anomalous C6 vertebrae in our population were associated with a higher likelihood of cervical pain (P = 0.013). Authors propose that morphologic variations in the C6 ventral laminae could be linked to other developmental abnormalities such as vertebral canal stenosis, might affect regional biomechanics and should therefore be considered clinically relevant in horses. Future, controlled prospective studies are needed to test this theory.