An equine cadaver study investigating the relationship between cervical flexion, nuchal ligament elongation and pressure at the first and second cervical vertebra.

Pressure in the atlanto-axial region due to hyperflexion ('rollkur') may influence the development of a nuchal bursa, as adventitious bursae may be caused by pressure. Investigating the pressure between the nuchal ligament and atlas/axis in a flexed position may provide information on the pathogenesis of nuchal bursitis. In this study, ten equine head and neck specimens with one side of the soft tissues over the cervical vertebral spine removed were placed in lateral recumbency on a table in neutral, mildly flexed, and hyperflexed head and neck positions. Angulations of the neck were measured using markers placed on the nuchal ligament and drilled into the skull, vertebrae and withers. In six specimens, the pressure between the nuchal ligament and the atlas and the axis was measured using an inflatable air pouch. Hyperflexion was associated with the highest nuchal ligament length and with the highest pressure values at the site of the nuchal bursa over the atlas (99±24mmHg, more than four times the pressure in the neutral position) and over the axis (77±30mmHg, more than twice the pressure values of the neutral position). Also, over the three head and neck positions, neck flexion angles were highly correlated with pressure values and with nuchal ligament length. This marked increase in pressure at the level of atlas and axis caused by head and neck hyperflexion should be considered during training of horses at risk of, or diagnosed with, nuchal bursitis.