Davidson Elizabeth J, Stefanovski Darko, Slack Joann, Manzi Timothy J
Department of Clinical Studies, University of Pennsylvania, Kennett Square, Pennsylvania, USA.
Equine Vet J. 2025 Mar;57(2):398-405. doi: 10.1111/evj.14133. Epub 2024 Jul 11.
BACKGROUND: Cervical articular process joint (CAPJ) therapy is advocated for horses with neck disorders. Several ultrasound-guided CAPJ techniques have been described in cadaver studies with 72%-89% intra-articular injection accuracy; however, the CAPJ injection accuracy in clinical equine practice has not been extensively reported. OBJECTIVES: To describe a modified cranial approach for ultrasound-guided caudal CAPJ injections, to investigate the accuracy of this CAPJ injection technique in live horses, and to assess the effect of CAPJ injection location, laterality, operator, and radiographic CAPJ enlargement on injection accuracy. STUDY DESIGN: Retrospective case study. METHODS: Medical records of adult horses in which ultrasound-guided caudal (C4-T1) CAPJ injections were performed using a modified cranial approach between November 2006 and December 2020 were reviewed. Radiographic images of caudal cervical vertebrae were assessed by a blinded radiologist and the degree of CAPJ enlargement was graded using a previously described grading system (Rgrade 1-5b). Ultrasound-guided caudal CAPJ injection accuracy was determined by synovial fluid retrieval during an individual CAPJ injection. Statistical analysis was performed using mixed-effects multivariable logistic model to evaluate the association of CAPJ injection accuracy and the CAPJ injection location, Rgrade, laterality (right, left), and operator. RESULTS: The study included 149 horses with 177 hospital admissions. Synovial fluid was obtained from 586/658 (89.1%) caudal CAPJs using modified cranial ultrasound-guided approach for CAPJ injections. C6-C7 CAPJ injections had 7-fold higher likelihood (OR = 6.78, 95% CI: 1.67-27.52; p = 0.007) of synovial fluid retrieval compared with C4-C5 CAPJ injections. Operator, CAPJ injection side (left, right), and degree of radiographic CAPJ enlargement did not have significant effects on the success of synovial fluid retrieval from ultrasound-guided caudal CAPJ injections. MAIN LIMITATIONS: Retrospective study design. CONCLUSIONS: Intra-articular ultrasound-guided caudal CAPJ injections using a modified cranial approach can be performed accurately in live horses with and without CAPJ arthropathy.
背景：对于患有颈部疾病的马匹，提倡采用颈椎关节突关节（CAPJ）治疗。在尸体研究中描述了几种超声引导下的CAPJ技术，关节内注射准确率为72%-89%；然而，临床马匹实践中CAPJ注射的准确率尚未得到广泛报道。 目的：描述一种改良的经颅入路用于超声引导下尾侧CAPJ注射，研究该CAPJ注射技术在活体马匹中的准确性，并评估CAPJ注射位置、侧别、操作者以及影像学上CAPJ增大对注射准确性的影响。 研究设计：回顾性病例研究。 方法：回顾了2006年11月至2020年12月期间成年马匹的病历，这些马匹采用改良的经颅入路进行超声引导下尾侧（C4-T1）CAPJ注射。由一名不知情的放射科医生评估颈椎尾侧的X线影像，并使用先前描述的分级系统（R级1-5b）对CAPJ增大程度进行分级。通过在单次CAPJ注射期间获取滑液来确定超声引导下尾侧CAPJ注射的准确性。使用混合效应多变量逻辑模型进行统计分析，以评估CAPJ注射准确性与CAPJ注射位置、R级、侧别（右侧、左侧）和操作者之间的关联。 结果：该研究包括149匹马，共177次住院治疗。采用改良的经颅超声引导入路进行CAPJ注射，从658个尾侧CAPJ中的586个（89.1%）获取了滑液。与C4-C5 CAPJ注射相比，C6-C7 CAPJ注射获取滑液的可能性高7倍（OR = 6.78，95% CI：1.67-27.52；p = 0.007）。操作者、CAPJ注射侧（左侧、右侧）以及影像学上CAPJ增大程度对超声引导下尾侧CAPJ注射获取滑液的成功率没有显著影响。 主要局限性：回顾性研究设计。 结论：采用改良的经颅入路，在有或没有CAPJ关节病的活体马匹中，均可准确地进行超声引导下尾侧CAPJ关节内注射。
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