England Devon, Newsom Lauren, White Constance, McKenzie Erica
Department of Clinical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, Oregon, United States of America.
Department of Biomedical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, Oregon, United States of America.
PLoS One. 2025 May 7;20(5):e0323083. doi: 10.1371/journal.pone.0323083. eCollection 2025.
Site selection for cervical stabilization surgery in horses with spinal ataxia frequently relies on measurements derived from radiographic myelography. A variety of measurement criteria exist and can provide conflicting results. The main objectives of this study were to assess the correlation between two commonly used myelographic measures, dorsal contrast column reduction (DCCR) and dural diameter reduction (DDR), and their association with previously selected operative sites in a population of horses operated at a tertiary clinic. Secondary objectives were to determine if articular process joint (APJ) atrophy occurred in a subset of operated horses with radiographic follow-up, and to describe complications of cervical stabilization surgery and long term outcomes. The study was primarily cross-sectional using previously recorded medical information and images from horses operated between 2008 and 2022: three masked raters assessed previously acquired pre-operative myelograms obtained in neutral, flexed and extended neck positions from horses that had subsequently undergone stabilization surgery consisting of cervical interbody fusion via a Kerf-cut cylinder technique at one or two sites. A veterinary radiologist evaluated changes in APJ in radiographs obtained in a subset of horses re-evaluated >18 months after surgery. DCCR was unremarkable at nearly all articulations in all horses, while DDR met reduction criteria at over 50% of articulations in flexed position. Neither DCCR nor DDR distinguished operated from non-operated sites at most intervertebral junctions, except at the C6-7 articulation in neutral and extended position. The two measures were also poorly correlated at most sites and in most positions. Surgical complications included a high incidence of laryngeal hemiplegia. Comparison of operated to non-operated sites within individuals radiographed years later showed consistent, mildly reduced APJ opacity at most operated sites without a consistent decrease in APJ height or area ratios. Our results suggest that DCCR and DDR measures did not reliably predict surgical site selection in this surgical cohort except at C6-7, and that the two measures yielded conflicting diagnostic classification at many sites and positions. Complication rates from stabilization surgery were high; and predictable reduction in APJ height or area after surgery was not demonstrated by radiography in this study.
对于患有脊髓性共济失调的马匹，颈椎稳定手术的部位选择通常依赖于脊髓造影X线测量结果。存在多种测量标准，且可能得出相互矛盾的结果。本研究的主要目的是评估两种常用的脊髓造影测量方法，即背侧对比柱缩减（DCCR）和硬脊膜直径缩减（DDR）之间的相关性，以及它们与在一家三级诊所接受手术的马匹群体中先前选定的手术部位的关联。次要目的是确定在接受放射学随访的一部分手术马匹中是否发生关节突关节（APJ）萎缩，并描述颈椎稳定手术的并发症和长期预后。该研究主要采用横断面研究方法，利用2008年至2022年间手术马匹的先前记录的医疗信息和图像：三名盲法评估者评估了先前获得的术前脊髓造影图像，这些图像是在颈部处于中立、屈曲和伸展位置时获取的，这些马匹随后接受了通过Kerf-cut圆柱体技术在一个或两个部位进行颈椎椎间融合的稳定手术。一名兽医放射科医生评估了在手术后>18个月重新评估的一部分马匹的X线片中APJ的变化。几乎所有马匹的所有关节处DCCR均无明显变化，而在屈曲位置超过50%的关节处DDR符合缩减标准。除了在中立和伸展位置的C6-7关节处，在大多数椎间连接处，DCCR和DDR均无法区分手术部位和非手术部位。这两种测量方法在大多数部位和大多数位置的相关性也很差。手术并发症包括喉偏瘫的高发生率。多年后对接受X线检查的个体中手术部位与非手术部位的比较显示，在大多数手术部位，APJ不透明度持续轻度降低，但APJ高度或面积比没有持续下降。我们的结果表明，除了在C6-7处，DCCR和DDR测量方法在这个手术队列中不能可靠地预测手术部位的选择，并且这两种测量方法在许多部位和位置产生了相互矛盾的诊断分类。稳定手术的并发症发生率很高；并且在本研究中，放射学检查未显示手术后APJ高度或面积有可预测的降低。
