Ultrasound-guided injection technique of the equine cervical nerve roots.
Authors: Fouquet Gregoire, Abbas Ghazanfar, Johnson Jessica P, Pompermayer Endrigo, Harel Camille, Aldous Eman, Puchalski Sarah, David Florent
Journal: Frontiers in veterinary science
Summary
Cervical radiculopathy remains diagnostically challenging in horses due to non-specific clinical presentation overlapping with neck pain and forelimb lameness, yet no evidence-based treatment protocols exist in the equine literature. Using five cadaverous horses under general anaesthesia, researchers developed and validated an ultrasound-guided injection technique for depositing contrast-laden latex into cervical nerve roots C3–C8, with accuracy verified by both computed tomography imaging and subsequent anatomical dissection. Of 60 intended injections, 55–57 achieved accurate placement within the target zone, with direct contact between injectate and nerve roots achieved in approximately 75% of cases and a further 25% achieving near-proximity deposition; critically, unwanted diffusion into neural tissue (≤11%), vertebral vasculature (<4%) and vertebral canal (<4%) occurred rarely. This technique offers farriers, veterinarians and rehabilitation specialists a potentially transformative therapeutic option for radiculopathic cases previously limited to supportive management, though the occasional risk of vascular or intraneural spread necessitates operator experience and careful patient selection when translating this approach into clinical practice.
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Practical Takeaways
- •Ultrasound-guided cervical nerve root injection is now a technically viable treatment option for equine cervical radiculopathy, with high accuracy and low complication rates when performed under general anesthesia
- •Direct injectate contact with nerve roots occurs ~75% of the time, with the remainder in close proximity; diffusion effects likely improve clinical efficacy beyond direct contact
- •Risk of serious complications (intravascular or intraspinal injection) is low (<4%), but practitioners should remain cautious and maintain proficiency with ultrasound guidance and anatomical knowledge
Key Findings
- •Ultrasound-guided cervical nerve root injections (C3-C8) achieved 91.7-95% accuracy with injectate in direct contact with target nerve roots in 73.7-76.4% of cases
- •Injectate within nerve/sheath occurred in ≤11% of injections, while vertebral vessel and canal involvement was <4% in both cases
- •No significant variation in success rate or safety profile based on injection site (C3-C8)
- •Technique feasibility confirmed with consistent visualization of nerve roots and reproducible methodology across all cervical levels