Should radiographs of the thoracolumbar spine remain part of the pre‐purchase examination?
Authors: Looijen Maty G. P., Morgan Rhiannon E.
Journal: Equine Veterinary Education
Summary
# Editorial Summary Looijen and Morgan's review addresses the contentious question of whether thoracolumbar radiographs should routinely form part of a pre-purchase examination, prompted by recent FEEVA guidance recommending their exclusion. The authors examined the historical rationale for including spinal radiography, the technical limitations of ambulatory radiography in detecting clinically relevant pathology, and the evidence base linking radiographic findings to performance outcomes across different disciplines and levels. Their critical analysis revealed significant concerns: lack of standardised grading criteria creates substantial inter-observer variability, and importantly, sparse scientific evidence demonstrates correlation between radiographic thoracolumbar abnormalities and either clinical signs of back pain or future performance problems. The authors conclude that routine thoracolumbar radiographs should not be performed during PPEs unless specific clinical indicators from the lameness and ridden examination justify further investigation. For equine professionals involved in pre-purchase work, this reinforces the importance of thorough clinical examination protocols and raises important questions about the evidential basis of radiographic screening; practitioners should consider whether routine radiography represents justified diagnostic practice or contributes to unnecessary costs and potentially misleading findings.
Read the full abstract on the publisher's site
Practical Takeaways
- •Routine back radiographs are not recommended during PPEs unless the clinical examination findings warrant further imaging investigation
- •Radiographic findings of thoracolumbar abnormalities cannot reliably predict back pain or performance problems, so should not drive purchasing decisions
- •Clinical examination of the back remains the appropriate screening tool; reserve radiography for cases with specific clinical indicators
Key Findings
- •No consistent or repeatable grading systems exist for assessing thoracolumbar radiographs, highlighting subjective variability in interpretation
- •Sparse scientific evidence demonstrates correlation between radiographic abnormalities of the thoracolumbar spine and clinical back pain or future performance
- •Laterolateral radiographs of spinous processes have significant diagnostic limitations in ambulatory practice settings
- •FEEVA advocates exclusion of routine spinous process radiography from pre-purchase examinations