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Ultrasonographic guidance for perineural injections of the cervical spinal nerves in horses
Author(s) -
Wood Andrew Douglas,
Sinovich Matthew,
Prutton James Stephen Winter,
Parker Russell Alexander
Publication year - 2021
Publication title -
veterinary surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.652
H-Index - 79
eISSN - 1532-950X
pISSN - 0161-3499
DOI - 10.1111/vsu.13610
Subject(s) - medicine , cadaver , anatomy , foramen , intervertebral foramen , spinal cord , vertebral artery , spinal nerve , lumbar , dorsum , psychiatry
Objective To evaluate the accuracy of ultrasonographic guidance for injection near the ventral rami of the cervical spinal nerves (VRCSN). Study design Ex vivo study. Sample population Ten cadavers (n = 40 injections). Methods Left and right VRCSN at C4/5 and C5/6 were infiltrated at the intervertebral foramen (IVF) under ultrasonographic guidance. A vertically orientated 3.5‐MHz curvilinear probe was used to identify the craniocaudal midpoint of the articular process joint (APJ). The probe was moved ventrally until the IVF was identified. An 18‐gauge 15‐cm‐long spinal needle was aimed immediately below the ventral margin of the cranial articular process, where 1 mL of latex was injected. Cadavers were dissected, and the location of the latex was recorded relative to the ventral ramus, the spinal cord, and the vertebral artery. Results Direct infiltration of the ventral ramus occurred in 73% (29/40) of injections; 15% (6/40) of injections were < 0.5 cm from the ventral ramus, and 13% (5/40) of injections were > 0.5 cm (maximum 1.5 cm). Latex was located at a mean of 2.4 cm (range, 0.8–4) from the spinal cord and 0.9 cm (range, 0–1.5) from the vertebral artery. Conclusion Ultrasonographic guidance of perineural injections of the caudal VRCSN was repeatable and accurate, with 88% of injections located within 0.5 cm of the ventral ramus. Iatrogenic damage was limited to one penetration into the vertebral artery. Clinical significance Ultrasonographic guidance of perineural injections of the caudal VRCSN may be considered by operators experienced in cervical APJ scanning in horses with suspected cervical spinal nerve compression.