Cervical (Neck) Injections

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In our practice, we believe that any horse with neck stiffness, mild ataxia, intermittent or unrelenting forelimb lameness or obscure hindlimb lameness should be investigated for cervical issues.  Most horses that exhibit abnormal cervical manipulation either resist lateral flexion totally or avoid lateral flexion by offering a more ventral flexion of the head and neck (as in the video above).  The rider often describes resistance to lateral bending, being ‘heavy on one rein’ or resistance to achieving the frame desired.    

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It can be difficult to rule out problems in the cervical region without the screening tool of nuclear scintigraphy (above), as these areas are easily highlighted by increased radiopharmaceutical uptake (arrow above).  Radiography alone can be used to document some cases of cervical arthropathy.  Radiography can highlight enlarged facets (arrow below), previous trauma (such as fracture) or entheseous bone formation and narrowing of the spinal canal, although these findings may not always carry clinical significance.

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Once it is determined that a cervical facet arthrosis is present, treatment may include ultrasound-guided facet injections.  The technique is demonstrated in the following photos.  After alcohol is sprayed over the cervical region, the facet joints to be injected are located via ultrasound examination (above).

Bleb2

The facet joint is located ultrasonographically and local anesthetic is injected just dorsal to the probe with a 25 gauge needle (above).  The local anesthetic is placed as a bleb under the skin and then somewhat deeper into the muscle, especially on more sensitive horses.  In this case, the bleb for C5-6 is being placed, while the bleb for C6-7 can be seen in the background (below).

Blebbing
Needle

Once the area is scrubbed again and sprayed with alcohol, the facet joint is located with the ultrasound and an 18 gauge spinal needle is introduced at a 45 degree angle just dorsal to the probe (above).   The assistant removes the stylet and injects the medication while the ultrasonographer steadies the needle and continues to view the screen ensuring that the medication is deposited into the joint space (below).

Inject

The video below shows the needle advancing from the upper left quadrant of the ultrasound screen toward the cervical facet joint to be treated.  The cloud appearing at the end of the needle is the medication actively being injected into the joint.

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