Feasibility and safety of lumbosacral epiduroscopy in the standing horse

• Published in: Equine veterinary journal Vol. 49; no. 3; p. 322
• Main Authors: Shrauner, B, Blikslager, A, Davis, J, Campbell, N, Law, M, Lustgarten, M, Prange, T
• Format: Journal Article
• Language: English
• Published: United States 01.05.2017
• Subjects: Animals; Endoscopy - methods; Endoscopy - veterinary; Epidural Space - surgery; Female; Horse Diseases - surgery; Horses; Lumbosacral Region - surgery; Male; epiduroscopy; horse; endoscopy; spinal nerve; back pain; hindlimb lameness
• ISSN: 2042-3306
• DOI: 10.1111/evj.12591

The large size of the adult horse prevents the use of advanced imaging modalities in most areas of the axial skeleton, including the lumbosacral vertebral column. Traditional imaging techniques are frequently unable to pinpoint the underlying pathology in horses with caudal back pain. In man, lumbosacral epiduroscopy is used to diagnose and treat subjects with chronic back and leg pain. This technique may close the diagnostic gap in horses with similar clinical signs. To evaluate the safety and feasibility of lumbosacral epiduroscopy in the standing adult horse. Descriptive, experimental study. Seven adult horses weighing 504-578 kg were sedated and restrained in stocks in preparation for aseptic surgery. Vascular dilators of increasing size were inserted cranial to the first moveable vertebra caudal to the sacrum to facilitate a minimally invasive approach into the epidural space. A flexible video-endoscope was introduced and advanced as far as its 60-cm working length permitted. Pre-, intra- and post-operative plasma cortisol samples were collected, and neurological and lameness examinations were performed prior to and during the 2 weeks following the procedure. Post-mortem examinations were conducted in 5 of the 7 horses. Standing lumbosacral epiduroscopy was well tolerated by all horses. The anatomic structures in the epidural space (dura mater, spinal nerve roots, fat and blood vessels) were followed as far cranial as the thoracolumbar region. No complications related to the procedure were noted in the 2-week monitoring period following epiduroscopy. Small, organised haematomas were identified in the sacral epidural space during necropsy in one horse. No abnormalities were seen in the other 4 animals. Lumbosacral epiduroscopy can be performed safely in sedated standing horses. The procedure may become a valuable diagnostic tool in horses with caudal back or hindlimb pain of unknown origin.