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  Discussion on Cervical Radiographs of a 7 year-old horse
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Member:
ekaufman

Posted on Thursday, Jun 18, 2009 - 12:01 pm:

Hello DrO,

I'd be curious to hear your opinion of these cervical radiographs. They are of a 7 yo horse with a history of non-performance with various low grade hind end lamenesses and symmetric poor muscle development. The neuro exam on this horse was "not quite right" on the hind end, though there were no glaring, repeatable failures.









Moderator:
DrO

Posted on Friday, Jun 19, 2009 - 8:15 am:

Hello elk,
Of all skeletal radiographs cervical vertebral radiographs are some of the very hardest to accurately interpret requiring the very best resolution, often over an hour of review with rulers, marking pens, and calculators to determine the significance of perceived irregularities. In the above images many of the facets and spinal canal spaces are not clear enough for a good evaluation. They may be fine on the orignals however.

So let me turn this around and ask you did the folks reviewing the originals and hopefully spend the required time to assess the hundreds of individual points of interest in such a radiographic series find any abnormalities? I always think it wise to have such a set of radiographs with questionable findings be reviewed by a equine radiologist or orthopedic surgeon.
DrO
Member:
ekaufman

Posted on Friday, Jun 19, 2009 - 9:37 am:

Hello DrO,

The x-rays were reviewed as carefully as possible, I believe, given the experience and schedules of the folks involved. The originals are somewhat more clear, though not perfect-- it's a very big horse. Conversion to jpeg format and reduction for posting has not improved them! These x-rays also have been referred out for review.

The equine surgeon who examined the horse and (with her colleagues) reviewed the x-rays was suspicious that there was evidence of DJD in C5-C7, with C6-C7 being the area most highly compromised.

Based on this, the horse has been recommended to be euthanized or retired. If retired, they warned me that he may experience significant degeneration over time (rate of decay unknowable), to the point where he may become unstable or even unable to stand.

This working diagnosis is somewhat influenced by the neurologic changes in the sire of the horse, who was stringhalt as he aged (at the time, attributed to neck trauma or old age). Unfortunately, I own 4 horses with these genetics, so I want to be very careful with the diagnosis. We had x-rayed every leg joint in this horse many times, never with an OCD finding elsewhere, though I understand the neck lesions can be found in horses with no other visible DJD.

The diagnosis is not implausible given the history and symptoms that took the horse to x-ray.
Moderator:
DrO

Posted on Sunday, Jun 21, 2009 - 10:51 am:

elk, sorry for the delay I wanted to view this in my office where I have a large screen high contrast monitor. Hmmmm...the first image, which appears to be a retake of the last image to help bring out the details of C6-C7, does show a step in the articulation of the bodies of C6-C7 but I lose details of the facets and most important the margins of the the vertebral canal. This step may represent the narrowing they are discussing but my lack of regular review of such radiographs makes my interpretation subject to question.
DrO
Member:
ekaufman

Posted on Sunday, Jun 21, 2009 - 3:39 pm:

Hi DrO, thank you.

In the original format on the large viewer at Littleton, the changes you note are even clearer. C6-C7 look almost as if they were starting to fuse, and the canal appears to have narrowed such that it is most probably beginning to impinge on the spinal cord.

Do you concur that, if the x-rays have been read correctly, the horse is unsafe to ride?

Do you know anything about the origins, management, or progression of this condition? Littleton clearly felt that it would be progressive and eventually fatal, should the horse be left to degenerate indefinitely. They could not speculate on how rapidly that progression might occur, and felt that it was probably similar to other forms of OCD (significantly hereditary, with environmental and management factors as well).
Moderator:
DrO

Posted on Sunday, Jun 21, 2009 - 10:39 pm:

I see...I had presumed the loss of definition of the articular facets was with the image size and quality. The way you frame the question it is a easy call elk, if the spinal cord is being impinged, yes the horse should be considered dangerous to ride and the disease most likely progressive.

Concerning your questions on origin, management, and progression they are discussed in the article. If you have specific question not covered post it back here.
DrO
Member:
ekaufman

Posted on Monday, Jun 22, 2009 - 3:29 pm:

Thanks DrO. I've read the article carefully, and wasn't being clear in my questions.

In your experience, do horses with this spinal condition deteriorate slowly or quickly?

Do you believe it's a gradual degeneration, or is it more like a step function (trotting one day, falling down the next)?

Anecdotally, I have heard that this form of OCD can show up much later than, for example, hock OCD. Someone told me a story about a horse that x-rayed clean at 4, and then showed neck lesions at 8 (and died of a broken back in a fall). Is that a credible progression, or better explained by the difficulty interpreting these x-rays, or perhaps an undetected trauma leading to OA?

None of the studies I've seen explore the heritability of OCD in the neck. Is it reasonable to presume it's similar to other forms? Note that the folks at LLAC thought this might be genetic rather than congenital or trauma/use-related, and the horse is 7. Does that seem plausible to you?

And a question against your experience as a vet and horseman: how painful do you think it is for horses in this condition? I realize that falls are painful, so I'm asking whether you think standing around grazing, eating, etc. is likely to be a reasonably comfortable thing, or a painful just-get-through-the-day thing.

Thank you.
Member:
leslie1

Posted on Monday, Jun 22, 2009 - 4:59 pm:

Elk
I am so sorry to hear this. I had a filly with OCD/stifle and also ended up with Wobblers. I went out to feed one morning...she couldnt get up. Probably was down quite a few hours. So, anyways, my vet gave her some bute, steriods and DMSO. She was very wobbly and the vet thought she was a danger to herself and also to be around as she could possible fall., I ended up having to euth.
My heart is with you.
Moderator:
DrO

Posted on Monday, Jun 22, 2009 - 8:52 pm:

elk you are looking for patterns in a disease process that is very variable. While most horses worsen slowly there can be an acute impingement, say when the horse stumbles, that can cause the horse to go down and not rise.

Research strongly suggest that OC does have genetic predispositions. It seems plausible to me this is true of cervical vertebrae OC.

The amount of pain will vary and depend mostly on impingement of the lower motor neurons leaving the neck. This pain will cause him to move stiffly. How stiff his neck is will be your best indication of painfulness.
DrO
Member:
mrose

Posted on Tuesday, Jun 23, 2009 - 11:44 am:

This is very educational. Thank you for posting. I am particularly interested since Dr.O. mentioned this problem can be the result of injury also. We just retired our 20 yr. old stallion due to weakness in the hind end which after reviewing x-rays and sonograms, the vet felt was the result of an old injury to the neck. Our horse doesn't seem to have pain as long as he isn't worked heavily. If he overdoes, he becomes lame in the rear end. His vet felt his condition would continue to worsen and that work would hasten the worsening of the condition.

This is heartbreaking for you I'm sure when it's a young horse and when you have other related horses.

Dr O., did I read somewhere there is a blood test available now that will indicate whether a horse is a carrier or is apt to contract OCD?
Member:
ekaufman

Posted on Tuesday, Jun 23, 2009 - 12:00 pm:

This horse's sire was stringhalt in his old age. Anecdotally this was due to injury, but now there's a presumption that he was just a "late breaking" case of cervical OCD. I'm having trouble understanding how the sire could have had such a long performance career with OCD in his neck, but I suppose it's conceivable that he was stoic and it was an unusually slow-progressing case. I'm tempted to exhume him from my pasture to necropsy his neck. If we're going to be digging a large hole out there anyhow, it seems as though it might be worth getting some answers.

We'll be x-raying my 4 other related horses today: 2 sons, a half-sister by the same sire, and a sorta-cousinish mare with connections further back on the sireline. I'll post the results in this thread, for the sake of others who may deal with this in a breeding program in the future.

X-ray those necks folks-- this horse showed NO symptoms of this disorder until he was 6, and nothing remotely neurologic for another year. His leg x-rays were clean at 1, 3 and 6. Even now, you really have to know the horse (or believe the owner) to see anything at all.
Moderator:
DrO

Posted on Wednesday, Jun 24, 2009 - 6:41 am:

Sara, we recently reported the discovery of a gene associated with an increase incidence of OC but there is no commercial lab test available at this time. For more on this see, Diseases of Horses » Lameness » Joint, Bone, Ligament Diseases » OCD and DOD in Horses » Research Study: Gene found associated with OCD.
DrO
Member:
canter

Posted on Wednesday, Jun 24, 2009 - 7:17 am:

Elizabeth, I surely hope that the x-rays on the related horses show nothing but good news.
Member:
ekaufman

Posted on Wednesday, Jun 24, 2009 - 11:17 am:

We took cervical x-rays of the 4 related horses yesterday. Neither my vet nor I have expertise in neck x-rays, though that didn't stop us from looking hard at them. They will be sent for referral.

My gut on what I saw is that the smaller colt looks clean, and the distantly-related 3 year-old is likely clean of this as well, though she has some idiosyncracies that I personally can't interpret. The very large colt has several things in the images that we could not account for, and the other 3 year-old has 2 areas that make me concerned-- one in the facet at C2, and the other within the vertebral canal at C5. So we will wait for the experts to weigh in. Both on radiograph and "on paper," the large colt is clearly at higher risk for OCD of any kind than the older filly, though it isn't as if they are passing an OCD baton around. It may be years before I really know how this one ends, by which point the horses could easily have fallen down a well, been struck by a meteor, or done any of the spectacularly creative self-destructive things that horses do, with or without OCD.
Member:
mrose

Posted on Wednesday, Jun 24, 2009 - 11:22 am:

Dr.O, Yes, I read it and also articles in several different horse mags. It just seemed like I'd read there was a lab test; I suppose I read they are hoping to find a lab test. If a gene has been found, I would assume that at some point the desease could be irradicated. How great that would be!

If radiographs are similar for changes in bone and impingement caused by injury and by OCD, when dealing with a mature horse, how do you tell which caused them? Is there enough difference in the pictures? To an uneducated eye they look the same.

Elk, like Fran I hope your other horses are free of this.
Moderator:
DrO

Posted on Wednesday, Jun 24, 2009 - 3:27 pm:

They have a lab method for identifying this gene Sara, but it is just not commercially available that I am aware of. Also you may have read about the expression of certain proteins, MMP's of some type I believe, seen in OC lesions. Again I don't think anyone is touting they have a test for this to diagnose OC. Let's be clear this is all just a small part of a very complicated process. Are there other genes implicated? How does the gene work? Are there non-genetic forms also? We have a long way to go before much definite can be said about these issues.

For the firm ante-mortem diagnosis of OC at a particular location you really need radiographic or other imaging modality changes of abnormal cartilage formation as described in the article on OC. Unfortunately these lesions appear difficult to pick up radiographically in the vertebrae and most descriptions we have are from direct and histological examination on post mortem cases. Severe OC lesions are frequently found in horses so examined who were put down do to cervical stenotic myelopathy and some believe a major contributing cause.

Of course there are many different facets of the diagnostic process. Sometimes you have either a clear history and radiographic signs of acute trauma (fracture or displacement) that might help you with the diagnosis. And certainly signalment plays a role for instance a 20 year old is unlikely to start having signs from an OC lesion.
DrO
Member:
ekaufman

Posted on Monday, Jun 29, 2009 - 6:06 pm:

Sara, I think this is what you may be remembering: https://www.equineortho.colostate.edu./pdf/skeletal_tissue_turnover.pdf

We have some contacts over at that research facility, and have put in a call to see whether they will accept blood samples from outside foals. The conclusions could be expressed more clearly (in my opinion), but seem to indicate that multiple samples over time are necessary to indicate whether any lesions are transient or persistent and (therefore) potentially problematic.

The feedback on my situation is mixed. My 2 fillies rads have been read and reviewed at Littleton and CSU, and both places concur they seem to be within normal limits everywhere. Good.

The 2 colts (sons of the horse who was tentatively labelled a wobbler) get different feedback-- Littleton feels they are clean, while CSU points out multiple areas of concern on each colt. Not so good.

The 7 year-old who started this thread also has mixed feedback-- Littleton's outside expert feels the x-rays are within normal range, the rest of the staff (who saw the horse) disagree, so we're waiting on CSU for a third opinion. In the meantime, we're discussing other rule-outs, to be sure we don't miss something we might try to treat.
Member:
mrose

Posted on Wednesday, Jul 1, 2009 - 10:53 am:

Elk, yes it was! Thanks for finding it. I get the Morris Foundation newsletter and saw it in there.
Member:
ekaufman

Posted on Friday, Jul 3, 2009 - 9:53 am:

Hi Sara,

We did ask about the serum test referenced in the CSU paper-- I wasn't clear in the end whether I could have submitted blood to the lab for it, but I WAS clear on the price tag ($700 for each sample, and the testing requires multiple over time). Also, the researchers in this area don't yet have the ability to interpret the test results for individual horses. So I think we put this in the basket marked "suggestive early research." It isn't ready for prime time, and certainly isn't useful for evaluating OCD risk in an individual foal.
Member:
mrose

Posted on Friday, Jul 3, 2009 - 12:14 pm:

Yikes! very pricey, esp. if you have more than one foal you want tested!
Member:
ekaufman

Posted on Thursday, Jul 23, 2009 - 9:12 pm:

I thought it might be useful to post an update on this horse, since I know others here have wrestled with diagnostics for horses that are "not quite right" behind.

A summary-- my breeding program is heavily based on a single sireline from a very old PRE stud in Spain; my oldest stallion came to me neurologic (stringhalt) after a successful performance career in Spain. We presumed that his neurologic status was due to trauma. His son, whose radiographs are posted above, is 7 and has had setback upon setback starting his own career under saddle. Most recently, we had a run of variable hind end lamenesses and generally crappy performance. At a recent exam, the surgeon felt that he was neurologic rather than simply lame, and took a series of neck x-rays which, she felt, demonstrated CVM.

These x-rays, in their original (larger, clearer) format were sent out for second opinions to several specialists. Opinions came back all over the map-- he's a wobbler, he has OA, he has OCD, and several people felt his neck was within normal range. The various followup diagnostics are very expensive (myelogram, neck CT, etc.) and everyone disappeared for summer travel.

Because we seem to have a family tendency towards neurologic problems behind, and because the horse in question has 2 young sons as well as a sister and a sorta cousin on the property, I felt that I needed to develop a better understanding as quickly as I could.

I read every article on Horseadvice that might shed light on this scenario, and I read the article on EDM about 4 times. I decided I *might* be looking at a heritable condition that would remain undetected in this sireline's original habitat, which is in the salt marshes and sunflower fields of southern Spain.

I started my 7 year-old and both his sons on high daily doses of Vitamin E. I also added significant protein (alfalfa and Enrich 32), fat (Ultium and flax) and Omega 3s (flax) to the older horse's diet. It has been 3 weeks, and my vet yesterday could find no sign whatsoever of any neurologic deficit. The horse has been in an increasing level of groundwork, and has remained sound.

Of course, it's possible that he has an inflammatory condition (such as cervical OA) that is currently causing intermittent deficits. But the initial results have encouraged me to continue to try to replicate his ancestral diet (though I haven't gone straight to sunflower seeds) in the hope that his progress continues.

My vet and I have agreed that he needs to hold up to very heavy work on the ground before I get back in the saddle. I would characterize her position as "skeptically supportive." The feed is relatively cheap, and the approach can't hurt the horse, so she's curious about his current turnaround w/o promising that it will persist.
Member:
scooter

Posted on Thursday, Jul 23, 2009 - 9:25 pm:

How interesting is that!
I hope improvement continues.
Thanks for the update
Member:
mrose

Posted on Friday, Jul 24, 2009 - 12:07 am:

Interesting indeed! Thanks for the update.
Member:
canter

Posted on Friday, Jul 24, 2009 - 8:03 am:

Elizabeth, I truly hope that the diet continues to work for your horses and that your 7 yo old improves enough to go back under saddle.

Are you thinking that the diet will also be "proactive" and prevent any issues in the 2 young sons?

Best wishes on this and please keep us updated.
Moderator:
DrO

Posted on Friday, Jul 24, 2009 - 8:35 am:

elk,
that is great news and congratulations on taking a questionable diagnosis with a grave prognosis and trying other possible rule outs with a better prognosis. I agree with you that right now that whether this is helping is a bit up in the air but the last thing I would do is stop considering the history you give.
DrO
Member:
frances

Posted on Friday, Jul 24, 2009 - 8:54 am:

That's fascinating elk. Well done, and please let us know how things develop.
Member:
ekaufman

Posted on Friday, Jul 24, 2009 - 11:07 am:

Thanks everyone. I'm very grateful to have this site: it allowed me to sift carefully through a complete range of possible diagnoses, and to identify a neglected possibility that is inexpensive to treat. I'm fortunate to live in an area with deep veterinary skeletal expertise, but that means that no one had yet mentioned to me the possibility of a disorder such as EDM.

Yes, Fran, if my 7yo in fact has EDM, then it seems to be highly heritable, and his foals would need supplemental Vit. E to prevent future neurologic deficits. In the meantime, it can't hurt them.

Nothing in his history or his family history rules out EDM, and Vit. E is cheap and easy to feed. The other feed additions are more speculative on my part, and based on the traditional management practices for this particular line and breed of horse.
Member:
lilo

Posted on Friday, Jul 24, 2009 - 2:36 pm:

Elizabeth - here is hoping that the improvement continues and all your horses will be successful.
Lilo
Member:
ekaufman

Posted on Wednesday, Aug 5, 2009 - 2:34 pm:

Another incremental update-- my vet was here for a different lameness yesterday, and re-examined this horse. She says he now has no perceptible neurological deficit; also he's muscling well over his croup, his back, and in his hind end, which she felt was a good indication of neurologic health.

His current workload is pretty heavy (she saw one of his gymnastic grids and called it "ridiculously difficult"), so a neck lesion is starting to seem less likely. She's still skeptical of the EDM theory, but agrees that *something* has changed dramatically in this horse. She told me that whatever I was doing, I ought not to stop, and did also verify that I was supplementing the foals.

Without HA, I might well have followed the guidance to give up on this horse. I would never have known there was a potentially-manageable alternative diagnosis for his symptoms. Here's hoping his progress continues.
Member:
canter

Posted on Wednesday, Aug 5, 2009 - 7:58 pm:

Keeping my fingers crossed that he continues to do so wonderfully!
Member:
frances

Posted on Thursday, Aug 6, 2009 - 6:14 am:

It's really heartening to hear of such improvement following simple but well-thought out dietary changes. Clever you to have gone back to the sire's original environment to find a treatment.
Moderator:
DrO

Posted on Thursday, Aug 6, 2009 - 8:02 am:

Thanks for the good news elk and the kudos but you did most of the heavy lifting by taking the time to back up a step and read and digest the Ataxia and EDM article. The one on Ataxia is not one of the easier reads on HA.
DrO
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