Cervical spine compression10/2/2023 Inflammatory pain is characterized by hypersensitivity of injured, inflamed tissues caused by stimulation of the local immune system. Sensory input from the periphery is transmitted through the dorsal nerve root into the dorsal horn of the spinal cord where it synapses with interneurons and is relayed to the sensory cortex via the ascending spinal cord tracts. Afferent sensory fibers have cell bodies located within the dorsal root ganglion. Nociception is the “neural process of encoding and processing noxious stimuli”. Nociceptive pain is protective and the immediate response of the body that serves to limit contact with noxious stimuli by reflexive withdrawal in an effort to constrain tissue damage. Pain management strategies or treatments need to be targeted specifically depending on the type of pain present. General categories include pain of nociceptive, inflammatory, and pathological mechanisms. The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage”. It is the authors’ opinion that as more and more practitioners and riders begin to recognize the complexity of these cases, we can work together to ultimately improve the clinical outcome of these challenging cases. As information is being added to the literature at a rapid rate, it is important for veterinarians presented with these types of cases, to stay abreast of new material. This synopsis is meant to highlight the many topics and considerations when dealing with a horse presenting for concerns related to the neck. The goal is to provide a synopsis of the current knowledge of common disease processes, diagnostic approaches, and treatment strategies used for managing cervical pain and dysfunction in horses. Due to the paucity of peer-reviewed equine literature on this topic, the information discussed here is a hybrid of a literature review, which includes human and other animal species as needed to delineate specific concepts, combined with the authors’ clinical and research experience. This underscores the challenges that we face in equine practice to understand and diagnose this frustrating and potentially debilitating condition in horses. However, human physicians also struggle to identify the source of neck pain even after employing advanced imaging modalities or other diagnostic techniques and obtaining verbal feedback from their patients. The prevalence of neck pain in humans ranges from 30% to 50% and appears mostly associated with abnormal joint motion and disc degeneration. Unfortunately, diagnostic imaging modalities often fail to help to fully elucidate the underlying disease process, which is similar to what is seen in human patients. However, understanding exactly which structures within the cervical region are affected remains difficult and a potential source of frustration. It is becoming increasingly recognized that many horses presented to equine practitioners for poor performance have underlying cervical axial skeletal lesions that result in pain syndromes and an inability to meet athletic demands. Improving the knowledge in these areas will ideally help to return horses to a state of well-being that can be maintained over time and through the rigors of their job or athletic endeavors. Provided is a synopsis of the current knowledge as to different disease processes that can result in cervical pain and dysfunction, diagnostic approaches and treatment strategies. There are multiple treatment options available and each must be carefully chosen for an individual horse. ![]() After completing the clinical evaluation, several imaging modalities may be implemented to help determine the underlying pathologic processes. Osseous structures, soft tissues and the central and the peripheral nervous system may all play a role in these various clinical presentations. ![]() There are many steps needed to systematically evaluate the various tissues of the cervical spine to determine which components are contributing to cervical pain and dysfunction. Understanding and distinguishing the different types of neck pain is a starting point to comprehending how the clinical presentations can vary so greatly. Many affected horses are presented for poor performance, while others will present with dramatic, sometimes dangerous behavior. ![]() ![]() Interest in the cervical spine as a cause of pain or dysfunction is increasingly becoming the focus of many equine practitioners.
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