Implications of the neuroanatomy of the equine thoracolumbar vertebral column with regional anaesthesia and complications following desmotomy of the interspinous ligament.

Abstract

Impinging/overriding dorsal spinous processes (DSPs) of the thoracolumbar vertebrae are a common cause of poor performance in horses. In the last five decades, numerous surgical treatments have been reported on, from transverse transection of the affected DSPs, and endoscopic resection of the affected DSPs, to transection of the interspinous ligament. Until recently, cosmetic outcomes have been reported as good to excellent in studies. However, a previously unreported complication of neurogenic atrophy of the contralateral epaxial muscle following desmotomy of the interspinous ligament has been recently reported. The authors hypothesised that this was because of a more lateral approach than previously described, resulting in the scissors being too far across midline and transecting a nerve in the region. Considering this finding, we have reviewed the literature on the neuroanatomy of the thoracolumbar region in the horse. Literature on the neuroanatomy of the horse is lacking when compared with that of humans and companion animals, with most of the work extrapolated from companion animals. Based on the current literature, we hypothesise that transection of an intermediate branch of the dorsal spinal nerve supplying the m. longissimus is potentially the cause of the post-operative neurogenic atrophy. The lack of detailed knowledge of the neural anatomy of the equine back has resulted in the role of local anaesthesia in localising pain in the equine back being poorly understood. The wide variation in techniques used for localising back pain may explain why some horses suffering from poor performance or an abnormal gait because of back pain improve to local anaesthesia of the back while others do not. This review article highlights a lack of anatomical knowledge regarding the equine thoracolumbar region in the literature despite diagnostic local anaesthesia, medication, and surgery in this area being relatively common.