Retrospective radiographic myelogram measurements and long-term outcomes in horses undergoing cervical interbody fusion surgery: 22 cases

Site selection for cervical stabilization surgery in horses with spinal ataxia frequently relies on measurements derived from radiographic myelography. A variety of measurement criteria exist and can provide conflicting results. The main objectives of this study were to assess the correlation between two commonly used myelographic measures, dorsal contrast column reduction (DCCR) and dural diameter reduction (DDR), and their association with previously selected operative sites in a population of horses operated at a tertiary clinic. Secondary objectives were to determine if articular process joint (APJ) atrophy occurred in a subset of operated horses with radiographic follow-up, and to describe complications of cervical stabilization surgery and long term outcomes. The study was primarily cross-sectional using previously recorded medical information and images from horses operated between 2008 and 2022: three masked raters assessed previously acquired pre-operative myelograms obtained in neutral, flexed and extended neck positions from horses that had subsequently undergone stabilization surgery consisting of cervical interbody fusion via a Kerf-cut cylinder technique at one or two sites. A veterinary radiologist evaluated changes in APJ in radiographs obtained in a subset of horses re-evaluated >18 months after surgery. DCCR was unremarkable at nearly all articulations in all horses, while DDR met reduction criteria at over 50% of articulations in flexed position. Neither DCCR nor DDR distinguished operated from non-operated sites at most intervertebral junctions, except at the C6-7 articulation in neutral and extended position. The two measures were also poorly correlated at most sites and in most positions. Surgical complications included a high incidence of laryngeal hemiplegia. Comparison of operated to non-operated sites within individuals radiographed years later showed consistent, mildly reduced APJ opacity at most operated sites without a consistent decrease in APJ height or area ratios. Our results suggest that DCCR and DDR measures did not reliably predict surgical site selection in this surgical cohort except at C6-7, and that the two measures yielded conflicting diagnostic classification at many sites and positions. Complication rates from stabilization surgery were high; and predictable reduction in APJ height or area after surgery was not demonstrated by radiography in this study.