Clinical Approach to the Horse with Sore Back with Dr Rachel Salz
Clinical approach to the horse with a sore back Rachel Salz, BVSc, DVCS, DVM-PhD, Dip ACViM-LAIM Evaluation of horses with back pain can be challenging and clinical presentation can be very variable. Back pain may be secondary to hindlimb lameness or due to primary back pathology. Common presenting complaints in horses with back pain include pain on palpation, reduced flexibility, poor performance, muscle atrophy, reduced hindlimb propulsion, bucking and difficulties with canter work. A systematic and thorough approach to these cases is essential, including a detailed history, thorough clinical and lameness examination and imaging. Imaging of the back should include the entire spine as there are often multiple lesions present. A combination of radiography and ultrasonography should be performed in every horse. Radiographs can be used to assess the cervical articular process joints (APJs) and thoracolumbar dorsal spinous processes (DSPs). High power generators can also be used to obtain diagnostic images of the thoracolumbar APJs. Oblique ventro-dorsal views of the APJs are useful to assess each side independently. Ultrasound can also be used to visualise the thoracolumbar APJs and is used for accurate medicated of these joints when indicated. Transrectal ultrasound is used to assess the lumbosacral area and ventral aspect of the sacroiliac joints where most pathology occurs. Nuclear scintigraphy can be useful in some of these horses but beware of a reasonably high number of false negatives and occasional false positives. Two of the commonest causes of back pain include impinging DSPs and APJ osteoarthritis, which often occur together. Management of these conditions requires an accurate diagnosis of all the lesions present and then a combined approach to treatment including exercise modification (with core and back strengthening work), non-steroidal anti-inflammatory medication (more effective for acute cases), intra-lesional corticosteroids, manual therapies, bisphosphonates, shockwave, laser and mesotherapy.
