Page 290 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

Musculoskeletal system: 1.7b The axial skeleton – thoracolumbar region 265

VetBooks.ir levels of analgesia early on and eventually heal, 1.504
Most cases of closed DSP fractures require good

allowing work to recommence from 3 to 4 months
post injury. Open fractures benefit from early surgi-
cal debridement and lavage together with antibiotic
cover. Loose displaced sections of DSP may need
removal, but often retain strong ligamentous attach-
ments. Ensuring adequate postoperative drainage in
the elevated position is the principal challenge for
any wither’s surgery (Fig. 1.504). Prolonged postop-
erative periods of antibiotic medication, pain manage-
ment, local wound treatment and repeat surgery for
sequestrum removal and lavage is normal.
Fig. 1.504 Ensuring adequate drainage is the
principal challenge associated with surgery of the
Prognosis withers.
Open fractures of the DSPs have a significant rate
of repeated swelling, draining supraspinous fistulas
(fistulous withers) and sequestration. The degree of 1.505
cosmetic blemish depends on the extent of displace-
ment. Modified tack may be required after healing to
allow the horse to return to ridden use. Articular facet
joint fractures tend to heal by ankylosis, and residual
functional restriction and pain are significant risks,
making the chances of full recovery guarded. Acute
traumatic fractures of the vertebral bodies in the back
have a guarded to hopeless prognosis.

SPONDYLITIS AND DISCOSPONDYLITIS

Definition/overview Fig. 1.505 Post-mortem specimen of a sagittal
Infection and osteomyelitis within vertebrae is section of the thoracolumbar spine of a yearling
termed spondylitis; if it also involves the interverte- that presented with acute localised spinal pain,
bral disc it is termed discospondylitis (Fig. 1.505). pyrexia and hindlimb neurological deficits. Note
the discospondylitis of the intervertebral disc and
Aetiology/pathophysiology surrounding vertebral bones, with subsequent spinal
Osteomyelitis in this location occurs predominantly cord compression. (Photo courtesy Graham Munroe)
in immune-compromised individuals, such as foals
with partial or complete failure of passive transfer with leucocytosis, neutrophilia and elevated acute
of immunity. The usual types of bacteria associ- phase proteins such as fibrinogen and serum amy-
ated with sepsis in such individuals are implicated, loid A. With progression infection may press on the
including staphylococcal and streptococcal species, spinal cord and spread into the meninges, causing
mycobacteria, Rhodococcus and others. deteriorating neurological signs and meningitis.

Clinical presentation Differential diagnosis
Clinical signs predominantly relate to the systemic Sepsis, osteomyelitis and septic synovitis elsewhere;
symptoms of sepsis, with fever and malaise. Focal soft-tissue or bone trauma from being trodden on or
spinal pain is present. Haematology shows infection, kicked.