Assessment of vertebral canal diameter and bony malformations of the cervical part of the spine in horses with cervical stenotic myelopathy

Magnification of cervical radiographs prevents accurate interpretation of vertebral canal absolute minimum sagittal diameter (MSD) values and application of the established MSD values for diagnosis of cervical stenotic myelopathy (CSM). Variability in MSD determination in human beings, owing to radiographic magnification, is minimized by assessing a ratio of the vertebral canal diameter to the sagittal width of the vertebral body. This relative measurement technique improves the accuracy of diagnosis of cervical spinal stenosis in human beings. The MSD of the vertebral canal was determined in 50 horses with CSM and 50 control horses, using a radiopaque marker method for correction of magnification. In addition, a ratio of the absolute MSD to the sagittal width of the vertebral body and a ratio of the absolute MSD to the length of the vertebral body were determined in 100 CSM-affected and 100 control horses. Response operating characteristic curve analysis of each method determined that the sagittal ratio method of canal diameter assessment provided the most accurate interpretation of cervical radiographs for diagnosis of CSM, with sensitivity and specificity of larger than or equal to 89% at each vertebral site. The accuracy of the ratio method, without consideration of bony malformation, supports the importance, and perhaps prerequisite, of generalized vertebral canal stenosis in the pathogenesis of CSM. Subjective evaluation of bony malformations from cervical radiographs of 100 CSM-affected horses and 100 control horses indicated that CSM-affected horses have more severe bony malformation than do control horses. However, moderate to marked degenerative joint disease of the articular processes was frequently observed in control horses. Subjective evaluation of bony malformation does not distinguish between CSM-affected and unaffected horses.