Warmbloods and C7-T2 - What can go wrong?

January 20, 2025

Sue Dyson, Laura Quiney, Kathryn Phillips, Shichen Zheng, Monica Aleman

Background
The study investigates the cervicothoracic junction (C7 to T2) in Warmblood horses presenting with neck-related clinical signs (e.g., neck pain, stiffness, forelimb lameness, ataxia) compared to controls. It focuses on radiological abnormalities, such as modeling of articular processes, spondylolisthesis, discospondylosis, and sagittal ratios. Previous studies lacked comprehensive descriptions of these features, particularly in symptomatic versus asymptomatic horses.

Methods
This prospective analytical cross-sectional study examined 223 Warmblood horses (127 controls, 96 cases). Horses were evaluated clinically and radiographically with standard lateral and oblique radiographs of the cervicothoracic vertebrae. Radiological assessments included measurements of sagittal diameters and articular process modeling. Data were analyzed using logistic regression to identify abnormalities associated with clinical signs.

Results
-Key Radiological Findings:
-Cases had a higher prevalence of severe articular process modeling at C7–T1 (OR 4.25, p = 0.04).
-Spondylolisthesis was significantly more common in cases at C6–C7 (OR 21.53) and C7–T1 (OR 3.61, p < 0.001).
-Discospondylosis was observed at C7–T1 (9.4%) and T1–T2 (15.6%) in cases but rarely in controls.
-Narrowing or obliteration of the intervertebral disc space occurred more frequently in cases, especially at T1–T2.

-Sagittal Ratios:
-T1 sagittal ratios were significantly smaller in cases with neck pain, forelimb lameness, or neurological signs (p < 0.05).

-Control Findings:
-Mild to moderate articular process modeling and wedge-shaped vertebral foramina were also common in control horses, emphasizing the need for
clinical correlation.

Limitations
The study was limited to Warmblood horses, restricting generalizability. Image acquisition challenges and variability in radiographic quality may have influenced findings. The radiological findings' direct contribution to clinical signs was not quantified. Additionally, high-field imaging modalities, such as MRI, were not utilized.

Conclusions
The study highlights the clinical importance of assessing the cervicothoracic junction in horses with neck-related signs. Radiological abnormalities such as severe articular process modeling, spondylolisthesis, and discospondylosis at C7–T1 and T1–T2 are more prevalent in symptomatic horses. These findings support the inclusion of these regions in routine diagnostics and the development of detailed, evidence-based guidelines for radiological assessment.

A, Lateral–lateral image of the seventh cervical (C7) to second thoracic (T2) vertebrae of a case with neck stiffness and pain. Note the difference in shape and size of both the articular processes of C7–T1 and the intervertebral foramen compared with Figures 2A–D and 3A–C. There is a complete obliteration of the intervertebral joints (symphyses) of C7–T1 and T1–T2 and increased opacity of the adjacent bones, consistent with discospondylosis. There is an ill-defined mineralized opacity (arrow) dorsal to the C7–T1 symphysis. The articular processes of T1–T2 are severely enlarged with the narrowing of the intervertebral foramen. B, Lateral–lateral image of the seventh cervical (C7) to first thoracic (T1) vertebrae of a case.

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