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Objective: To compare the results of a novel minimally invasive surgical technique with intralesional corticosteroid medication, as treatment for overriding dorsal spinous processes (ORDSP) in horses., Study Design: Retrospective controlled clinical case series., Animals: Horses (n = 68) with ORDSP., Methods: ORDSP was diagnosed based on history, clinical, and radiographic examination. All narrowed spaces were treated. Horses undergoing medical treatment had methylprednisolone acetate injected directly in the affected space under radiographic control. Surgical cases had interspinous ligament desmotomy (ISLD) using Mayo scissors; supraspinous ligaments were left intact. All horses had the same controlled exercise plan and returned to work 3-6 weeks after treatment., Results: Methylprednisolone was administered in 1-7 spaces in 38 cases, compared with ISLD in 3-8 spaces in 37 cases. Thirty-four horses (89%) treated medically initially resolved signs of back compared with 35 horses (95%) treated surgically. From these, back pain recurred in 19 medical cases and in none of the surgical cases. Horses having ISLD were 24 times more likely to experience long-term resolution of signs of back pain (OR 24; 95%CI: 5-115; P = < .0001). Repeat radiographs in 19 surgical cases indicated that interspinous spaces widened significantly postoperatively (P = < .0001)., Conclusions: This surgical technique allowed horses with back pain and radiographic ORDSP to return to work without further clinical signs of back pain and to show radiographic evidence of improvement., (© Copyright 2012 by The American College of Veterinary Surgeons.)

Objective: To report the technique and results of cheek teeth repulsion in standing, sedated horses., Study Design: Case series., Animals: Horses (n = 12), ponies (6)., Methods: Medical records (2006-2009) of horses that had cheek tooth repulsion while standing were reviewed. Inclusion criteria included: maxillary or mandibular cheek tooth disease diagnosed by clinical and radiographic examination where attempted oral extraction failed necessitating repulsion. Horses were sedated and a local nerve block performed. Intraoperative radiographs facilitated instrument positioning and ensured repulsion of all dental remnants. Alveolar cavities were packed postoperatively and secondary dental sinusitis treated with lavage., Results: Median horse age was 7 years (range, 1-30 years). Maxillary (n = 15) and mandibular (5) cheek teeth were removed successfully. One horse was euthanatized 1 week after tooth removal because of concurrent liver disease and 10 horses (59%) had resolution of discharge after the 1st treatment; 41% of extractions required follow-up medical or surgical treatment to resolve signs [6/12 maxillary sinusitis and 1/5 persistent mandibular drainage]., Conclusions: Standing repulsion of diseased and fractured cheek teeth is an effective means of resolving clinical signs of dental disease when oral extraction fails. Chronic sinus involvement increased the risk of postextraction surgical treatment for sinusitis., (© Copyright 2011 by The American College of Veterinary Surgeons.)

Objective: To assess the reliability of computed tomography (CT) to identify the direction of implant insertion for cortical screws along the longitudinal axis of intact (nonfractured) distal sesamoid bones., Study Design: In vitro study., Sample Population: Cadaveric paired equine forelimbs (n=16)., Methods: Insertion of a cortical screw in lag fashion along the longitudinal axis of intact (nonfractured) distal sesamoid bones was evaluated in 2 groups (3.5 and 4.5 mm) of 8 paired limbs. In each group, the direction of the distal sesamoid bone was determined by CT (Equine XTC 3000 pQCT scanner). Screw placement was verified by specimen dissection. Implant direction was considered satisfactory if the entire screw length was within the distal sesamoid bone and not damaging the articular or flexural surfaces., Results: In our sample and according to our criteria, the proportion of satisfactory direction of screws was 0.63 (5/8) for 4.5 mm implants, and 0.87 (7/8) for 3.5 mm implants., Conclusions: CT is a useful imaging modality to identify anatomic landmarks for insertion of a 3.5 mm cortical screw in the distal sesamoid bone., (© Copyright 2010 by The American College of Veterinary Surgeons.)

Reasons for Performing Study: Incisional drainage and suppuration occurs commonly following exploratory laparotomy; any technique with the potential to reduce the incidence of this complication warrants investigation., Objectives: To determine if abandoning the use of subcutaneous sutures in laparotomy wound closure is safe and whether it reduces the risk of suppuration., Methods: A randomised controlled study was carried out at 2 referral hospitals in the UK, involving 309 horses undergoing exploratory laparotomy; 150 horses underwent '2-layer' closure without a subcutaneous suture, while 159 underwent conventional '3-layer' closure. Information regarding degree of oedema and gross types of discharge was recorded daily; suppuration was defined as discharge of pus. Telephone follow-up was carried out 30 days after hospital discharge to identify those complications occurring after that date and, thereafter, every 3 months. The influence of closure method on risk of wound suppuration was assessed by Chi-squared analysis and by logistic regression. Time to suppuration was modelled using a Cox proportional hazards model., Results: No catastrophic failures of 2-layer closures were recorded. Prevalence of suppuration was not significantly different, being 18.7% and 23.9% for 2- and 3-layer closures, respectively (OR = 1.37, 0.79-2.37, P = 0.263)., Conclusions and Potential Relevance: This study found no significant difference in prevalence or rate of wound suppuration in 2-layer closures compared to conventional 3-layer closure. Two-layer closure is recommended as a safe alternative means of achieving ventral midline abdominal closure in horses.