Surgery is often the best option for treating an inflammatory injury at the poll called cranial nuchal bursitis, according to a recent study.
Bursa are fluid-filled sacs found at points of friction between bones and soft tissue structures, such as ligaments and tendons. The cranial nuchal bursa is located between the nuchal ligament, which runs along the ridge of the neck, and the atlas vertebra (first cervical vertebra) at the top of a horse’s neck.
Injury to this area typically leads horses to behave in predictable ways, says José M. García-López, VMD, of Tufts University. “They will exhibit a stretched neck and low head carriage,” he says. “In the early manifestations, you will see resistance to bending or flexing at the poll region or resistance to being ‘on the bit.’”
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García-López teamed up with researchers from Rhinebeck Equine in New York and Utrecht University in the Netherlands to review the records of 35 horses diagnosed with cranial nuchal bursitis over a 25-year period. The horses ranged in age from 5 to 22 years old, with a median age of 13. “Most, if not all of them, were English sport horses, with a high percentage of dressage horses,” says García-López, supporting the idea that the postural demands of certain riding styles may contribute to the development of cranial nuchal bursitis.
Fourteen of the study horses were treated with anti-inflammatory medications and the rest underwent surgery to address the problem. “The surgeon performs a minimally invasive procedure called bursoscopy, which allows the thorough examination of the inside of the bursa and for copious lavage [flush] and debridement [removal] of debris and inflammatory tissue,” explains García-López.
The researchers found that surgery resulted in improved outcomes: 78.6 percent of the horses who underwent the lavage procedure returned to their previous level of work. Although 66.7 percent of horses treated only with medication also were able to return to work, Garcia-Lopez notes that “some had to undergo surgery afterward as the medical management was not completely effective.”
In addition, he says, “horses that responded well to medical management typically had only fluid accumulation within the bursa and not a lot of debris or synovial thickening [thickening of the lining of the bursa].” Only 25 percent of horses who had surgery after failing to respond to medication were able to return to their previous level of performance.
García-López says the initial choice of treatment is best guided by ultrasound0 or radiology to determine the extent of damage to the bursa. “Medical management is best tried in horses with just inflammation, which consists of fluid distention with little or no inflammatory debris. Once debris is present, surgery is recommended,” he says. “If the distention is only fluid with no debris, it is OK to try once with a combination of steroids and polyglycan or hyaluronic acid. But if the inflammation recurs and/or there is debris, surgery should be performed right away.”
Reference: “Diagnosis, treatment and outcome of cranial nuchal bursitis in 30 horses,” Equine Veterinary Journal, November 2017
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This article was originally published in EQUUS 486, March 2018