• Clinical examination and palpation revealed mild bilateral distal interphalangeal joint effusion
• Dynamic examination revealed a grade 2/5 (AAEP scale) left front lameness, worse on the right circle
• Lameness worsened following both distal and full limb flexion
• Neither perineural nor intra-articular diagnostic analgesia of the left front limb resulted in improvement of the lameness
• Due to the inability to localize the cause of the lameness to the limb, it was suspected that the lameness may be due to pathology of the cervical spine and radiographs of this region were performed

Findings:

• Mild to moderate smooth osseous proliferation at ventral aspect of left C6-7 articular facet joint, best identified on oblique image
• Slight undulation of caudal aspect of right C6-7 articular facet joint

Conclusions:

• Articular process hypertrophy at C6-7, mildly narrowing the left intervertebral foramen
• Mild osteoarthritis of the right C6-7 articular facet joint

• Ultrasonographic examination of the cervical spine was performed

Ultrasound imaging report:

Findings:

• Moderate osseous remodeling and mild effusion of the left C6-7 articular facet joint
• Mild osseous remodeling and effusion of the left C4-5, C5-6 and right C6-7 articular facet joints

Conclusions:

• Mild-moderate osteoarthritis, left C6-7 articular facet joint
• Mild osteoarthritis, left C4-5, C5-6 and right C6-7 articular facet joints

Ultrasound-guided injection of the left C4-5 and C5-6 and right C6-7 articular facet joints was performed

This was followed by a series of extracorporeal shockwave treatments of the cervical spine

• Only partial response seen to therapy:
• Whole body nuclear scintigraphy performed to assess for potential additional source of left front lameness
• Computed tomography of the cervical spine performed, including intra-articular administration of contrast media at C5-6 and C6-7 articular facet joints bilaterally, to better characterize cervical spine pathology

Nuclear Scintigraphy Imaging Report

Findings:

• Moderate, focal increased radiopharmaceutical uptake (IRU) of the left C6-7 articular facet joint
• Mild, focal IRU of the right C6-7 articular facet joint

Conclusions:

• Moderate left C6-7 articular facet osteoarthritis consistent with enlargement seen on CT
• Mild right C6-7 articular facet osteoarthritis consistent with enlargement seen on CT

• Cone beam computed tomography (CT) of the cervical spine was performed, including intra-articular administration of contrast media at C5-6 and C6-7 articular facet joints bilaterally, to better characterize cervical spine pathology

CONE-BEAM COMPUTED TOMOGRAPHY (CT)

Cone-shaped x-ray beam and large-area detector plate provide large volume data

Sequence of images acquired in single rotation without patient movement through the scanner

Cone Beam CT Imaging Report

Findings:

• Moderate, bilateral irregular osseous proliferation of the cranial articular facets of C7, causing narrowing of the C6-7 intervertebral foramina bilaterally. The left is more affected than the right, with focal, triangular osseous proliferation.

Conclusions:

• C6-7 articular facet enlargement and osseous proliferation with bilateral stenosis of the intervertebral foramina. Likely impingement of the left C7 nerve root

Case Outcome

• Patient received a course of systemic corticosteroids (oral prednisolone) to reduce inflammation associated with osteoarthritis of articular facet joints and associated nerve root impingement, a neuromodulator (oral gabapentin) to resolve associated nerve root pain and systemic bisphosphonates (intramuscular clodronate) to attempt to reduce progressive bone remodeling

Supporting Literature