Short Communications
Short Communications
Prevalence of
cervical vertebral
stenotic myelopathy
in a population of
thoroughbred horses
J. Oswald, S. Love, T. D. H. Parkin, K. J. Hughes
Cervical vertebral stenotic myelopathy (CVSM) is a common
cause of spinal ataxia and paresis in horses that results from stenosis of
the cervical vertebral canal and static or dynamic compression of the
spinal cord (Nout and Reed 2003). The disease is seen commonly in
young, rapidly growing horses. Certain breeds, including thorough-
breds, appear predisposed to the condition, and male horses are at
increased risk (Mayhew and others 1993, Levine and others 2008).
Two forms of CVSM have been described: type 1 is caused by verte-
bral malformation and/or malarticulation leading to dynamic instabil-
ity of the vertebral canal and is most common in young horses, while
type 2 is more often seen in older horses and results from cervical oste-
oarthritis leading to static compression of the spinal cord (Mayhew and
Green 2000, Levine and others 2007). However, both types of CVSM
may be present at the same time in an individual horse (Hahn and
others 2008). CVSM can be diagnosed presumptively on the basis of
neurological findings and examination of plain lateral radiographs for
evidence of cervical vertebral malformation or vertebral canal stenosis
using intravertebral and intervertebral sagittal ratios (Moore and others
1994, Hahn and others 2008). Confirmation of CVSM is obtained by
gross and histopathological postmortem examination (Nout and Reed
2003) or myelography (Mayhew and Green 2000).
Although the clinical and pathological aspects of CVSM are well
established, there is little available epidemiological information about
the disease. An improved epidemiological understanding of CVSM
might contribute to improved preventive approaches in clinical prac-
tice. This short communication describes a study aiming to determine
the prevalence of CVSM in a population of thoroughbred horses for
which free-text clinical data were available, over a seven-year period,
and identify any age or sex predispositions.
Content analysis software was used to review over 350,000 free-
text clinical records dating from January 2000 to December 2006 in
the databases of thoroughbred breeding establishments in Europe (three
Veterinary Record (2010) 166, 82-83 doi: 10.1136/vr.b4781
J. Oswald, Mr Hughes’ present address is School
S. Love, BVMS, PhD, MRCVS, of Animal and Veterinary Sciences,
K. J. Hughes, BVSc, FACVSc, Charles Stuart University, Locked Bag
DipECEIM, MRCVS, 588, Wagga Wagga, New South
Weipers Centre for Equine Welfare, Wales, 2678, Australia
T. D. H. Parkin, BSc, BVSc, DipECVPH,
PhD, MRCVS, Correspondence to Mr Hughes, e-mail:
Boyd Orr Centre for Population and krhughes@csu.edu.au
Ecosystem Health,
Institute of Comparative Medicine, Provenance: not commissioned;
Faculty of Veterinary Medicine, externally peer reviewed
University of Glasgow, Bearsden Road,
Glasgow G61 1QH
Veterinary Record | January 16, 2010
farms, 936 foals) and the USA (one farm, 353 foals), using a method
described by Lam and others (2007). Briefly, the database (Excel;
Microsoft) was imported by year into the content analysis program
WordStat v5.1 (Provalis Research), a modular component of the sta-
tistical software SimStat v2.5 (Provalis Research). A dictionary of diag-
nostic words for CVSM was created and used to search the database to
identify horses with the disease (the dictionary is available from KJH
on request). Confirmed CVSM was defined as myelographic evidence
and/or gross and histopathological postmortem examination findings
of spinal compression, and presumptive CVSM was defined as clinical
findings and/or plain lateral cervical radiograph findings supportive of
CVSM. For each horse with CVSM, the disease type (type 1, type 2 or
unknown), sex, age at diagnosis and outcome data were recorded. The
prevalence of CVSM was determined by expressing the number of foals
born that developed CVSM as a percentage of the total number of foals
born at the four breeding establishments, overall and annually, from
January 2000 to December 2006. All data for age at onset and outcome
are presented as mean (sd). Mann-Whitney U tests were used to identify
significant differences in age at diagnosis for type 1 and type 2 CVSM.
Significance was set at P<0.05. Chi-squared tests were used to identify
differences in the proportion of males and females with CVSM.
Twenty-three cases of CVSM were identified; there were six
confirmed and 17 presumptive cases. For all horses with confirmed
CVSM, the diagnosis was made by postmortem examination. For the
presumptive CVSM group, a diagnosis was obtained from the clinical
and radiographic findings in 16 horses and clinical findings alone in
one horse. Intravertebral sagittal ratio values were available for five
horses in this group.
Type 1 CVSM was identified in 13 horses and type 2 CVSM was
identified in five horses; it was not possible to determine the type of
disease from the records of the other five horses. The age at onset of
signs of type 2 CVSM (1188.6 [95 days], range 1085 to 1299 days) was
significantly greater than that for horses with type 1 CVSM (433.8
[220 days], range 48 to 702 days) (P=0.002). For the five horses with
unknown disease type, the mean (sd) age of onset was 566 (279) days
(range 202 to 986 days). Significantly more male (17) than female (six)
horses were diagnosed with CVSM (P=0.02).
Seventeen of the 23 horses with CVSM were born between
January 2000 and December 2006. The other six horses (two con-
firmed and four presumptive cases) were born before January 2000
and were excluded from the determination of disease prevalence. A
total of 1289 horses (644 males and 645 females) were born at the
four farms during this period. The overall prevalence of CVSM for the
study period was 1.3 per cent and annual prevalence ranged between
0.7 and 2.1 per cent (Fig 1). The annual prevalence of CVSM for indi-
vidual farms ranged from 0 to 5.8 per cent (data not shown); how-
ever, this information was not assessed due to the unknown effects of
movements of horses between farms.
Seventeen horses with CVSM were euthanased, two horses com-
menced training at 616 and 659 days of age, one horse was retired
and three horses were lost to follow-up. The horses that were eutha-
nased had a lifespan of 1067 (922) days (range 454 to 4438 days) and a
duration between the onset of signs and euthanasia of 415 (798) days
(range six to 3158 days).
This report is the first detailed documentation of the prevalence
of CVSM in a population of thoroughbred horses. The overall preva-
lence in the study (1.3 per cent) is similar to a previous estimation
that 2 per cent of thoroughbred horses have CVSM (Rooney 1969),
and supports the perception that the disease is common in this breed
(Mayhew and others 1993, Nout and Reed 2003, Levine and others
2008). However, the prevalence of CVSM reported in this study is
derived from four breeding establishments and represents sample prev-
alence. It is not known whether the prevalence of CVSM determined
for the population of horses in the present study reflects the prevalence
in the global thoroughbred racehorse population. One limitation of
the current study is that the prevalence of CVSM in the population of

2.5
2 ing susceptibility to spinal cord trauma or the vertebral canal diameter
Prevalence (%)
1.5
1 presumptive disease had signs consistent with a cervical spinal cord
0.5
0
2000 2001 2002 2003 2004 2005 2006
Year
FIG 1: Annual prevalence of cervical vertebral stenotic myelopathy
in a population of 1289 thoroughbred horses from January 2000 to
December 2006
horses studied may have been underestimated, given the study design.
It is possible that one or more horses born within the study period
developed CVSM after December 2006 and such horses would not
have been detected by the method of content analysis.
The majority of horses with CVSM in the present study were
euthanased, which indicates an actual or perceived poor prognosis,
economic considerations, or risks associated with the disease for
affected animals, unaffected cohorts or personnel. Similarly, in a case-
control retrospective analysis of a North American veterinary medi-
cal database, Levine and others (2008) found that horses with CVSM
were more likely to be euthanased than control horses. Collectively,
these findings suggest that CVSM is an important cause of morbidity
and/or mortality in equine populations.
The use of content analysis software allowed a large volume of free-
text clinical records to be searched in a systematic manner for retrieval
of data on horses with CVSM. The use of this software to analyse
equine clinical records has been described previously by Lam and others
(2007). Those authors found it to be a reliable and efficient tool for the
retrospective analysis of retirement patterns in thoroughbred racehorses.
Collectively, these studies indicate the potential of content analysis soft-
ware for retrospective clinical epidemiological investigations, as has been
demonstrated in human studies by Heinze and others (2001).
The horses with type 2 CVSM were significantly older than the
horses with type 1 CVSM at the time of diagnosis. This finding is
consistent with the developmental nature of type 1 disease (vertebral
malformation) in contrast to the osteoarthritis that causes spinal cord
compression in type 2 disease (Mayhew and Green 2000, Nout and
Reed 2003). Significantly more affected horses were male than female,
consistent with previous reports that male horses are at a higher risk
for the disease (Moore and others 1994, Levine and others 2008). The
Short Communications
reasons for this sex predisposition are unknown; however, they may
include behavioural patterns or the role of sex hormones in influenc-
(Levine and others 2008).
The lack of a definitive diagnosis in 17 of the 23 horses with
CVSM was a limitation of this study. However, all the horses with
lesion, and 16 of them underwent cervical radiography and had radio-
graphic findings supportive of a diagnosis of CVSM (Mayhew and
others 1993, Nout and Reed 2003).
From the prevalence and outcome data determined in this study it is
evident that CVSM is an important disease of thoroughbred horses and
leads to wastage in the thoroughbred industry through the inability to
race and the loss of affected horses. Further investigations of the preva-
lence of CVSM in populations of thoroughbreds, and other breeds, and
determination of risk factors for the disease are warranted.
Acknowledgements
This study was funded by the Beaufort Cottage Educational Trust.
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January 16, 2010 | Veterinary Record