Diagnostic Imaging Approaches to Equine Back Pain A Practical Comparative Review with a Field-Oriented Decision Pathway

Background: Back pain is one of the leading causes of poor performance in sport horses, yet localization of pain remains challenging because of overlapping bony, ligamentous, and muscular structures. Radiography and ultrasonography are the two most practical imaging tools available in field practice, each visualizing distinct aspects of pathology. Objective: To compare the diagnostic performance and limitations of radiography and ultrasonography for evaluating equine back pain and to propose a structured decision pathway that integrates both modalities for field and hospital contexts. Methods: A structured narrative review was performed using PubMed, CAB Abstracts, and ScienceDirect with the terms equine back pain, radiography, ultrasonography, thoracolumbar, and sacroiliac. Titles and abstracts were screened using a structured approach to minimize selection bias; uncertainties were resolved after repeated review. Studies were grouped into four lesion categories: dorsal spinous process (DSP) and facet OA, sacroiliac (SI) pathology, soft-tissue lesions, and multifactorial back pain. MRI/CT-only studies were excluded but are discussed for context. Results: Radiography is most reliable for detecting osseous abnormalities such as DSP impingement, facet remodeling, and sacroiliac sclerosis. Ultrasonography complements by revealing soft-tissue lesions including supraspinous/interspinous desmopathy and thoracolumbar fascia injury. Interpreting both modalities together increases diagnostic confidence and reduces ambiguous cases. The proposed five-step decision pathway provides a reproducible workflow for ambulatory and referral use. Conclusion: Integrating radiography and ultrasonography sequentially enhances diagnostic accuracy for sport-horse back pain, minimizes over- and under-diagnosis, and supports structured referral in the absence of MRI/CT.

کلیدواژه ها:

equine back pain ، radiography ، ultrasonography ، thoracolumbar ، sacroiliac