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Developments in ultrasound-guided thecal puncture in horses
  1. Robert J. MacKay, BVSc, PhD
  1. University of Florida, Gainesville FL 32610, USA
  1. e-mail: mackayr{at}


SINCE the 1970s, needle puncture into the subarachnoid space in horses (thecal puncture) has been used more or less routinely to collect cerebrospinal fluid (CSF), for intrathecal medication and, more recently, as a portal for introduction of an endoscope (Mayhew 1975, Johnson and Constantinescu 2000, Steinman and others 2000, Prange and others 2011). Originally, there were two accepted techniques: upper cervical puncture via the atlanto-occipital (AO) space in recumbent horses under general anaesthesia; and lumbosacral cisternal puncture in conscious (usually standing) horses. Each of these techniques has advantages and drawbacks. AO cervical puncture is technically straightforward, safe for the operator, can be performed under brief intravenous anaesthesia, and usually yields clean limpid samples uncontaminated by blood. However, recovery from anaesthesia in neurologically compromised horses can be difficult and, occasionally, disastrous. By contrast, the lumbosacral approach is technically challenging even for the experienced operator, carries a small but real risk of explosive reaction by the horse, and significant blood contamination of the aspirated CSF sample is relatively common. At both sites, puncture-associated sepsis is a possibility but apparently very rare. Severe headache after dural puncture is a frequent problem in people (Bezov and others 2010), but signs consistent with headache are not seen in horses following the procedure.

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