In dogs, distinct reference intervals are used for CSF obtained from the AO space versus the LS space due to significant differences found in the nucleated cell count and protein concentration.
8 However, most laboratories report a single reference interval that is applied to fluid collected from either site. Cerebrospinal fluid collected from the AO and LS spaces differs slightly in horses. The C1‐C2 technique has not been directly compared to LS centesis, in terms of fluid sample characteristics and ease of sample collection. 7 However the description of the technical and safety aspects of the technique were reported in a small number of primarily normal horses. 4 Recently, a percutaneous, ultrasound‐guided technique has been described to obtain CSF from the C1‐C2 space in standing horses. 4, 5, 6 Recovery from general anesthesia presents a greater risk for horses that are weak or uncoordinated due to neurologic disease. This technique is simpler than LS centesis but does present a greater risk of iatrogenic trauma, particularly in horses with increased intracranial pressure. Until recently, the only alternative technique was atlanto‐occipital (AO) thecal puncture, which typically requires general anesthesia. 4 These reactions occur rarely but can result in injury to the veterinarian, horse handler, or to the horse itself. 4, 5 Finally, penetration of the dura mater with the needle has been associated with violent reactions in some horses. 3 Although LS centesis is the technique of choice in horses with suspected spinal cord lesions or multifocal disease, if intracranial disease is suspected it may be preferable to collect CSF from a location closer to the foramen magnum. Blood contamination can limit the diagnostic usefulness of the sample, artifactually increasing the protein concentration and nucleated cell count in the sample, 2 or giving false‐positive results when testing for equine protozoal myeloencephalitis (EPM) using Western blot analysis. In overweight or muscular horses, it can be difficult to palpate landmarks, and although ultrasound‐guided LS centesis can assist with needle placement, 1 it is not uncommon to obtain CSF with iatrogenic blood contamination. The most commonly used technique for CSF collection in horses is standing lumbosacral (LS) centesis however, this can present a number of challenges. However, CSF collection in horses is often limited by technical difficulty and perceived risk of injury to personnel and the horse. Complete neurologic system evaluation requires examination of cerebrospinal fluid (CSF).
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