Current and Future Central Nervous System Surgery-Part 2: Radiculopathy, Vertebral Fractures, and Intracranial Surgery.

Current advancements in equine neurosurgery are expanding treatment options beyond traditional cervical stabilization, addressing conditions like radiculopathy, vertebral fractures, and intracranial issues with innovative surgical techniques.

Overview of Equine Neurosurgery Challenges

• Equine neurosurgery is complex, especially when dealing with central nervous system (CNS) diseases beyond the commonly treated cervical vertebral compressive myelopathy.
• The most frequent procedure is ventral cervical stabilization, addressing cervical vertebral compression.
• Many CNS conditions in horses remain difficult to treat due to anatomical and technical challenges.

Advancements in Diagnostic and Surgical Technologies

• Improved diagnostic imaging techniques (such as advanced MRI, CT scans) enhance the ability to localize and characterize neurological lesions.
• Minimally invasive instrumentation reduces surgical trauma and improves recovery times.
• Computer-assisted surgery provides greater precision in planning and executing complex procedures.

Expanded Therapeutic Indications

• New surgical interventions now target radiculopathy, which involves nerve root compression causing pain and dysfunction.
• Vertebral fractures in horses are being addressed more effectively with novel surgical techniques.
• Intracranial and intraspinal masses, previously difficult to manage, are approachable through emerging surgical methods.

Innovative Surgical Techniques

• Percutaneous foraminotomy: A minimally invasive procedure that relieves nerve root compression by widening the intervertebral foramen.
• Facet fixation: Stabilizing vertebral joints to manage instability or deformity.
• Targeted decompression: Focused removal of compressive lesions sparing normal tissues.
• Novel implant systems: Advanced hardware designed for equine spinal anatomy to provide better stabilization.
• Exploratory cranium approaches: Surgical access to intracranial structures for mass removal or lesion management.

Future Directions and Clinical Impact

• As surgeons gain experience with these new methods, clinical outcomes for horses suffering from various CNS pathologies are expected to improve.
• The expanding arsenal of surgical options offers more precise and less invasive treatments tailored to specific neurological conditions.
• Continued innovation and research are critical to overcoming current limitations in equine CNS surgery.