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Equine veterinary journal2023; 55(5); 788-797; doi: 10.1111/evj.13919

Percutaneous full endoscopic foraminotomy for treatment of cervical spinal nerve compression in horses using a uniportal approach: Feasibility study.

Abstract: Cervical spinal nerve insult can be a sequel of osteoarthropathy in horses due to enlargement of the articular processes (AP). Objective: To describe the percutaneous endoscopic cervical foraminotomy procedure in horses. Methods: Ex vivo experimental study and clinical case report. Methods: The technique was performed in three equine cadavers and in two clinical cases with history of forelimb lameness located in the caudal cervical region. Briefly, the horse was positioned in lateral recumbency, with the affected AP joint uppermost. Under fluoroscopic guidance, the endoscopic instruments (Ø 6.9 mm, length 207 mm, 25° angle of vision) were positioned at the dorsal bony margin of the intervertebral foramen (IVF). The bone was freed from soft tissues and removed using diamond various burrs, hence widening the IVF. The bone drilling was continued until the medial cortical surface of the caudal AP was removed. Thereafter, the endoscope was removed and the skin portal was closed. Results: The average of operation time in clinical cases was 98 ± 24 min. The horses recovered smoothly from the operation. At 12-month follow-up, the clinical signs had resolved completely without recurrence. Conclusions: Small number of clinical cases and absence of post-mortem examination or histopathology performed in the cadaver study to assess possible iatrogenic injuries. Conclusions: Cervical spinal nerve decompression via minimal invasive foraminotomy is feasible in horses. More research is required before this procedure can be recommended in clinical cases. Unassigned: Eine Beeinträchtigung des Halswirbelnervs kann eine Folge der Osteoarthropathie bei Pferden sein, die auf eine Vergrößerung der Gelenkfortsätze (AP) zurückzuführen ist. Unassigned: Beschreibung des Verfahrens der perkutanen endoskopischen cervikalen Foraminotomie bei Pferden. Methods: Experimentelle ex-vivo Studie und klinischer Fallbericht. Methods: Die Technik wurde an Pferdekadavern (n = 3) und klinischen Fällen (n = 2) mit einer Vorgeschichte einer Lahmheit der Vorderextremität, die auf Höhe der caudalen Halswirbelsäule lokalisiert wurde, durchgeführt. Das Pferd wurde in lateraler Seitenlage gelagert, wobei das betroffene AP-Gelenk oben positioniert wurde. Unter fluoroskopischer Kontrolle wurden die endoskopischen Instrumente (Ø 6,9 mm, Länge 207 mm, 25° Blickwinkel) am dorsalen knöchernen Rand des Foramen intervertebrale (IVF) positioniert. Der Knochen wurde von den Weichteilen freigelegt und mit verschiedenen Diamantfräsern abgetragen, wodurch das IVF geweitet wurde. Der Bohrvorgang durch den Knochen wurde fortgesetzt, bis die mediale Kortikalfläche des kaudalen AP entfernt war. Danach wurde das Endoskop entfernt und das Hautportal verschlossen. Results: Die durchschnittliche Operationszeit in den klinischen Fällen betrug 98 ± 24 min. Die Pferde erholten sich komplikationslos von der Operation. Bei der 12-monatigen Nachuntersuchung waren die klinischen Symptome vollständig und ohne Rezidiv abgeklungen. WICHTIGSTE EINSCHRÄNKUNGEN: Geringe Anzahl klinischer Fälle und keine post-mortale oder histopathologische Untersuchung in der Kadaverstudie zur Beurteilung möglicher iatrogener Verletzungen. Unassigned: Die Dekompression des cervikalen Spinalnervs mittels minimalinvasiver Foraminotomie ist bei Pferden durchführbar. Bevor dieses Verfahren in klinischen Fällen empfohlen werden kann, sind weitere Untersuchungen erforderlich.
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Publication Date: 2023-01-10 PubMed ID: 36572912DOI: 10.1111/evj.13919Google Scholar: Lookup
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Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

This research assesses the feasibility of using a minimal invasive percutaneous endoscopic foraminotomy to treat cervical spinal nerve compression in horses, which is often a result of osteoarthropathy. The procedure was performed on three horse cadavers and two living horses, proving to be successful, though the authors note further research is needed.

Methodology

  • The procedure was practiced initially on three equine cadavers before being applied to two live clinical cases which displayed history of forelimb lameness traced to the caudal cervical area.
  • Under fluoroscopic guidance (real-time x-ray imaging), the endoscopic instruments were used to expose the intervertebral foramen (IVF), penetrating through the skin and muscle.
  • The affected articular processes (AP) joint was cleared of soft tissue and part of its bone was removed using diamond burrs, hence widening the IVF. This process aims to decompress the cervical spinal nerve by enlarging the vertebral opening (foramen) that the nerve passes through.
  • The procedure terminated with the extraction of the endoscope and the closure of the skin portal.

Results

  • The average operation time concluded with 98±24 minutes, considered feasible in a clinical setting.
  • The two clinical cases underwent a smooth recuperation from the operation without any complications.
  • After a follow-up period of 12 months, the symptoms had completely disappeared without the reoccurrence of lameness.

Conclusion

  • The authors concluded that the procedure is effective for the treatment of cervical spinal nerve compression in horses and could indeed be feasible for use in live animals.
  • However, they also cautioned the limited application of the procedure due to the small number of clinical cases involved within the study and the absence of any post-mortem examination or histopathology conducted on the cadavers to assess possible iatrogenic injuries (unwanted side effects of the medical intervention).
  • The authors therefore contend that more research is necessary before the procedure can be recommended for wider clinical application.

Cite This Article

APA
Swagemakers JH, Van Daele P, Mageed M. (2023). Percutaneous full endoscopic foraminotomy for treatment of cervical spinal nerve compression in horses using a uniportal approach: Feasibility study. Equine Vet J, 55(5), 788-797. https://doi.org/10.1111/evj.13919

Publication

Equine veterinary journal
ISSN: 2042-3306
NlmUniqueID: 0173320
Country: United States
Language: English
Volume: 55
Issue: 5
Pages: 788-797

Researcher Affiliations

Swagemakers, Jan-Hein
  • Tierklink Lüsche GmbH, Bakum, Germany.
Van Daele, Peter
  • O.L.V. van Lourdes Ziekenhuis, Waregem, Belgium.
Mageed, Mahmoud
  • Tierklink Lüsche GmbH, Bakum, Germany.

MeSH Terms

  • Horses
  • Animals
  • Foraminotomy / veterinary
  • Foraminotomy / methods
  • Feasibility Studies
  • Cervical Vertebrae / surgery
  • Endoscopy / veterinary
  • Endoscopy / methods
  • Spinal Nerves
  • Treatment Outcome

Grant Funding

  • No funding was received for this research.

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This article includes 30 references
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Citations

This article has been cited 3 times.
  1. Lee SH, Park JH, Kim DE, Hwang G, Moon CH, Lee D. Anatomical Validation and Technical Feasibility of Biportal Endoscopic Spinal Surgery Including Technical Notes in a Cadaveric Canine Thoracic Intervertebral Disc Disease Model. Animals (Basel) 2026 Jan 30;16(3).
    doi: 10.3390/ani16030435pubmed: 41681416google scholar: lookup
  2. Dyson S, Zheng S, Aleman M. Primary phenotypic features associated with caudal neck pathology in warmblood horses. J Vet Intern Med 2024 Jul-Aug;38(4):2380-2390.
    doi: 10.1111/jvim.17125pubmed: 38829000google scholar: lookup
  3. Dyson S, Pollard D. Application of the Ridden Horse Pain Ethogram to 150 Horses with Musculoskeletal Pain before and after Diagnostic Anaesthesia. Animals (Basel) 2023 Jun 9;13(12).
    doi: 10.3390/ani13121940pubmed: 37370450google scholar: lookup
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