HLA’s Equine Sports Medicine Service Offering Endoscopic Foraminotomy
Cervical spinal nerve compression is a painful condition in horses. It can manifest as a variety of clinical symptoms, making it difficult to diagnose and even more challenging to treat. Last summer, Cummings School of Veterinary Medicine at Tufts University acquired an advanced computed tomography scanner (CT) that enables clinicians to image new areas of the horse, including the entire neck. This technology allows them to identify cervical spinal pathologies, including cervical spinal nerve compression. With a diagnosis but few effective treatment options, the Equine Sports Medicine Service at Hospital for Large Animals (HLA) is spearheading an effort to offer a specialized endoscopic procedure, foraminotomy, to treat this condition.
The cervical spine of the horse is complex. Cervical spinal nerves course through the intervertebral foramina, spaces between the joints of the cervical spine. Osteoarthritis of these joints is a common problem in horses. It can result in excessive bone proliferation, compressing the roots of the spinal nerves as they exit the foramen.
“This surgery is very novel,” says Dr. Stefanie Arndt, assistant clinical professor of large animal surgery, on HLA’s Equine Sports Medicine Service at Cummings School. “We are increasingly diagnosing horses with cervical spinal nerve compression when we do CTs of the horse’s neck, and now with this equipment, we can actually help the horses right here at Tufts.”
Possible symptoms of horses with cervical spinal nerve compression include a unilateral forelimb lameness, unresponsive to diagnostic analgesia (nerve blocking), changes in behavior, neck stiffness, and poor performance, to name a few.
“As we are starting to diagnose more horses with this condition, we notice more and more clinical symptoms possibly related to the disease,” says Arndt.
Dr. Joe Davis is an assistant clinical professor of large animal surgery on HLA’s Equine Sports Medicine Service at Cummings School. He says, “With the new CT, we can see much finer detail and recognize lesions causing neurological signs and behavior changes associated with nerve pain that would have been impossible to diagnose accurately with radiographs.”
Treatment options for horses diagnosed with cervical spinal nerve compression, however, had been previously limited to systemic anti-inflammatory medications or local injections for pain and physical therapy.
“We have the equipment necessary to do a full neck CT, and because we’re now doing neck CTs, we have a much better idea of what the disease process is in horses with neck pain. Since we can diagnose this, we need to have the option of treatment,” says Dr. Kirstin Bubeck, assistant clinical professor of large animal surgery, head of HLA’s Equine Sports Medicine Service at Cummings School.
A veterinary surgeon, working in Germany, who developed the procedure, called percutaneous full endoscopic cervical foraminotomy for horses, extrapolated from a technique in human medicine to treat nerve compression in the lumbar area. The new procedure is performed by inserting an endoscope and surgical instruments through a centimeter-wide incision in the horse’s neck to reach the intervertebral foramen and removing excessive bone formation to relieve the spinal nerve compression. The procedure can alleviate excruciating neck pain for the horses and resolve lameness in the front limbs by eliminating pressure on the associated cervical spinal nerves. Recovery time is often relatively short, usually just six weeks.
“I reached out to a couple of colleagues, watched the surgery, and was pretty convinced that I wanted to get this to Tufts[HLA] and make a difference for our equine patients,” says Arndt.
Bubeck and Davis agreed. All three underwent training in this new procedure, and Cummings School secured funding to acquire the specialized endoscopic equipment, which arrived earlier this summer.
The new procedure is minimally invasive for the patient. Davis explains, “What’s unique is this setup. Surgery is performed in the neck, through one small hole, allowing us to work deep without traumatizing surrounding tissues.”
“Horses previously diagnosed with cervical spinal nerve compression did not have any chance of getting better,” says Bubeck. “Pain medication doesn’t resolve it, and injections are only short-lived. This is a big step forward to help a lot of horses, which can now return to their previous athletic activity. It’s a new possibility that we didn’t have before.”
Source: https://vet.tufts.edu/
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