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

Abstract

BACKGROUND: Cervical spinal nerve insult can be a sequel of osteoarthropathy in horses due to enlargement of the articular processes (AP). OBJECTIVES: To describe the percutaneous endoscopic cervical foraminotomy procedure in horses. STUDY DESIGN: 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. MAIN LIMITATION: Small number of clinical cases and absence of post-mortem examination or histopathology performed in the cadaver study to assess possible iatrogenic injuries. CONCLUSION: 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.