Liphook Equine Hospital, which is part of UK and European veterinary group VetPartners, is currently the only equine practice in the UK performing the foraminotomy procedure to address spinal nerve compression.
The keyhole surgery relieves pressure on nerves that are being pinched by bony enlargements in the lower neck. It involves inserting a special type of rigid endoscope – a long tube containing a camera and surgical instruments – through a 2cm incision to remove excess bone and soft tissue.
Liphook Equine Hospital, which is one of the largest specialist veterinary practices in the UK, has performed foraminotomies on six horses, with Dr Rachel Tucker, a European specialist in equine surgery, leading the surgical team.
Nerve compression in the neck occurs when the intervertebral foramen – openings in the vertebrae where nerves leave the spinal cord – become narrowed due to arthritic changes. If less space is available within the foramen, the surrounding bone and cartilage can impinge on the nerve, causing radiculopathy (commonly known as a pinched nerve).
This can lead to pain or sensory deficits resulting in signs such as tripping, a shortened forelimb stride or a hopping lameness, neck stiffness, behavioural issues and reduced performance, with the signs often made worse when the horse is ridden. Diagnosis of nerve compression is based on a combination of the presenting signs, CT imaging findings, negative nerve blocks in the forelimbs and a positive response to nerve root medication.
If significant nerve impingement is identified after a thorough examination and diagnostic tests, a foraminotomy can be performed to enlarge the area around it to relieve compression.
Rachel undertook extensive training in Germany, where the procedure was first performed in horses, and at the Royal National Orthopaedic Hospital in London, where similar surgery is performed in people.
She said that if nerve impingement remains undiagnosed or untreated, the condition can result in ongoing discomfort for the horse and retirement from ridden work.
Rachel continues: “Enlargement of the articular process joints of the lower neck is a relatively common finding in horses, but occasionally this can cause compression and irritation of the spinal nerves. The foraminotomy procedure means horses experiencing nerve pain can be made comfortable and have a good chance of returning to ridden work and a competition career.
“We are very pleased with how the procedures at Liphook went. Our patients are continuing to recover well and we are looking forward to following their progress in the future.
“The surgery is minimally invasive but it is a very delicate procedure to perform because you are working very close to the spinal cord. Due to the location, the surgery is performed down a single portal under direct visualisation using a camera, guided by ultrasound and X-ray. What has been remarkable so far has been the rapid recovery of the horses, who have been home and out in a small paddock within a few days of surgery with some showing rapid signs of improved comfort and movement.”
Rachel adds that in Germany and the US, where around 250 foraminotomy surgeries have been performed, there has been a success rate of 70 to 80 percent, with owners reporting a return to performance along with general improved comfort and behaviour. Many horses are show jumpers, eventers and dressage horses, performing at all levels. Following surgery, owners are given a six-week rehabilitation programme for their horses including physiotherapy and an exercise programme.
