The introduction of uniportal endoscopic foraminotomy will offer horse owners and referring veterinary surgeons a viable treatment option for cervical spinal nerve compression, where previously only limited options were available to prevent long-term suffering.
The spinal cord runs inside the bony spinal canal that is formed by the adjacent vertebrae. From the central spinal cord, individual spinal nerves arise that travel into the periphery of the body connecting extremities with the central spinal cord and brain. The nerve roots exit the spinal canal via the intervertebral foramen (IVF), an opening on either side between two adjacent vertebrae. The IVF is unique since its boundaries consist of two movable joints: the ventral (non-synovial) intervertebral joint and the dorsal (synovial) articular process joint (APJ). Pathological changes to one or both joints can result in narrowing of the IVF, causing cervical spinal nerve compression, the most common of which is at the 6th (C6) and 7th (C7) vertebrae at the base of the horse’s neck.
When experiencing cervical spinal nerve compression, horses can exhibit one, or a combination, of the following clinical signs: neck pain/stiffness; intermittent or persistent forelimb lameness; proprioceptive deficits (ie stumbling, falls); and poor performance (ie ridden complaints).
Funding from the RVC Animal Care Trust, Betty Phillips Charitable Trust and Follett Trust provided vital equipment and enabled the RVC’s equine surgeons, led by Dr Alex Hawkins, lecturer in equine surgery at the RVC’s Equine Referral Hospital, to undertake specialist training. This was initially conducted in Germany and later at the RVC itself – under the guidance of Dr Jan-Hein Swagemakers, the developer of the surgical technique.
To facilitate this service, the RVC team will conduct clinical examinations before identifying suitable surgical candidates using the recently installed Qalibra computed tomography (CT) machine. The minimally invasive procedure will then be performed, on suitable candidates, under general anaesthesia to remove excess bone, relieve nerve compression and create more space within the spinal canal – ultimately reducing pain and improving neurological function.
With only one other established equine hospital currently offering this treatment in the UK, these collaborative and pioneering efforts (supported by the expertise of RIWO Spine UK and Dr Rachel Tucker from Liphook Equine Hospital) enhance the RVC’s ability to expand its equine clinical services and deliver the highest standard of care for horses affected by this debilitating condition.
Following the launch of this service, the RVC team will be embarking on a collaborative research project with the aim of improving diagnosis and treatment for equine patients by deepening understanding of the anatomy, surgical techniques and advanced imaging of the equine cervical intervertebral foramen.
Dr Alex Hawkins, lecturer in equine surgery at the RVC Equine Referral Hospital, said: “We are excited to introduce uniportal endoscopic foraminotomy as a surgical option at the RVC’s Equine Referral Hospital. Developed by Dr Jan-Hein Swagemakers, this innovative, minimally invasive surgery offers new hope for owners with horses suffering from chronic or debilitating neck pain, helping to improve their comfort, mobility, and overall quality of life. It also offers referring veterinarians a reliable, evidence-based option for managing suitable cases of cervical spinal nerve compression.
“More than 300 surgeries have now been performed worldwide with early outcomes showing promising results (reported to be an approximately 80 percent success rate) and so we encourage colleagues to consider this minimally invasive procedure for horses showing clinical signs consistent with foraminal stenosis, particularly those not responding to conservative management.”
