Foraminotomy: A new frontier in the treatment of pathological conditions of the cervical vertebral column in horses
Based upon: R. Tucker, J. Anderson, S. M. Schmidt and J. Stavisky, Disorders of the cervical vertebral column part 2: Update on current surgical techniques. Equine Vet Educ., 2025, 00, 1 – 12. https://doi.org/10.1111/eve.14192
Rachel Tucker and co-workers have recently published a review of the surgical techniques available for treatment of surgical disorders in the cervical vertebral column in horses. In horses, abnormalities and disorders of the neck vertebrae can cause pain, which may manifest as behavioural issues. They can also cause neurologic deficits, with a high resultant mortality rate in young horses diagnosed with spinal cord compression. While there are surgeries available to treat this, such as cervical vertebral interbody fusion (‘Wobbler surgery’), they can be expensive and there is a high potential for complications. However, successful surgery results in significant improvements in ataxia, although the fatality complication rate can be high, reported at 6 – 18% overall.
Foraminotomy for treatment of spinal nerve compression
Foraminotomy, where an intervertebral foramen – the opening between adjacent vertebrae where nerve roots exit – is widened, is a treatment for spinal nerve compression. It offers the potential to treat spinal canal stenosis, where the space in the spinal canal has been narrowed, specifically by enlarged articular process joints. In humans, foraminotomy is a widely performed technique for various indications, but in horses this procedural approach is still in its infancy. However, the recent advent of computed tomographic (CT) imaging of the entire horse neck means that the anatomy of this region can now be accurately assessed, improving diagnoses and surgical understanding. This has enabled cervical foraminotomy to become a viable technique to treat radiculopathy – compression or irritation of a nerve root . It may yet become an alternative to cervical vertebral interbody fusion in some cases.
Sharing medical innovations: the transfer of knowledge from human to animal medicine
In this regard, the cross-over from human to animal medicine is extremely interesting, with the possibility of collaboration between human and equine veterinary surgeons, as well as with instrument manufacturers, giving real promise to the treatment of horses with pathological conditions of the spinal column, particularly in the neck. Where this procedure has been completed, success rates have been high, comparing favourably with the more established cervical vertebral interbody fusion:
78 of the first 90 patients (80%) operated on by Dr. Swagemakers, who was the first to publish in this area in 2023, had a positive outcome according to owner feedback, meaning the horse showed either partial or complete improvement in their clinical signs.
To date, 74% of operated horses have returned to full work.
In only 13% of cases, the surgery did not resolve the presenting complaint, possibly due to incorrect initial diagnosis, the presence of pre-existing irreversible neurological damage or due to failings of the surgical technique.
Uniportal endoscopic foraminotomy: an exciting new frontier in equine treatment
In summary, uniportal endoscopic foraminotomy is an exciting new surgery for treatment of pathological conditions of the cervical vertebral column in horses. While this field is still in its infancy, the burgeoning collaborations between human medicine and veterinary, as well as instrument manufacturers and suppliers, mean that this is a field to watch!