In this episode of the Disease Du Jour podcast, Travis Tull, DVM, DACVS, joined us to discuss cervical nerve root compression in horses, including clinical signs, diagnosis, and management. He also described a surgical technique for treating the condition called percutaneous endoscopic foraminotomy, which he has helped pioneer in the United States.
What Is Cervical Nerve Root Compression in Horses?
Tull explained that cervical nerve root compression occurs when the horse’s spinal nerve becomes impinged by excess bone, causing inflammation, pain, and neurologic dysfunction.
Tull said this condition was only recognized in horses about four or five years ago, though there have been some reports in the literature from the 1990s. “Until we got technology and imaging to a point that we could really look at this area more closely, it was very difficult to diagnose,” he explained. “Advent of digital radiography and portable units that have enough power to get through all the muscle mass in the caudal neck of the horse, as well as three-dimensional imaging, really changed our ability to look at this and diagnose it.”
Tull said there are no known risk factors for the condition, and it occurs in horses of all breeds and disciplines.
Clinical Signs of Cervical Nerve Root Compression
Tull said one common sign of cervical nerve root compression is a forelimb lameness that cannot be blocked out. Behavioral problems, such as balking at jumps, bucking, or refusing to go forward, can also point to cervical pain.
“Unfortunately, a lot of these signs overlap with many other things that we see,” Tull said. “Cervical pain is almost a diagnosis of exclusion in that we’re trying to rule out all the other things that could be causing it, and then to get all the way to a nerve root problem takes a while.”
Diagnostic Imaging
Tull said the first step in diagnosing the condition is taking cervical radiographs. However, while radiographs can tell you some abnormality is present, they don’t always give a clear answer to what exactly the abnormality is. Therefore, three-dimensional imaging with computed tomography (CT) is necessary to reach a diagnosis.
Percutaneous Endoscopic Foraminotomy
Tull then described a surgical technique for treating cervical nerve root compression called percutaneous endoscopic foraminotomy, which was developed in Germany by Jan-Hein Swagemakers, DVM, Dr.med.vet. Tull now performs this surgery at Ocala Equine Hospital and has helped educate other veterinarians in the U.S on the technique.
Percutaneous endoscopic foraminotomy involves making a small incision in the neck through which the surgeon inserts a specialized endoscope, using ultrasound and radiographs to guide it along the foramen. The surgeon then uses various tools to shave the excess bone and reduce spinal nerve impingement. (Tull explained this procedure in more detail in the episode.)
Swagemakers has performed this surgery on about 300 horses in Germany, and Ocala Equine Hospital has done 74 surgeries on 51 horses. Tull said about 80% of horses improve following the surgery. Because the technique is new, they don’t yet know if the bone will regrow in the future. However, CT scans of some horses one to three years post-surgery have so far revealed only minimal regrowth. “We’re hoping that either it doesn’t come back much at all, or it takes a really long time to become a problem again,” Tull said.
Rehabilitation
Tull said horses can return to ridden work six weeks after surgery. The rehabilitation process involves a couple of days of stall rest followed by turnout in a small paddock with hand-walking. He encourages hand-walking up and down hills, on different surfaces, and in figure-eights to help the horse become more coordinated (as long as it is safe to do so). He recommends using bands or a Pessoa longing system to strengthen the horse’s core, as well as balance pads to improve the horse’s balance. Range of motion exercises and carrot stretches are also helpful. Tull said it’s important to continue with these exercises even after the horse returns to ridden work.
Final Thoughts
In closing, Tull said he has been very happy with outcomes from this procedure. “We’ve got horses that have been doing four- and five-star eventing competitions that have gone back to that level. We’ve had a horse that’s raced again,” he said. “Even if the horse doesn’t get back to the level that people wanted it, we help their pain, and I think that’s really important in the long term for these animals.”
About Dr. Travis Tull
Travis Tull, DVM, DACVS, is an owner and surgeon at Ocala Equine Hospital in Ocala, Florida. He is a graduate of the University of Georgia College of Veterinary Medicine. He completed an internship and surgical residency at Rood and Riddle Equine Hospital. Following his time in Lexington, he was a surgeon at Brown Equine Hospital in Pennsylvania before accepting the position as a surgeon and hospital clinician at Rood & Riddle Equine Hospital in Saratoga from 2013-2017. His professional interests are orthopedics, soft tissue surgery, and lameness in performance horses.
Related Reading
- Cervical Ventral Laminae Transposition and Neck Pain in Horses
- Ventral Interbody Fusion for Horses With C7-T1 Pathology
- Is That Horse’s Radiographic Neck Lesion Important?
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