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FULL ENDOSCOPIC FORAMINOTOMYFOR TREATMENT OF CERVICALSPINAL NERVE COMPRESSION Liphook Equine Hospital, Forest Mere, Liphook, Hampshire, GU30 7JGTel: 01428 727200 I theleh.co.uk I post@theleh.co.ukWe are excited to bring a new minimally invasive surgery to the UK, allowingtreatment of certain neck and lameness issues in the horse. Surgical widening of a narrowed intervertebral foramen can be performed torelieve associated pain and loss of nerve function caused by spinal nervecompression (radiculopathy) 1

If you are a veterinary surgeon and would like to discuss a case or possiblereferral, please contact us at hospitalreception@theleh.co.uk or on 01428727200. To discuss any aspect of nerve compression or foraminotomy please contactRachel Tucker at rachel.tucker@theleh.co.uk or at the hospital. THE TREATMENT OF NECKCONDITIONS AT LIPHOOK EQUINEHOSPITAL We are the only UK hospital able to offer the full complement of available diagnosticand treatment options for neck conditions in the horse, including:Computed tomography (CT) of the entire neckMyelography Foraminotomy surgery Articular process (facet) joint arthroscopyVentral stabilisation (Wobbler) surgery Perineural injection of the cervical spinal nervesArticular process joint injection Our specialists in surgery, medicine and diagnostic imaging apply an inter-disciplinaryapproach to the diagnosis and treatment of horses with neurologic, musculoskeletal orpoor performance concerns. We have close links with international specialists toensure we remain at the forefront of this rapidly progressing field. We endeavour towork closely with our clients and referring vets to provide a tailored andcompassionate approach to achieve optimal outcomes for all.Liphook Equine Hospital, Forest Mere, Liphook, Hampshire, GU30 7JGTel: 01428 727200 I theleh.co.uk I post@theleh.co.uk2

WHAT IS SPINAL NERVECOMPRESSION/RADICULOPATHY?Liphook Equine Hospital, Forest Mere, Liphook, Hampshire, GU30 7JGTel: 01428 727200 I theleh.co.uk I post@theleh.co.uk3Enlargement of the articular process joints of the lower neck is a relatively commonfinding in horses. Occasionally this can cause compression and irritation of the spinalnerves as they pass through the intervertebral foramen, which lies ventral to the articularprocesses. In humans this condition causes pain in the neck or arm, as well as weakness andnumbness/tingling/shooting pain in the arm or hand. In horses this condition can causeforelimb lameness, neck pain, shortened forelimb stride length, tripping, and non- specificsigns of pain or behavioural issues. Signs are often exacerbated by riding and influencedby head position. It is sometimes observed as a ‘hopping’ lameness. Diagnosis is based on presenting signs, CT imaging findings of foramen narrowing,negative diagnostic analgesia of forelimb lameness and positive response to nerve rootmedication.After extensive planning and practice, including training in Germany, the US and at theRoyal National Orthopaedic Hospital Stanmore, we are excited to bring foraminotomysurgery to the UK. We are grateful to Jan-Hein Swagemakers DVM and RIWO-Spine fortheir training and assistance.

WHAT IS FULL ENDOSCOPICFORAMINOTOMY?Liphook Equine Hospital, Forest Mere, Liphook, Hampshire, GU30 7JGTel: 01428 727200 I theleh.co.uk I post@theleh.co.uk4In lateral recumbency, a 2cm skin incision is made over the affected articular process underultrasound and x-ray guidance. A 12mm diameter cannula, which accommodates aspecialised uniportal endoscope, is positioned against the dorsal bony margin of the foramen.After soft tissue dissection, the bone causing stenosis is removed using a motorised burr. One site can be operated at a time, with a second surgery possible 2 weeks later if thecondition is bilateral. A 6-week rehabilitation program is prescribed after surgery, with returnto ridden work thereafter.Transverse CT image showing the intervertebralforamen before and after foraminotomy surgery(Swagemakers et al 2021)WHAT ARE THE OUTCOMES?Between 2021 and June 2024, around 250 foraminotomy surgeries have been performed,both in Germany and the US, with a success rate of 70-80%. There has been one fatality.Owners report return to performance along with general improved comfort and behaviour.Many horses are show jumpers and dressage horses, performing at all levels. Collaborativeresearch is ongoing, with active monitoring of post surgical cases.There is one peer-reviewed scientific publication about the use of this technique in horses todate: Swagemakers et al 2022 Vet. Surg. DOI: 10.1111/evj.13919Cadaver demonstration of the surgeryRachel Tucker BVetMed MVetMed CertAVP(ESO) DipECVS MRCVSRCVS and European Specialist in Equine Surgery