Endoscopic anatomy of the cervical vertebral canal in the horse: a cadaver study.
Authors: Prange T, Derksen F J, Stick J A, Garcia-Pereira F L
Journal: Equine veterinary journal
Summary
# Editorial Summary: Endoscopic Anatomy of the Cervical Vertebral Canal in the Horse Cervical vertebral stenotic myelopathy (CVSM) remains notoriously difficult to localise precisely in affected horses, limiting diagnostic accuracy and treatment planning. Prange and colleagues conducted a cadaveric study on 25 mature horses to establish a surgical approach to the cervical vertebral canal and characterise the endoscopic anatomy visible via epiduroscopy (examination of the epidural space) and myeloscopy (examination of the subarachnoid space). Two minimally invasive techniques proved unreliable and frequently caused iatrogenic damage to neural tissues, whereas an open approach via the atlanto-occipital space allowed successful endoscope advancement through the entire cervical canal to the C7–T1 intervertebral space in all specimens without complications. The endoscopic views revealed critical anatomical landmarks: the epidural space contained the dura mater, nerve roots, epidural fat and the ventral internal vertebral venous plexus, whilst the subarachnoid space afforded visualisation of the spinal cord itself, nerve roots, blood vessels, denticulate ligaments and the accessory nerve's external branch. For equine practitioners, this work provides a proof-of-concept for a diagnostic technique that could substantially improve localisation of compressive lesions in CVSM cases and potentially aid diagnosis of other cervical spinal cord pathologies, though the open surgical requirement means this would remain a specialist referral procedure rather than a routine clinical tool.
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Practical Takeaways
- •Cervical vertebral canal endoscopy via open atlanto-occipital approach is a feasible diagnostic technique that could help precisely localize spinal cord compression sites in horses with cervical vertebral stenotic myelopathy, improving diagnostic accuracy beyond current imaging methods
- •Minimally invasive endoscopic approaches to the cervical canal are not recommended due to unreliable access and risk of iatrogenic neurological injury; the open technique is safer and more reliable
- •This technique has potential clinical applications beyond cervical stenotic myelopathy for visualizing other cervical spinal cord pathology, though further clinical validation studies are needed
Key Findings
- •Open surgical approach via atlanto-occipital space allowed successful endoscopic access to cervical epidural and subarachnoid spaces in all 25 horses with no iatrogenic nervous tissue damage
- •Minimally invasive techniques failed to reliably access the cervical vertebral canal and frequently caused damage to nervous tissues
- •Epiduroscopy and myeloscopy visualized distinct anatomical structures including dura mater, nerve roots, spinal cord, denticulate ligaments, and the ventral internal vertebral venous plexus