Cervical vertebral canal endoscopy in a horse with cervical vertebral stenotic myelopathy.
Authors: Prange T, Carr E A, Stick J A, Garcia-Pereira F L, Patterson J S, Derksen F J
Journal: Equine veterinary journal
Summary
# Cervical Vertebral Stenotic Myelopathy: Why Direct Visualisation Matters A 3-year-old Thoroughbred gelding presenting with seven months of progressive hindlimb ataxia and paresis underwent comprehensive cervical imaging to identify the source of myelopathic signs, despite cervical radiographs and myelography suggesting compression at C5–C6 with 90% reduction of the dorsal contrast column. Using direct endoscopic visualisation—both epiduroscopy (epidural space) and myeloscopy (subarachnoid space)—under general anaesthesia, the research team identified the true site of pathology at C6–C7, where substantial subarachnoid narrowing was evident, whilst the C5–C6 region appeared uncompressed on direct inspection. Post-mortem histopathology confirmed severe myelin and axon degeneration with Wallerian degeneration spanning multiple spinal cord segments at C6–C7, validating the endoscopic findings and revealing that conventional myelography had been misleading. This case demonstrates that cervical vertebral canal endoscopy—particularly myeloscopy—can provide superior anatomical localisation compared to contrast radiography alone, allowing direct visualisation of the spinal cord and subarachnoid space to identify the precise site of compression. For practitioners managing horses with cervical myelopathy, this work highlights that endoscopic techniques may be essential diagnostic adjuncts when conventional imaging findings are inconsistent with clinical signs or fail to explain the neurological presentation.
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Practical Takeaways
- •Myeloscopy should be considered when cervical myelography results do not correlate with clinical signs and imaging findings in suspected cervical vertebral stenotic myelopathy cases.
- •Relying solely on myelography for localizing cervical spinal cord compression may lead to incorrect diagnosis; direct endoscopic visualization can provide more accurate anatomical information.
- •In horses with progressive neurological deficits and equivocal imaging, cervical vertebral canal endoscopy offers a valuable diagnostic tool to guide treatment decisions before irreversible spinal cord damage occurs.
Key Findings
- •Cervical vertebral canal endoscopy (myeloscopy) successfully identified the true site of spinal cord compression at C6-C7, while cervical myelography was misleading and indicated compression at C5-C6.
- •Histopathological examination confirmed severe myelin and axon degeneration with Wallerian degeneration at C6-C7, supporting myeloscopy findings over myelography results.
- •Myeloscopy detected substantial subarachnoid space narrowing at C6-C7 while epiduroscopy showed no abnormalities, demonstrating the diagnostic superiority of direct visualization techniques.