Internal fixation of a fractured cranial articular process of the sixth cervical vertebra by means of computer-assisted surgery in a Warmblood gelding.
Authors: Käfer-Karrer Melanie J, de Preux Mathieu, Van der Vekens Elke, Mattei Larissa I, Kuhlmann Jovana, Klopfenstein Bregger Micaël D, Easley Jeremiah T, Koch Christoph
Journal: Veterinary surgery : VS
Summary
# Editorial Summary A 12-year-old Warmblood gelding presenting with neck pain and ataxia following a fall was found to have a fractured right cranial articular process of C6—a challenging injury that typically requires intervertebral body fusion to prevent excessive callus formation and potential neurological compression. Rather than pursuing conventional fusion techniques, the surgical team employed computer-assisted navigation to place two 4.5 mm cortex screws in lag fashion across the fracture site, allowing precise screw positioning that would be difficult to achieve through conventional open techniques alone. The fracture achieved robust healing with minimal callus formation on radiographic follow-up; whilst the horse experienced transient postoperative complications including ataxia, left triceps myopathy, and focal right supraspinatus atrophy, these resolved within the recovery period, and the gelding returned to ridden work within one year. This case demonstrates that computer-assisted lag screw fixation offers a viable alternative to fusion for C6 articular process fractures, potentially reducing the risk of troublesome callus formation that can compromise the cervical spinal canal. For equine surgeons managing similar injuries, this approach may be worth considering where appropriate imaging and navigation systems are available, particularly as it preserves normal spinal biomechanics and appears to facilitate functional recovery.
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Practical Takeaways
- •Computer-assisted surgery may offer a viable alternative to traditional intervertebral fusion for cranial articular process fractures, with potential for better functional outcomes and return to work.
- •Even with postoperative complications (ataxia, myopathy), careful management can result in resolution and return to ridden exercise within 1 year.
- •Minimizing callus formation through accurate internal fixation is critical to prevent secondary spinal cord compression in cervical fractures.
Key Findings
- •Computer-assisted surgery successfully enabled lag screw fixation of a fractured cranial articular process of C6 with minimal callus formation and bone healing confirmed at 1 year.
- •Transient postoperative ataxia and left triceps myopathy resolved, with only focal right supraspinatus muscle atrophy persisting.
- •The gelding returned to ridden exercise and performed well 1 year post-surgery.
- •Computer-assisted surgery represents a potential alternative to intervertebral body fusion for this fracture type by reducing excessive callus formation that could cause spinal cord compression.