Arthroscopic approach and intra-articular anatomy of the equine atlanto-occipital joint.
Authors: Wright Linda, Puchalski Sarah M, Kristoffersen Mads, Lindegaard Casper
Journal: Veterinary surgery : VS
Summary
# Arthroscopic Access to the Atlanto-Occipital Joint: Establishing Safe Surgical Approaches The atlanto-occipital joint presents a significant surgical challenge due to its anatomical complexity and proximity to the spinal canal and meninges, making it poorly accessible via conventional arthroscopic techniques and difficult to treat when affected by septic arthritis or other pathologies. Wright and colleagues developed and validated both dorsal and ventral arthroscopic approaches in ten equine cadaveric specimens and one clinical case of neonatal septic arthritis, using CT arthrography to guide portal placement and ultrasonography to prevent inadvertent penetration of critical neural structures. Whilst dorsal arthroscopy successfully visualised approximately 50% of the occipital condyle and 15% of the atlas articular surface, blind dorsal portal placement resulted in dura perforation in 40% of attempts; ultrasound-guided approaches eliminated this complication entirely. The authors successfully debrided infected joint tissue and osteomyelitis in their clinical case, establishing proof of concept for therapeutic arthroscopy of this notoriously difficult joint. For practitioners managing horses with atlanto-occipital pathology, these findings underscore the critical importance of advanced imaging for both diagnosis and surgical planning, and demonstrate that ultrasonography-guided arthroscopic access can enable effective treatment of conditions previously considered surgically inaccessible without unacceptable neurological risk.
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Practical Takeaways
- •Ultrasound guidance is critical when performing arthroscopy of the atlanto-occipital joint to avoid catastrophic dural perforation and spinal cord damage
- •The dorsal arthroscopic approach provides limited but useful access to the cranial joint surfaces and may be considered for septic arthritis in young foals
- •Advanced imaging (CT and ultrasound) should guide surgical planning for A-O joint procedures to improve safety and surgical outcome
Key Findings
- •Dorsal arthroscopic approach provided access to 50% of dorsocranial occipital condyle and 15% of dorsocranial atlas articular surfaces
- •Blind dorsal approach resulted in dura perforation in 2 of 5 cadaver joints; ultrasonography-guided approaches prevented all dural perforations
- •Arthroscopic debridement successfully treated septic arthritis and osteomyelitis in a clinical case of a 2-week-old foal
- •CT imaging identified dorsal and ventral A-O joint outpouchings that improved surgical planning and safety