Laminectomy
1. Principles/General considerations
Fracture of the ventral arch of the atlas and disruption of the ligaments that secure the dens within the atlas, can lead to the formation of a bony callus that impinges on the vertebral canal and may eventually lead to ataxia.
2. Preparation and approach
This procedure is performed with the patient positioned in sternal recumbency through the dorsal midline approach to the cervical spine.
3. Laminectomy
After exposing the dorsal surfaces of the atlas, the unstable fragment or bony callus that impinges on the vertebral canal is carefully removed. The dorsal laminectomy can relieve spinal cord compression created by the fragment or fracture callus and may result in a long-term improvement in the neurologic status of the horse.
This procedure is performed very rarely; therefore it will not be covered in this reference.
4. Closure
One deep layer under the nuchal ligament, the nuchal ligament, and the subcutaneous tissue are closed in layers with simple continuous patterns. The skin is closed with staples. A stent bandage is applied and covered with an adhesive barrier drape to keep the incision clean and dry during recovery.
5. Aftercare
Following surgery, antibiotics and NSAIDs are routinely administered for 3 days. If indicated, they need to be continued.
Routinely follow up radiographs are taken immediately after surgery and after 2 and 4 months.
The rehabilitation protocol includes 2 months of stall confinement, followed by 1 month of hand-walking, and 2 months of progressive exercise.
Only when the ataxia has completely disappeared, the horse can return to training or other activities.
