Veterinarians successfully repair a rare C6 fracture using advanced imaging and computer-assisted navigation.Dr. Christoph Koch performed surgery to repair the neck fracture itself. | Courtesy Dr. Christoph KochOn a lightly drizzly January morning Emilie Martorell could barely make out the distant snowy peaks of the Swiss Alps through the winter haze. Not that it mattered; she knew her horses would still enjoy their daily turnout, even on a wet morning, after a night tucked into their warm barn.And they did. Like every morning, Martorells horses frolicked in their individual paddocks, throwing a few kicks and bucks as they galloped about in their winter sacrifice spaces.That morning, though, DavidOr took a bad leap. Just a few feet in front of Martorell, the 17.3-hand bay Warmblood bounded high into the air and came down on his forelimbs with full forceright onto a patch of thin mud. He slipped sideways and came crashing down on his left side, smashing his head and neck into the most horrific of positions.Martorellin complete shocksaw the whole scene unfold. Even worse, she heard it.There was a crack, she says. Suddenly, all the worst scenarios were running through my head at that moment. I dont know if I screamed but in my head I did. It was awful.DavidOror, more affectionately, Doudou (literally Soft-Soft, a typical French nickname for plush animal toys)had been Martorells heart horse his entire life. Shed fallen in love with him as a weanling and snatched him up, bonding with him and building an athletic career based on show jumping, eventing, andmost recentlyfull-time dressage.But now, her Soft-Soft lay groaning in the light clay mud, unable to even try to get up. Martorell remained at his side.But then I told myself, No, you have to pull yourself together! she recalls. You have to get a grip and call the vet. Youve got to get help. After that, I didnt really have time to panic or cry.DavidOr finally managed to stand after about 15 minutes prostrate, just before the treating veterinarian arrived. The vet found no fractures in the back or pelvis but recommended immediate assessment of the neck and chest at a referral clinic. Martorell promptly loaded the gelding into the trailer and headed for the Equine Clinic at the Vetsuisse Faculty of the University of Bern.Initial Diagnosis and Treatment ApproachesThere, through heavy clouding caused by all the inflammation, vets could make out hints of a fracture in the bones of the neck on X ray. But the prognosis was unclearespecially since some of these fractures heal well on their own, says Christoph Koch, DrMedVet, Dipl. ACVS, ECVS, a senior clinician and surgeon at the Equine Clinic Bern. After three days DavidOr was less ataxic (incoordinated) and moving his head and neck better, so the team sent him home on stall/paddock rest, with plans for follow-up evaluations five weeks later.During that recovery time DavidOr moved around normally and seemed mostly fine except for restricted range of motion in the neck. I thought, if hes doing that, he cant be in pain; he must feel good, Martorell says.Unfortunately, though, that wasnt the case. His follow-up exam revealed ongoing neck pain and limited range of motion. Imaging now showed a clearly defined fracture in the cranial articular process of the sixth cervical vertebra (C6, the second-to-last bone in the lower neck). The vets suggested either monthslong stall rest or a standard surgical approachfusing two vertebrae together. Fusion helps prevent the formation of bone callus as the fracture heals, which can impinge on the spinal cord and cause neurologic problems such as lifelong ataxia, Koch says.Martorell didnt want to pursue either of those options. Koch explains that fusion comes with the risk of incidental damage to the vertebrae and surrounding tissues, causing disease processeswhich can be debilitating or even fatalin the horses bone, larynx, trachea, esophagus, or spinal cord. Its not a procedure without risk by any means, he says.As for months of stall rest, that was inconceivable, Martorell says. This is a very energetic horse who needs a lot of movement. Even one week on stall rest was very complicated, and he had to be on sedatives. So, keeping him locked up in a box for three months, I couldnt imagine him living like that. Thats not a life.Fortunately, her surgeon told her he had a third option in mind: repairing the fracture itself. While that might seem obvious, the reality is fixing a vertebral process fracture in a horses neck comes with such high risks that veterinarians generally decline. Thats because the repair involves placing screws into thin, fragile bone structuressurrounded by numerous tiny but critical blood vessels and nerveswith meticulous precision. That leaves really little room for error, Koch says.Computer-assisted surgery combines CT scans with camera tracking systems. | Courtesy Dr. Christoph KochStill, he says he was confident this would be possible with computer-assisted surgery. After all, human patients were already getting their spinal fractures repaired thanks to this technology.Computer-Assisted Equine Surgery as an OptionThe computer-assisted surgery system veterinarians use at the Equine Clinic Bern combines intraoperative cone-beam computed tomography (CT) scans with camera tracking systems. Together they provide 3D imaging, virtual models, detailed surgical planning, and real-time orientation for controlled hole-drilling and highly refined screw placement, even in the most delicate areas, says Koch.The cone beam offers rapid imaging and reduced radiation for the patient compared to helical CTs, he adds. Clinicians and staff leave the room during image acquisition and are not exposed to radiation.Kochs team has used computer-assisted surgery on a routine basis for many years and for nearly all procedures requiring intraoperative image guidance. Theyd performed more than 180 computer-assisted surgeries on live horses, countless practice experimental surgeries on cadaveric specimens, and more than 30 on food animalsalthough, up to this point, never on cervical vertebrae, he says.Basically, it allows us to be very confident whenever it comes to intraoperative image guidance, Koch explains. It gives us all the information we needand that we can get from a CT scan during the operation, if things change. So, its a great system.Still, before offering the option to the owner of his newest patient, Koch reached out to a group of surgeons at Colorado State University, in Fort Collins, headed by Jeremiah Easley, DVM, Dipl. ACVS, and Brad Nelson, DVM, Dipl. ACVS, for advice. Their team has both the same computer-assisted surgery equipment and considerable knowledge about equine spinal surgery.They reminded me of the complications and risks associated with that procedure, Koch says. But then they said, On the other hand, if youre confident that you can do a good job of it, because you have this navigation system, we think its something you could propose to the owner. And thats exactly what we did.For Martorell, accepting the experimental surgery carried significant uncertainty. It wasnt really a question of confidence, she says. For me, I didnt really have a choice. I told myself it was basically the only solution to save my horse.Eight weeks after his accident, DavidOr underwent surgery in Bern. Imaging showed a 3-millimeter-wide fracture and a small triangular bone fragment. In an operation lasting more than three hours, Koch and his colleagues followed their computers guidance for the successful placement of two screws.Surgery involved placing screws into thin bone surrounded by numerous blood vessels and nerves. | Courtesy Dr. Christoph KochSurgical Recovery and RehabWhile the operation went well, DavidOr struggled with the lengthy anesthesia, and it took him an hour and a half in recovery to stand. He needed respiratory assistance for more than an hour after the surgery and appeared to have some brain swelling, which eventually resolved without complications.Swelling at the surgical site, meanwhile, led to temporary ataxia. Overall, the complications resulted in a tense wait-and-see period for veterinarians and the owner. It was extremely stressful, because even though one part had gone well, there was a whole other series of problems afterward, Martorell says.Two months later, results remained questionable. Despite no more ataxia, DavidOr was experiencing ongoing reduced range of motion and shoulder muscle atrophy. The atrophy likely resulted from suprascapular nerve compression associated with surgical limb positioning.The good news, though, as Koch reminded everyone, was the screws were in place without any signs of callous formation. Because of that Martorell got the green light to start longeing the gelding lightly.By four months post-procedure, the atrophy had improved and range of motion had returned. From that point, Martorell says, she slowly started riding againhacking him out at first, once the ataxia was gone.And things only went uphill from there. Today, DavidOr and Martorell are back at the same competitive dressage level as before the accident. Hes regained full mobility of the neck in both directions. At this point he has absolutely no aftereffects; he can do everything like before, Martorell says.As for the muscle atrophy, she reports just a tiny superficial leftover spot. If I dont point it out, people dont even notice it, she says.A year following the surgery Martorell and DavidOr were back in the show arena. | Courtesy Emilie MartorellWhat This Outcome Could Mean for Future SurgeriesDavidOr represents a success story Koch attributes to refined human-machine collaboration. Youve got the tracking equipment, which is great, but you still have people drilling the holes, he explains. Its a whole separate skill set, where you have to kind of work like in a computer game on a screen. Youve got to concentrate and know your aim, and focus on whats going on with the incision.Would he have even attempted the fracture repair without this system?Kochs answer is clear. No way, he says. Far too risky. Martorell admits she finds the results with DavidOr nothing short of miraculous. They saved his life, she says. Without those people who truly did everything for this horse, he wouldnt be here today. I cant thank them enough.This article is from the Spring 2026 issue ofThe Horse: Your Guide to Equine Health Care. We at The Horse work to provide you with the latest and most reliable news and information on equine health, care, management, and welfare through our magazine and TheHorse.com. Your subscription helps The Horse continue to offer this vital resource to horse owners of all breeds, disciplines, and experience levels. To access current issues included in your subscription, please sign in to theAppleorGoogleapps ORclick herefor the desktop version.