Clinical outcome and Follow-up
As the horse was getting very restless in the box and when walked by hand, it started to be turned out in a small grass paddock (15x15m) at two months post-surgery. The horse did not show any signs of lameness or ataxia and the cervical range of motion did not appear to be decreased. The horse was turned out several hours per day for one more month and then started additionally being worked on long-reins in walk and trot for another two months. The owner reported mild stiffness on the right lead that improved gradually with exercise. Check-up radiographs taken five months after surgery showed complete healing of the fracture(Figure 5) . The horse resumed canter work after the five-month check-up. As the owners gradually increased the canter work, they noticed a respiratory noise at exercise. The horse was diagnosed with a right-sided laryngeal hemiplegia grade 3. The horse was turned out every day in a grass field with another horse and continued light exercise until upper airway surgery was performed seven months following axis fracture repair. A bilateral transendoscopic laser ventriculocordectomy and a right-sided laryngeal reinnervation using the spinal accessory nerve were performed. Following the mandatory six-week rehabilitation time after upper airway surgery, training was resumed. At ten months post-surgery, the horse is back to normal flatwork and gradually increasing the level of the jumping training.