bilateral hindlimb neurectomy and fasciotomy surgery

[Bayboys123]

Hello all, has anyone ever had this surgery for their horse? (bilateral hindlimb neurectomy and fasciotomy surgery) good and bad outcomes? What should i expect? Booked for next week and a friends experience was not ideal. Thank you all any comments appreciated.

 

[Wizpop]

Find out all you can about this. My horse is potentially due to have it, but due to my circumstances it has been delayed. I’ve done a lot of research and am now going to get back and hind feet X-rays done as these seem to often be underlying causes- as do Sacroiliac issues. My horse is very low mileage and quite young too so that makes me question how he has come to have PSD. Also, the N & F only means the horse doesn’t feel anything in that area and not that the problem is cured. Are you also aware that you can’t compete Affiliated after this surgery? - If my horse turns out to need the N&F though that is irrelevant. There is a PSD group on FB which can be helpful although there does seem a strong bias towards not going down the N&F route. Good luck whatever you decide to do. Would be interesting to know how you get on.

 

[sbloom]

I would endorse Wizpop, I didn't want to reply as you didn't ask for opinions but experience. I do have customers with horses with neurectomies, most of them regret it once they find out more about posture and underlying causes of these sorts of issues.

 

[AShetlandBitMeOnce]

Good luck with whatever you choose.
I seriously question how ethical this surgery is, but it seems so common now I must be in the minority.

 

[HelenBack]

I've no direct experience myself but have quite a few friends whose horses have had the surgery and most of them seem to have done okay. They mostly seem to have had other issues as well though, usually with their hocks and/or backs. One friend's horse had the op and she felt that it made no difference to her horse but I think he probably had other issues elsewhere too.

I also question how ethical it is though and it worries me that it seems to be the latest fad that so many horses seem to have offered to them. I seriously hope it's never found to be an issue with my horse because I dread to think what I would do if ever in that situation. It just seems to be given that you would go ahead with the surgery though so must be hard to say no I would imagine.

 

[AShetlandBitMeOnce]

I would say no if it was offered to my horse. Imagine you walk in a particular way and thus you have negatively affected all the tendons on the top of your foot and they are now incredibly painful, the surgeon rather than fix this just removes your ability to feel your foot, so not only are you now completely incapable of any self preservation regarding that foot but you also don't fix/improve the condition of your tendons, nor the way in which you walk that has caused this in the first place.

 

[nutjob]

My horse had bilateral hind leg PSD. I did discuss the surgery with the vet but he wasn't a candidate for N&F as his fetlocks had already dropped. He was only 6, had been in very light work and based on clinical symptoms was presumed to have ESPA / DSLD. If I had another young horse with a bilateral suspensory ligament problem I would at least investigate the possibility that they may have this devastating genetic condition before putting the horse through surgery. It's incurable and you are on a road to nowhere with other soft tissues being likely to be affected as the horse gets older.

 

[Starzaan]

Ok, I have rehabbed a fair few horses from this surgery, and I’m afraid I really disagree with it.
Generally these horses become yo-yos and just keep coming back to me for more rehab. Personally, I wouldn’t ever put a horse through it and really question why we are still doing it in this country.

 

[sbloom]

Ok, I have rehabbed a fair few horses from this surgery, and I’m afraid I really disagree with it.
Generally these horses become yo-yos and just keep coming back to me for more rehab. Personally, I wouldn’t ever put a horse through it and really question why we are still doing it in this country.

Yep, the root cause is never addressed, or we're pushing a permanent injury way beyond where the horse should be.

 

[Laafet]

Going against the grain - Nickel had this done at 8 years old, he went on another 10 years. No problems and I don't regret it at all. He was in so much pain before. He was very shut down. The operation turned him into a happy horse who competed to Medium, training AM, he jumped and hacked like a legend.
That said he was an ideal candidate and Andy Bathe did him. Go in prepared and the rehab is key. There's a good group on Facebook for help regardless of which route you take.

 

[ester]

I’ve been denerved, with no obvious benefits or problems either way so it’s been pretty benign all round.

I only know success stories of the ones I know about

 

[Bayboys123]

Find out all you can about this. My horse is potentially due to have it, but due to my circumstances it has been delayed. I’ve done a lot of research and am now going to get back and hind feet X-rays done as these seem to often be underlying causes- as do Sacroiliac issues. My horse is very low mileage and quite young too so that makes me question how he has come to have PSD. Also, the N & F only means the horse doesn’t feel anything in that area and not that the problem is cured. Are you also aware that you can’t compete Affiliated after this surgery? - If my horse turns out to need the N&F though that is irrelevant. There is a PSD group on FB which can be helpful although there does seem a strong bias towards not going down the N&F route. Good luck whatever you decide to do. Would be interesting to know how you get on.

Thank you for your reply! Yes i am aware i cannot compete affiliated. Fortunately for me thats not my goal. Its being done so i can do more than happy hack. Ive been told hes a good candidate as the nerve is what is causing the pain due to inflammation. I will keep all in the loop if i go ahead.

 

[greenbean10]

Going against the grain - Nickel had this done at 8 years old, he went on another 10 years. No problems and I don't regret it at all. He was in so much pain before. He was very shut down. The operation turned him into a happy horse who competed to Medium, training AM, he jumped and hacked like a legend.
That said he was an ideal candidate and Andy Bathe did him. Go in prepared and the rehab is key. There's a good group on Facebook for help regardless of which route you take.

Was hoping to see a positive story! My horse had it 18 months ago and all in all it’s been very positive. We have been jumping again, hacking, and she is so much happier in her work.

 

[Birker2020]

Was hoping to see a positive story! My horse had it 18 months ago and all in all it’s been very positive. We have been jumping again, hacking, and she is so much happier in her work.

Still waiting to hear back from my vet about cost of op and whether acdecision can be made on my horse or whether he is unsuitable. Also about further s.i and hock medication.

 

[Bayboys123]

Still waiting to hear back from my vet about cost of op and whether acdecision can be made on my horse or whether he is unsuitable. Also about further s.i and hock medication.

I know that the cost for me is around £2k -£2.5k and it depends on size of the horse due to the amount of drugs they use. The bigger the more expensive of course!

 

[Sprogladite01]

My boy had the surgery before I really knew about the whole "it's usually a secondary condition" thing - having been through it all, I would really now only do the surgery as an absolute last resort and AFTER hoof angles had been checked and hocks/SI/spine issues had been as completely ruled out as possible. Unfortunately my darling boy is being PTS in a few weeks time as it's been completely unsuccessful and he is worse than ever - not even field sound, which he was before the surgery. The whole thing is documented in this forum if you want to read it.

Hindsight is 20/20, and I wish I had known what I know now before I put my pony through the surgery.

 

[Wizpop]

My boy had the surgery before I really knew about the whole "it's usually a secondary condition" thing - having been through it all, I would really now only do the surgery as an absolute last resort and AFTER hoof angles had been checked and hocks/SI/spine issues had been as completely ruled out as possible. Unfortunately my darling boy is being PTS in a few weeks time as it's been completely unsuccessful and he is worse than ever - not even field sound, which he was before the surgery. The whole thing is documented in this forum if you want to read it.

Hindsight is 20/20, and I wish I had known what I know now before I put my pony through the surgery.

So very sorry to read this. We can only do the best based on what we know at the time. Sending hugs.

 

[AShetlandBitMeOnce]

My boy had the surgery before I really knew about the whole "it's usually a secondary condition" thing - having been through it all, I would really now only do the surgery as an absolute last resort and AFTER hoof angles had been checked and hocks/SI/spine issues had been as completely ruled out as possible. Unfortunately my darling boy is being PTS in a few weeks time as it's been completely unsuccessful and he is worse than ever - not even field sound, which he was before the surgery. The whole thing is documented in this forum if you want to read it.

Hindsight is 20/20, and I wish I had known what I know now before I put my pony through the surgery.

I have only just seen your post, I am also sorry that it has come out to this. I don't think there is a horse owner alive that doesn't regret something or have something play on their mind so try not to give yourself too much of a hard time, it's no crime to trust a professional's opinion. x

 

[Hormonal Filly]

My Welsh D had N&F surgery. He was only ever 1/10th lame behind, but my vet jumped straight for PSD rather than looking at anything else.

When he came back into work he didn’t feel massively different, only symptoms were lacking impulsion in canter and disliking walking downhill. New second opinion vet, found some issues in front feet (awful angles) and medicated SI. Rest of his body we xrayed showed no problems. Muscles enzymes were sky high so showed some kind of myopathy. New vet said he probably wouldn’t of recommended op before knowing the full picture.. but he did say it’s easy for him to say in hindsight.

2 years on hes sound and I sold him (declaring all issues) as a happy hacker, although does school and jump.

I believe lots of these horses are rushed in for N&F surgery for PSD but it seems a lot of the time it’s a secondary problem and there is a primary problem not yet found.

Hopefully it isn’t just money in the mind of big chain vets (same chain injected £350 gel into his stifles when X-rays showed they were clear and no real reason for doing so) my geldings op maxed out one claim of 5k with after visits and scans. That chain vet spent 10k in total and felt like I was no where better off, the second opinion vet was a small independent vet and we only spent £1500.

I don’t think I’d of operated if I knew what I did now.. I don’t think the suspensory was causing the symptoms we had (like @Sprogladite01 ‘s gelding!) yet we put so much trust into our vets. ?

 

[Hormonal Filly]

To add, he was even more lame for a few months after the op as he developed a awful infection in the incision in the right hind (the good leg!) which developed so much scar tissue he was always slightly more stiff on that leg afterwards and had a huge scar/lump ?

 

[Goldenstar]

I would never have this surgery done .PSD is a horrible thing and my experience is there’s a huge disconnect between the success rates the vets quote and the actual experience of people I know who have been down this route .

 

[Birker2020]

Follow on from reply 14

My vet felt that the horse wasn't an ideal candidate because he already slightly overloads his fetlocks when moving on the lunge and because he had multi faceted issues surrounding his KS and SI he didn't feel it would benefit him, having had his KS medicated twice in four months with no real improvement when ridden this alone speaks for itself.

Sadly I'm now looking at him going the blood bank in the spring or keep at present yard if I can find something else to ride. If not he will be pts. I will never pass him on as a riding horse.

OP I do know of a few other horses that have had the operation but I don't know long term how most have got on, I know one that went back to competing without an issue.

 

[ycbm]

I would never have this surgery done .PSD is a horrible thing and my experience is there’s a huge disconnect between the success rates the vets quote and the actual experience of people I know who have been down this route .

Ditto, it's on my "that's never going to happen" list.

 

[Hormonal Filly]

Ditto, it's on my "that's never going to happen" list.

Wish I had that list before agreeing to it. Learn from your mistakes I guess. My second opinion vet (small independent) believes it’s mostly a money spinner by the big chains. ?

 

[Slightlyconfused]

Ditto, it's on my "that's never going to happen" list.

This and colic surgery top my list

 

[Wizpop]

The more I read, the more I’m doubting my initial decision to have the surgery- he hasn’t yet had it.
im currently waiting to speak to my vet asIve been digging into horse’s history and one issue stands out as a glaring possible cause which I want investigating before I go and further. I might have to make a very difficult decision.

 

[Bellaboo18]

The psd discussion group on Facebook is worth a visit for anyone trying to decide what to do.

 

[Goldenstar]

I have been exactly where you are , and I put the horse down .
You just have to meet this head on there’s no nice way of dealing with it .

 

[Birker2020]

The more I read, the more I’m doubting my initial decision to have the surgery- he hasn’t yet had it.
im currently waiting to speak to my vet asIve been digging into horse’s history and one issue stands out as a glaring possible cause which I want investigating before I go and further. I might have to make a very difficult decision.

This was quite interesting reading:

https://thehorse.com/156597/which-psd-horses-are-good-hind-limb-neurectomy-candidates/#:~:text=Traditional treatment approaches generally involve,and fasciotomy (ligament splitting).

• First and foremost: Ensure an accurate diagnosis. “If you do not have a correct diagnosis, this surgery will not help the horse and, therefore, should not be recommended,” Watts stressed. She reviewed with practitioners how to use history, clinical signs, response to diagnostic analgesia (nerve blocks), and diagnostic imaging to definitively diagnose PSD.
• Be sure the suspensory injury is chronic, not acute. Performing surgery on acute cases leaves horses at risk for developing very severe, chronic PSD afterward. Watts said researchers think this is because denerving the acutely injured suspensory ligament can cause the horse to be comfortable enough to load it more than he would if not nerved, leading to the lesion expanding.
• Do not send horses with hyperextended hind-limb and hock conformation to surgery. “This conformation is known to significantly increase the risk of catastrophic failure of the suspensory apparatus following fasciotomy and neurectomy,” Watts said. “If this complication were to occur, the horse may require fetlock arthrodesis (fusing) … to survive long-term.”

 

[RHM]

My vet when explaining the surgery said he only recommends it when it’s a competition horse that someone wants a couple more seasons out of. He said because my pony was a family member he wouldn’t do it. The rational being if they are de-nerved you will get to the field one day and there will have been a complete breakdown of the ligament which will lead to an emergency PTS situation.

I do know someone who has done it on her gelding and she did successfully compete him for some time afterwards. But, his fetlocks have quite severely dropped now. (About 5 years later)