Suspensory ligament neurectomy, experiences, recovery etc (hinds)

horseywelsh

horseywelsh

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I would like to hear peoples experiences, recovery stories etc who have had a horse undergo hind suspensory ligament surgery. Something close to my heart with my own horse at the minute. Any experiences shared would be appreciated (PM if prefer). Thanks in advance.
 
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It was the best thing we ever did for my sister's little ginger boy.

We tried time off for a year and still no improvement so we went down the route of surgery, which we kept putting off as he is a nightmare patient with anything small, so we couldn't bare to think of what he would be like on box rest and walking out in hand. He also stresses out at the smallest thing.

Anyway, after the inital toys-out-the-pram paddy about staying in, having bandages on (he constantly bit them) and three weeks of walking out in hand, you could already see the improvemet.

He was just happier in himself and when we started ridden work again (after the exuberance had disappeared!) you could tell that he must have been in pain for quite a while before his diagnosis as all his work inproved 10 fold.

He is now back to competing (and winning) at BE100 and will hopefully make the step up to Novice next year as long as he remains comfortable and sound.

He is checked by the vet every three months. Each time they see him they are amazed at his recovery and tell us to keep going with him like normal but just avoid lunging and lots of schooling. He mainly hacks, only jumps once every fortnight and schools twice a week.

It is a dream come true to have him back to his best again.
 
Hello, I feel that I should give my negative view, because I couldn't find much about the negatives when I ws reasearching it and I'd have liked to have been a bit more prepared for the downsides.

My boy initially presented with a severe SI injury, medicated twice and was slowly coming back in to work after that, but to me never seemed right. Got the vet out again and after numerous trips to horspital and more scans than you could shake a stick at, he was finally diagnosed with bilateral PSD. Fasciotomy and neurectomy were recommended, and I agreed, having done a bit of research. The surgery went very smoothly although the recovery from the GA wasn't as smooth, but eventually he did come round and managed to stay upright. After surgery for the next few days he kept lying down, which was upsetting his bandages, then he got pressure sores from the bandages which meant we had to do different sorts of bandages, then the surgery wounds broke down (I have pics if you want :eek: ) and he had to be cross-tied for 5 weeks to stop him lying down, although he did still lie down, hanging from the tie ropes! The bandages had to be changed every couple of days by the vets, at between £200 and £300 per time, meaning the insurance money soon ran out. He also got a sort of shipping fever from being on cross ties and had to have a strong course of Baytril.

Eventually allowed out into a paddock the size of 2 stables, that we moved around a larger field so he didn't run out of grass (much electric fence-moving thanks to my patient OH). That programme carried on for a couple of months and in hand work commenced then, 4 weeks of walking in hand. It was obvious he was still lame, but the horspital said to keep going with the work and see what happens (scans looked good, they thought it was referred back pain making him lame). Gradually brought him back into ridden work and did so much rehab/physio work - to the exact letter of all my instructions. Got him so fit and so strong in his back, he virtually changed shape. To everyone's relief, he was finally declared sound in February 10 (surgery was April 09). Started schooling and doing proper work, normal hacking etc and entered a couple of dressage comps - did really well! Then he went lame again on one of his hinds, so vet came out to scan behind, fearing that the nerve may have regrown.

What we found was much worse. The ligaments had torn themselves apart and there was very little ligament left, particularly in the "sounder" hind leg. It was felt kindest to call it a day.

Everyone tried their best for him but it wasn't enough. The vets fees soon exceeded the £5k limit (part of that was due to the time it took to get the right diagnosis). I spent a further £5,000 or so on vets, physio, medication, bandages, scans etc. I was lucky to have the savings to spend, but I appreciate that not everyone is able to spend that sort of money.

I sincerely hope that whatever the situation that you're in, that you can make an informed decision. I have since read about a chap who fixes PSD without surgery, and I would suggest exploring that option before going down the surgery route. Whatever - GOOD LUCK!
 
Ali16 said:
It was the best thing we ever did for my sister's little ginger boy.

We tried time off for a year and still no improvement so we went down the route of surgery, which we kept putting off as he is a nightmare patient with anything small, so we couldn't bare to think of what he would be like on box rest and walking out in hand. He also stresses out at the smallest thing.

Anyway, after the inital toys-out-the-pram paddy about staying in, having bandages on (he constantly bit them) and three weeks of walking out in hand, you could already see the improvemet.

He was just happier in himself and when we started ridden work again (after the exuberance had disappeared!) you could tell that he must have been in pain for quite a while before his diagnosis as all his work inproved 10 fold.

He is now back to competing (and winning) at BE100 and will hopefully make the step up to Novice next year as long as he remains comfortable and sound.

He is checked by the vet every three months. Each time they see him they are amazed at his recovery and tell us to keep going with him like normal but just avoid lunging and lots of schooling. He mainly hacks, only jumps once every fortnight and schools twice a week.

It is a dream come true to have him back to his best again.
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Against the rules to run a horse that has had a neurectomy at BE so I would keep quiet about it if I was you
 
It is against the rules BE - hasn't stopped more than one team horse having it done. Ask the team trainers etc and they deny all knowledge, which strikes me as highly unlikely.
 
It is certainly not a normal de-nerving as only a tiny branch of the nerve is cut-
PSD neurectomy is100% legal under FEI eventing rules , its the commonest operation there is out there and many a Brit team horse has had it done!
 
I had this done on my mare November 2010. Everything went very smoothly, and after her 3 month follow up scan, her ligaments were declared almost completely normal. I will say that initially she had no significant lesions on the ligaments at all, the diagnosis and subsequent surgery were done because of enlargement of the ligaments, not sure if that would make a difference to surgery outcome or not.

She did not appear lame throughout the entire pre and post-op period at all and came back into work very well. She now has a good overtrack in walk where she had none at all previously and is very comfortable behind. I do feel it took her about 6 months to get used to her new legs though as she had a slightly unusual for her gait behind for quite sometime.

All in all I would definitely do this surgery again. It is also my understanding that it is legal to compete following this surgery and that it is front limb neurectomy that is not allowed. I am happy to be corrected on this though if someone has the rulings to hand! It isn't going to effect me for a while as my mare damaged a nerve in her shoulder so is now in-foal for a year to give that time to heal!
 
Thankyou for all your replies.

Ali16 great to hear such a positive response.

BeckyD sorry to hear of your experiences, can understand if you don't want to go into any more details but I was just wondering what you ment by an initial severe SI, were your boys thickened or did he have a tear etc?

Kira another great to hear experience, my vet did say they are better to operate on/outcome when they are thicker/more enlarged. Interesteing to hear about the improved walk too.
 
The BE Rule (3.42 i in the 2012 rule book which is online now) says:

All horses must be sound and free from infection or contagious disease. A horse is not eligible to compete when:
a) it has an open tracheotomy (tubed);
b) any of its limbs or parts of a limb have been de-sensitised by whatever means whether temporarily or permanently.

The way that reads suggests that even the PSD neuroectomy makes a horse ineligible to compete under BE rules. However as seabiscuit2 says there is more than one team horse that has had it done. Mostly they have some time off for 'corns' or a 'virus'!

I thought the BE rule was in line with FEI but perhaps not if it is FEI legal to comepte a horse that's had the PSD op?
 
SpottedCat said:
It is against the rules BE - hasn't stopped more than one team horse having it done. Ask the team trainers etc and they deny all knowledge, which strikes me as highly unlikely.
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A recent Burghley winner had a neurectomy in the front feet.Might have accounted for its in and out SJ rounds in major events.
It just goes to show the hypocrisy at BE as there is no way the team trainers and vets dont know.
 
SpottedCat said:
I thought the BE rule was in line with FEI but perhaps not if it is FEI legal to comepte a horse that's had the PSD op?
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I am sure it has not been changed ,I believe Dressage and SJ allows it though.Racing certainly does not allow it as shown by Howard Johnsons recent 8yr ban.
 
The actual ruling from the FEI.From the Veterinary conduct of events covering all disciplines.

2.6.4 Horses may not compete with a tracheotomy (i.e. a surgical opening through the
skin into the trachea) or after a neurectomy has been carried out for so long as the
absence of sensitivity persists.

So if strictly adhered to no neurectomy of any type is allowed .As they are carrying out more sensitivity test on horses you are more likely to get caught.
 
popsdosh said:
The actual ruling from the FEI.From the Veterinary conduct of events covering all disciplines.

2.6.4 Horses may not compete with a tracheotomy (i.e. a surgical opening through the
skin into the trachea) or after a neurectomy has been carried out for so long as the
absence of sensitivity persists.

So if strictly adhered to no neurectomy of any type is allowed .As they are carrying out more sensitivity test on horses you are more likely to get caught.
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Well in the case hind limb neurectomy unless you are a mind reader a sensitivity test won't show it from what I was told by the vets that did mine. My horse had it done just over a month ago and is going back in tomorrow to see if it has worked. He was not really lame as such, just moved wrong behind sometimes in the school varying from not quite right to full blown 'broken leg' lame for a stride. He passed flexion tests and was always sound on the hard. He was not reactive to pinching of pressure points or such like. I could also ride him on in a way to make him look sound. I really hope the op works for him, I was very anti neurectomies until I was faced with it and my vet was very good at explaining it.

I had also heard that more horses competing at top level had had the op than you would be led to imagine, I have to say since I have not been surprised given who's lorry I have seen up at the hospital, Newmarket is a long way from Hampshire/Wiltshire.
 
A top event rider who has won 4* said when trying horses that if the horse has had a hl neurectomy then thats great as it will save themselves from having to do it in the future.... also said team gb horses have had it done.... think its a pretty routine procedure especially according to my vet who treats many high profile horses.
 
It's completely routine and lots of top level horses have had it done. It doesn't make it any less against the rules and if you ask team trainers etc they will tell you they don't know of any. There was a question on the BE forum about it a while back where BE said it is against the rules and they don't know of any team horses that have had it done. One rule for the pros, another for the average amateur in this case!
 
Many top event horses have had it done
Common place at four star level according to my
vet. You would be hard pushed to prove it as if successfully there is nothing to see.
I think you will find most vets and ground jury turn a blind eye to it.
 
It is definitely 100% illegal to compete a horse BE that has had a Suspensory neurectomy!

The problem is, that it is almost impossible to detect, apart from possible slight scarring to the area however not all horses show this.

It is however allowed under BD and BS rules.
 
horseywelsh said:
Thankyou for all your replies.

Ali16 great to hear such a positive response.

BeckyD sorry to hear of your experiences, can understand if you don't want to go into any more details but I was just wondering what you ment by an initial severe SI, were your boys thickened or did he have a tear etc?

Kira another great to hear experience, my vet did say they are better to operate on/outcome when they are thicker/more enlarged. Interesteing to hear about the improved walk too.
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I'm happy to talk about it as it's better to be aware of worst case scenario than not be. Ronnie's initial problem was an acute, severe sacroiliac injury caused by doing forward rolls down the slight decline in his paddock. That happened October 08, was initially thought to be fractured pelvis so went off to Cambridge for whole body (I think) scintigraphy but that showed sacroiliac hotspot only. Medicated twice whilst on total box rest, then started walking exercise for about 2 months. It was when we started trot that I realised he still wasn't right.

When finally narrowed down to PSD by nerve blocks, scans of the ligaments showed only hypoechoic areas. I hope I've got that right! Anyway in layman terms, no tears or lesions, just thickening. Hence the shock at the last scan when there were more holes than there seemed ligament itself.

I know we were spectacularly unlucky, but I still get very upset about it, wishing I hadn't gone for the operation route. I am sure he'd still be with us now.

I'm shocked at how common the surgery sounds! I was warned that galloping him would be risky after surgery and that Eventing was unlikely. Was also banned from doing small circles ever again!
 
unfortunately, my experience with PSD and neurectomies is very similar to BeckyDs

both my current horse and horse before that have done/did their suspensory ligaments. both of them had shockwave and both had surgery. D, my previous horse, had a particularly degenerative condition. He briefly came sound after shockwave but as soon as we introduced trot work he went lame again. upon rescanning, the ligaments hadn't healed at all and were infact worse than when originally scanned. i went ahead with the op, he had about 4 weeks box rest/walking in hand and then i had to turn out as he was going loopy. he had two months out in the field doing nothing before starting slow build up work. all seemed good - he was sound and happy (though not schooling to the same level as pre-injury [he'd been working towards advanced medium]), but about 6 months post-op he went lame again. upon rescanning, my vet was completely shocked and said he had never seen a ligament so close to rupturing that hadn't actually ruptured and he was sure that the slightly wrong hoolie in the field and it would go. i made the absolutely heartbreaking decision to have him put down.

after d, i swore i wouldnt put another horse through the denerving - until nico also did his (less then 3 months after i bought him). but the distinct difference this time is that the ligament had healed after the shockwave, but the vets felt there was residual nerve damage causing the pain and they were as confident as they could be that the ligament wouldnt break down. i was completely torn about going down the surgery route again but given he was a young horse and that he clearly wasn't going to be sound unless it was done, i kinda didn't really feel there were any other choices at the time.

Unfortunately, nico has also had ongoing front foot pain and he is currently at rockley with nic barker. He's just starting to come back into work again now. looking good behind, although he is 'sliding' the foot a bit upon landing, as he does seem to have slightly less flexibility through the hocks than before the injury. i'm hoping this will improve with work and time and with him now being barefoot.

all-in-all, i think the surgery has a place, but if you have a horse who's ligament isn't showing signs of healing or who is particularly badly injured, i'm not sure I would want to go down that route.
 
It is my understanding too that not every horse is a candidate for surgery, I wonder what dictates that. I certainly never thought it was as common as it sounds.
 
robthecob said:
It is my understanding too that not every horse is a candidate for surgery, I wonder what dictates that. I certainly never thought it was as common as it sounds.
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all the vets i have spoken to about it seem to be in agreement that its becoming more and more common. as are SL injuries in general. I don't think anyone is entirely sure why, though personally, i think its probably something to do with working horses at a younger age and on more artificial surfaces and doing less road work, and probably something to do with breeding
 
Dreams - sorry to hear about your boys, Rockley sound like they do a great job though

I just wondered what front foot pain you were referring to. I read lots and lots about psd
 
Sorry on my phone.. But I read lots about psd and found that often upon treating the suspensorys problems in the front feet arose, a chicken and egg situation maybe.

My girl was diagnosed with psd bilaterally behind along with SI damage to the joint rather than ligaments. I never opted for surgery as I was told she was not a candidate. :-/ it does definately seem more common these days..
 
robthecob said:
Dreams - sorry to hear about your boys, Rockley sound like they do a great job though

I just wondered what front foot pain you were referring to. I read lots and lots about psd
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Thanks Rob :) Nic does a great job down there and I'm completely happy that if anyone can get him sound and back in work, its her :)

we aren't entirely sure what the front foot pain is as we haven't mri'd. he blocks to the heel region on his lf and whole foot + pastern on his rf. xrays didn't reveal anything. as he is almost sound on a straight line and only worse on a circle, i would hazard a guess at collateral ligaments, but i didn't want to waste money undergoing an mri as neither myself or my vet believed it would change the treatment or outcome. Nic barker says she see's a fair few horses with both hind suspensory and front foot pain. i guess its often a compensatory connection. my boy was slightly unusual in the fact that he was diagnosed with SL first, and foot pain second. Apparently, in her experience, its the other way round
 
Yes that does sound odd as you would think the sl injury would be compensation from taking the weight on the front feet. I have a feeling this is how my mares issues may have started, not that I'll ever know. You never saw nico walking round in a handstand to compensate the other way then ;) :D
 
robthecob said:
Sorry on my phone.. But I read lots about psd and found that often upon treating the suspensorys problems in the front feet arose, a chicken and egg situation maybe.

My girl was diagnosed with psd bilaterally behind along with SI damage to the joint rather than ligaments. I never opted for surgery as I was told she was not a candidate. :-/ it does definately seem more common these days..
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i suspect the front foot pain possibly occurs secondary to psd due to changing biomechanics as they compensate for the pain behind. if you are aware of nic's work, that would translate to a toe first landing, and entering the cycle of atrophy to the shock absorbing mechanisms of the back of the foot, leading to strain on soft tissue etc etc

i also think there is definitely a link between psd and SI damage - it would make sense biomechanically. i guess often the problem is knowing which one is the primary problem and which the secondary. not sure how the si injury itself would not make the horse a candidate for surgery... sometimes in my experience you have to fix the bit you can do something to fix and hope it will fix the other bit as well! you just have to go into it knowing that theres an even lower chance of success than normal.
 
robthecob said:
Yes that does sound odd as you would think the sl injury would be compensation from taking the weight on the front feet. I have a feeling this is how my mares issues may have started, not that I'll ever know. You never saw nico walking round in a handstand to compensate the other way then ;) :D
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sometime you have to wonder how these horses are ever sound dont you!:D
 
dreams579 said:
Thanks Rob :) Nic does a great job down there and I'm completely happy that if anyone can get him sound and back in work, its her :)

we aren't entirely sure what the front foot pain is as we haven't mri'd. he blocks to the heel region on his lf and whole foot + pastern on his rf. xrays didn't reveal anything. as he is almost sound on a straight line and only worse on a circle, i would hazard a guess at collateral ligaments, but i didn't want to waste money undergoing an mri as neither myself or my vet believed it would change the treatment or outcome. Nic barker says she see's a fair few horses with both hind suspensory and front foot pain. i guess its often a compensatory connection. my boy was slightly unusual in the fact that he was diagnosed with SL first, and foot pain second. Apparently, in her experience, its the other way round
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Ditto - Ronnie also had right front foot pain - didn't MRI as it was academic - he was only 1/2 a tenth a lame on it and (this sounds awful) I could usually get him to be sound on it under saddle, it was only lunging on a hard surface that it looked bad. The front foot pain was identified at the same time as the PSD. I took him to horsepital as I was sure he was lame on 3 legs. Only his near fore was sound (and that had previously suffered a SDFT injury).
 
My friend's lovely boy had this done yesterday. He is up and recovering (phew, must admit that outside my own horses he is my absolute favourite) so hopefully he'll come right. Very interesting to hear both sides of the story. I'll point her in the direction of this thread as I'm sure she'll be interested :)
 
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