Suspensory surgery (PSD) - your experiences/results

[IrishMilo]

I mentioned a few weeks ago that Tucker was diagnosed with PSD. Vet recommended surgery and I trust her opinion - she's very well respected locally and works under one of the best vets in the area. No holes but lots of lesions in both hinds and it's chronic rather than acute (he's an OTTB - flat). 1/5th lame on each leg with hard toe drag.

She cited around an 85% success rate to return to the work he was doing (which was basically nothing). I'd got him up to hacking ~3 times a week in trot/canter and maybe one very short/easy schooling session.

I'm concerned that if the insurance decides to cover it - (which is an if in itself due to previous pelvic break, vet is currently making a case that the two aren't related), I'd be putting him through an operation and a long box rest/rehab program with no gain for either of us.

His SI was done at the time of investigation as vet noted area was sore, and neck and back were X rayed too (I wanted this for my own peace of mind) - neck is fine but two processes are touching in lumbar area.

The plan was to keep him hacking in walk before the surgery to help him build more muscle but he came in hopping with mud fever about three days after the workup and is now very lame behind again...

He's such a nice horse I want to give him every shot at becoming a slightly more useful member of society, but not to his detriment. He was peanuts and I'm not pinning any hopes and dreams on him, I just like his character a lot.

Pic of the sicknote to make for less boring post:

Any success stories?

 

[ihatework]

Well the PSD surgery is reasonably straightforward in itself and the rehab perfectly do-able. So in a straightforward case I wouldn’t hesitate to do it, especially if insured.

BUT

Pelvic break
Kissing spine
Sacro
PSD

I’m afraid for me, this would be a case of chronically crocked ex racehorse and I wouldn’t be spending excessive money … it will just disappear into the never ending pit. Sorry not to be more positive.

 

[Sprogladite01]

My boy was diagnosed with chronic bilateral hind psd last July, and I've documented the whole thing here: https://forums.horseandhound.co.uk/threads/full-lameness-workup.808057/

Sadly not looking likely for a successful outcome, but I think the difference here is that you've found other issues with his SI along with his back. You're probably aware that PSD tends to be secondary in a lot of cases. If I had my time over, I would have attempted non-surgical treatment first, but when you have Sue Dyson telling you your options are try surgery or PTS then you do the surgery!

If this horse was mine, I'd treat the SI and back issues, try non-surgical options and see how he gets on. Good luck!

 

[Laafet]

The grey in my avatar was a car crash and had a very successful 10 years of life post surgery, going to schooling Advanced Medium and competing Medium. He had a whole heap of other problems that eventually caused his retirement and relatively early death. Best thing I did for him was the surgery.
I have known a few others that were very successful. However it is complex and not the fix all thing that people think it is. I also was very dedicated in my rehab to the point where he pretty much was in rehab his whole life but it kept him sound and happy.
I'd go with Sprogladite01 and treat the SI and back issues first, and don't go for shockwave as that is a pointless waste of time and money on hind suspensories

 

[IrishMilo]

The plan was to deal with the SI and back between now and operating but he put a pin in that by going dog lame. He's come right from the dermatitis now but super lame behind again which I can only assume is his suspensories giving him gyp. Vet said fine to turn out but he's clearly doing too much just with that alone.

I feel like it's a catch 22 - he needs to be comfortable to work properly to help his back and SI but he's not going to be able to do that until his suspensories are no longer hurting. My gut is to go with the surgery as I know horses who have come back from far worse but I'm just a pessimist and cynical!

 

[Bellaboo18]

We've got a positive story ?

She was very sore everywhere but mainly over her back and SI.
Back xrays showed a slight narrowing of two processes but not kissing. We medicated with no change at all so I believed it to be secondary to something else.
Bone scan showed an uptake over her SI nothing over her back. Medicated her SI *some* improvement.
Pushed and pushed got her suspensories scanned. Went for the op and she's never looked back. I believe as she wasn't putting her weight on her hinds she was carrying it over her back. Her back pain went pretty much instantly once she was home. She's such a happy little horse now ❤

Sorry for the long post but wanted to show for us the other issues were secondary to the suspensories. My concern in your case is you actually have kissing spine but I'd wonder if your vet might think after the psd op it would allow him to change his posture and work correctly over his back?

On the face of it we had a whole host of problems (although never actually lame behind) but really they all came from the psd.

Bilaterally lame in front
Ulcers
Narrowed processes in back
And clearly in a lot of discomfort everywhere.

I took her on in the mess and always said if we got to a point of her not improving she'd be pts but luckily as we chipped away she improved all the time.

Good luck with whatever you decide with your lad. I've found the psd Facebook group a really positive place.

 

[ycbm]

lots of lesions in both hinds and it's chronic rather than acute

My concern from this description would be that it would be the denerving aspect of the operation which brought him sound rather than the fasciotomy, and that he would break down further down the line. Can your vet reassure you on this?
.

 

[IrishMilo]

My concern from this description would be that it would be the denerving aspect of the operation which brought him sound rather than the fasciotomy, and that he would break down further down the line. Can your vet reassure you on this?
.

I can't actually remember if she recommend neurectomy alone or with the fasciotomy too. I'll have to check... it was a long day!

If just the neurectomy and it was done successfully (I did mention that I'd heard of cases where the nerves have reformed and was reassured that is a rare case these days), is your thought process that even if he was no longer feeling pain, the suspensories would go on to deteriorate?

 

[IrishMilo]

Sorry for the long post but wanted to show for us the other issues were secondary to the suspensories. My concern in your case is you actually have kissing spine but I'd wonder if your vet might think after the psd op it would allow him to change his posture and work correctly over his back?

Thanks for sharing, that's a great outcome for you!

That would be my thought process. She wasn't actually too concerned with the processes for now. I honestly don't think he's going to be able to work through the back and SI issues without getting his suspensories sorted first. He's uncomfortable just standing tied at times and I catch him snatching the off hind (the one most affected) and resting it often.

 

[Bellaboo18]

Thanks for sharing, that's a great outcome for you!

That would be my thought process. She wasn't actually too concerned with the processes for now. I honestly don't think he's going to be able to work through the back and SI issues without getting his suspensories sorted first. He's uncomfortable just standing tied at times and I catch him snatching the off hind (the one most affected) and resting it often.

I agree and think its got to be worth a try x

 

[ycbm]

I can't actually remember if she recommend neurectomy alone or with the fasciotomy too. I'll have to check... it was a long day!

If just the neurectomy and it was done successfully (I did mention that I'd heard of cases where the nerves have reformed and was reassured that is a rare case these days), is your thought process that even if he was no longer feeling pain, the suspensories would go on to deteriorate?

I've never had a horse with PSD, but I have heard of others going on to deteriorate (and some where it never worked) and I can understand why that would happen if the original cause is conformational.

I must admit, I'm against any form of denerving that I currently know about, with the possible exception of when a reason for the problem causing the pain can be definitely identified, and definitely removed.

The question I would want answered is how your horse, who has done so little work since he broke his pelvis, has ended up with multiple lesions in his suspensories.
.

 

[IrishMilo]

I've never had a horse with PSD, but I have heard of others going on to deteriorate (and some where it never worked) and I can understand why that would happen if the original cause is conformational.

I must admit, I'm against any form of denerving that I currently know about, with the possible exception of when a reason for the problem causing the pain can be definitely identified, and definitely removed.

The question I would want answered is how your horse, who has done so little work since he broke his pelvis, has ended up with multiple lesions in his suspensories.
.

I suppose that's exactly where the gamble with the op lies, although I can't see any other alternative that's viable really. The chance of coming good with rest alone is very poor - around 30% and he's not currently sound turned away either. And like you say, he's done next to nothing for virtually a whole year, so I don't think that would be a solution anyho.

I'm assuming the damage was done through racing - he had a fair few starts and was fairly decent - but who knows.

She's back in a few days for blocking and to re-scan so I'll have a better chance to ask some more questions!

 

[ycbm]

Well he's a lovely horse and I guess if the insurance will stump up then it's worth a try if you feel you can commit the time and emotion to the rehab. I hope it goes well.
.

 

[IrishMilo]

Well he's a lovely horse and I guess if the insurance will stump up then it's worth a try if you feel you can commit the time and emotion to the rehab. I hope it goes well.
.

Thank you. I value your opinion!

 

[greenbean10]

We've got a positive story ?

She was very sore everywhere but mainly over her back and SI.
Back xrays showed a slight narrowing of two processes but not kissing. We medicated with no change at all so I believed it to be secondary to something else.
Bone scan showed an uptake over her SI nothing over her back. Medicated her SI *some* improvement.
Pushed and pushed got her suspensories scanned. Went for the op and she's never looked back. I believe as she wasn't putting her weight on her hinds she was carrying it over her back. Her back pain went pretty much instantly once she was home. She's such a happy little horse now ❤

Sorry for the long post but wanted to show for us the other issues were secondary to the suspensories. My concern in your case is you actually have kissing spine but I'd wonder if your vet might think after the psd op it would allow him to change his posture and work correctly over his back?

On the face of it we had a whole host of problems (although never actually lame behind) but really they all came from the psd.

Bilaterally lame in front
Ulcers
Narrowed processes in back
And clearly in a lot of discomfort everywhere.

I took her on in the mess and always said if we got to a point of her not improving she'd be pts but luckily as we chipped away she improved all the time.

Good luck with whatever you decide with your lad. I've found the psd Facebook group a really positive place.

I have almost the exact same experience. I did the surgery, rehab has been tough but a lot easier than it would have been without surgery.

We’ve had a few more niggles but overall my horse is much happier and in terms of fixing the suspensories, it’s been a success. My insurance treated suspensories as an individual claim despite other things going on.

IMO the scariest part was the GA. Box rest was 4 weeks after surgery and virtually back to normal after that in terms of turnout.

 

[LEC]

Well the PSD surgery is reasonably straightforward in itself and the rehab perfectly do-able. So in a straightforward case I wouldn’t hesitate to do it, especially if insured.

BUT

Pelvic break
Kissing spine
Sacro
PSD

I’m afraid for me, this would be a case of chronically crocked ex racehorse and I wouldn’t be spending excessive money … it will just disappear into the never ending pit. Sorry not to be more positive.

I wouldn’t even be bothering with that list. It’s likely to be secondary to any of the other issues mentioned. Frankly with not even standing up to low level work then I would be even less inclined. Nice chap or not his conformation doesn’t help and I think he is likely to ? ? For outcome.

 

[Jules111]

One of mine had a neurectomy. He is very laid back and really enjoyed rehab. He literally had to be dragged out for the in- hand re-hab work. He's no world beater, never was. He's far more physically comfortable than before but I consider his working life to be a support to his health and soundness. I no longer have ambition to take him to any real comp levels, he was jumping 90 and dressage at novice at 7 yrs old so we didn't really take a huge step down. His "soundness" is key to keeping the balance of quality of life. I keep him as lean as I can (he's a very good doer), force him to live out when he'd much rather stand in a stable in front of a haynet, walk him in straight lines as much as possible to keep the legs working and back as strong as I can. Essentially our insurance has spent around £6k creating a reasonable nice but very slow hack. If it were my younger, far more spirited horses the process would have been torture, lots of box rest, very slow in hand work, limited (stable size) turnout and stop/start ridden work. My younger horses would have killed me or themselves with the boredom of the entire process. On the other side of this I don't have the horse I had pre PSD but he is much happier than he was before.

 

[Tiddlypom]

I'm sorry to hear about all his issues.

I doubt that he is going to be able to become anything but a happy pasture ornament at best. There's nothing wrong in that, as long as you are also happy with keeping him on as such.

He's a lovely horse, and you are a very conscientious owner. Good luck.

 

[ycbm]

Kissing spine
Sacro
PSD

My guess would be those are all linked, though, and fixing the cause will fix them all. I'm just not convinced that denerving will fix the cause and I'd be grilling the vet very hard on that. Personally, I don't think I could invest the time and money in the rehab, with his history, but I understand why IM would want to.

 

[IrishMilo]

Thanks all. I appreciate everyone's opinions and no need to apologise for not being positive. The point of this thread is to get a balance of honest opinions.

LEC out of interest what do you think is wrong with his confo? I think it's pretty decent.

Tiddlypom, thank you. I do try!

I do believe the suspensories are the main problem here rather than being a secondary issue.

 

[ycbm]

LEC out of interest what do you think is wrong with his confo? I think it's pretty decent.

I know you didn't ask me, but I'll poke my nose in anyway. He's got what we used to call, but I haven't heard for a long time, a pronounced goose rump, a very steep slope from SI to tail.

Knowing his history of a fractured pelvis, I'd be a bit worried that the way it is now is not entirely natural to him, but a result of the break and how it fixed.

I think you need to be very much guided by people who see him in the flesh though.
.

 

[Regandal]

He looks to be pretty straight through the hocks, that’s common with horses who develop psd. Long pasterns too. The fasciotomy may help, I wouldn’t do a neurectomy, that is cruel and I speak as an owner of a horse who had n & f prior to me owning him. He’s a quiet hack now, no tight circles.

 

[ycbm]

I'm not seeing straight hocks in that photo.
.

 

[greenbean10]

He looks to be pretty straight through the hocks, that’s common with horses who develop psd. Long pasterns too. The fasciotomy may help, I wouldn’t do a neurectomy, that is cruel and I speak as an owner of a horse who had n & f prior to me owning him. He’s a quiet hack now, no tight circles.

I think there's a slightly more sensitive way to say that you disagree with neurectomy than to write that it's cruel.

Lots of people have done N&F and had great success with it.

I have done everything I can to keep my horse happy and sound. Just because your horse had N&F before you got it doesn't give you a right to judge others who have chosen to do it. It sounds as though you are currently benefiting from the surgery that someone else probably agonised over.

 

[Regandal]

It sounds as though you are currently benefiting from the surgery that someone else probably agonised over.

Benefiting from? Hardly. I’ve had to re-rehab him and adjust his environment to suit him. Fix his appalling feet that possibly contributed to the psd. Spend a fortune on bodyworkers and new saddles. But, he is worth every penny and every minute.
IM, I apologise for my comments, I see straight hocks everywhere. Your horse is lovely and I hope he comes good for you.
Some vets are more pro neurectomy than others. What concerns me is that neurectomy removes the pain whilst the underlying cause of the pain might still be there.
The main thing post surgery is to build fitness slowly, avoid circles and deep going. Deep surfaces are not good.

 

[greenbean10]

Benefiting from? Hardly. I’ve had to re-rehab him and adjust his environment to suit him. Fix his appalling feet that possibly contributed to the psd. Spend a fortune on bodyworkers and new saddles. But, he is worth every penny and every minute.
IM, I apologise for my comments, I see straight hocks everywhere. Your horse is lovely and I hope he comes good for you.
Some vets are more pro neurectomy than others. What concerns me is that neurectomy removes the pain whilst the underlying cause of the pain might still be there.
The main thing post surgery is to build fitness slowly, avoid circles and deep going. Deep surfaces are not good.

Well I would imagine that his previous owners wouldn’t have done the surgery unless they thought there was no other option, so the fact that you currently have a horse that can hack is a benefit IMO. Unless your horse is now suffering more than he was before as a result of the surgery then I wonder how you could call it cruel but I suppose that’s your opinion.

My horse was very uncomfortable and now hacks out very happily, works in the school and lives out year-round in the field with her friends. You would never know from looking at her that she’d had anything done. I find it very offensive that anyone would suggest what I’ve done is cruel when she has a far better quality of life than many other leisure horses and, in fact, is far sounder.

 

[Bellaboo18]

Regarding his conformation. I can't see straight hocks. I can see the 50p bum which I think could be improved (a bit) with better posture.
Looking at the picture again, I'd personally get hoof xrays, his right hind is quite low heeled. Hard to say if thats a potential cause of the psd or he's 'crushing' them from the discomfort of the psd but you can see why his off hind is worse.

Yes the rehab is lots of hand walking on a hard surface. From the things I've rehabbed, I'd say it's relatively easy.

 

[hock]

I wouldn’t even be bothering with that list. It’s likely to be secondary to any of the other issues mentioned. Frankly with not even standing up to low level work then I would be even less inclined. Nice chap or not his conformation doesn’t help and I think he is likely to ? ? For outcome.

I was looking at his confirmation and I think we’re looking at a horse standing for comfort so his confy is misleading.

I would operate, my gut tells me the rest are all secondarys. If the insurance won’t cover it well that’s a while new depressing thread. My fingers and toes are crossed for you he is a beaut.

 

[AnShanDan]

I think it really depends on what you want from the horse. If you're happy to spend the time rehabbing and have not great aspirations beyond fairly light work then I would give it a go, as long as insurance is covering it. If you want to get out competing soonish, then no, I would probably retire.
The op itself and rehab are not a massive deal, horses are often back in the field in a few weeks and can start walk work soon after. The longer and slower the rehab the better. Correcting their way of going is key to real long term success.
Friend of mine has an ex grand prix SJ that had the op a few years ago, he was very carefully reschooled and he looks amazing now mainly doing dressage.
I'd also want the feet looked at.

 

[IrishMilo]

Yes to goose rump and yes to feet being a WIP (although take a look of my existing foot thread to see how much they've improved already). Although I'm going to go out on a limb and say his previous lifestyle is a major factor to his issues rather than the somewhat low heels.

I've had an email this morning from my insurers to say vet has said she can't rule out the pelvic break as the cause so they won't move forward with my claim until a definite diagnoses has been done... bugger.