Cervical OA and Basket Surgery (cervical interbody fusion) experience

[RosebudLaVie]

Hey all - I figured I’d write this post to add to the small number of posts on horses who have had this surgery due to arthritis. Let me know if you have any specific questions, but I’ll post a summary below.

My mare is a 13yr old Holsteiner that jumped in Europe, then was imported in 2018 as a hunter. I purchased her in 2020; she was doing the 3’ at that time. I did feet/limb radiographs, and took one view of the neck, but did not radiograph the entirety of the neck since she was sound and doing the job, and the PPE was stall side. She received monthly massages and occasional chiro/acupuncture, and was sound overall except for issues related to a NPA of the right front (mostly shoeing tweaks). She went on to compete in the 3’ Green Hunters on our A circuit, and competed in Kentucky at the GHIC.

Fast forward to early this year, when she developed a lower head carriage and was unwilling to pick up her left lead canter (by unwilling I mean bucking and shattering our arena mirror…). The surgeon I brought her too was concerned about her hocks/stifles, so we injected those. She improved for a few weeks, but then returned to her previous behavior. She returned to the surgeon, and this time she blocked out to her LF; a minor tendon strain was suspected (normal ultrasound), so she received shockwave and was off work for several weeks. She was also noted to have cervical OA at that time but treatment was not recommended. We brought her back very slowly, but once we went back to cantering she did not want to pick up either canter lead, and was now demonstrating ulcery behavior.

I took her to a DIFFERENT specialty clinic, and she was diagnosed with ulcers via scope, so we treated her for a month, which improved her attitude and behavior immensely; recheck scope 1 month later was clean, so we weaned off meds in the second month. However, I noticed she was still having issues with cantering, so I brought her back and we did neck injections with steroids bilaterally at C4/5, C5/6, and C6/7. She was graded as a 1-1.5 on the neuro scale. This improved her comfort immensely, and she no longer displayed discomfort cantering. However, I still felt her neck was SO stiff and her head carriage was lower than before. I tried carrot stretches and more body work, but didn’t see improvement. It was also noted that the muscling in her neck was inadequate for the amount of work she was in.
Back she went to the specialty clinic for CT/myelogram and recheck scope. Mild ulcers, but also severe OA of C5/6 and C6/7 leading to very mild and focal spinal cord compression, as well as severe narrowing of the foramina resulting in compression of the cervical nerve roots bilaterally. She was graded as a 1-2 on the neuro scale. I had her seen at NBC with Dr. Johnson for a second opinion, and she reviewed the imaging. All of the specialists agreed that the best chance at pain relief was to perform the basket surgery at 5/6 and 6/7, as it relieves compression of the spinal cord but also causes the arthritic articular processes to regress and opens the foramina, resolving the compression of the cervical nerves.
She had surgery at MAEC on 10/26; Dr. Grant, who invented the procedure back in the day and treated Seattle Slew, flew in to do it alongside the surgeons there. 2 other horses also had the same surgery for arthritis that week. All of the horses recovered without immediate complications. She continues to be stiff and sore, but got her appetite back the next day and has now returned to herself. She is on oral medications, and her staples come out on Monday. They usually go home 10-14 days after the procedure.

I plan on updating this post so people can read about the rehab journey and outcome with regard to pain and performance.

[2tempe]

Thank you for posting this. I have an 10 yr old dressage horse who has declined from GP (we were planning his “debut”) to barely training level over about11 months. Very similar symptoms. He was evaluated in October, some arthritic changes C4-C5 but vet did not think this was the issue. He was focused more on the C6-C7 area as there were some signs of malformation in that area. Not a real diagnosis, but rather led to the CT/Myelogram which was done a few days ago. I do not have results yet.
We also tested for EPM, Lyme, PSSM and did a muscle biopsy for MFM test while he was under for the CT scan. It is not clear to me whether I will do surgery if it is an option, but its interesting and helpful to read real world stories.

[RosebudLaVie]

There is a C6-7 malformation that has been discovered in Warmblood horses. Rose didn’t have it, but it is a known condition (ECVM). I hope you get helpful information from your CT/myelogram. Rose was tested for EPM and Lyme on her blood and CSF, but the other tests that your horse had were not recommended in her case.
I hope you can figure out the best treatment plan for your horse! I know how stressful and overwhelming it can be, and how much you want to do the right thing. Please keep us posted on how it goes.

[2tempe]

I have done much reading on the malformation issue and it is helpful, as I now understand much more than I did 6-8 weeks ago. Hoping to get the radiologist report in the next few days.

[2tempe]

Though I had expected malformations in my gelding, he has moderate OA in same areas as your mare, spinal cord compression and the narrowing of the foramina. ALSO some issues C7-T1 and mild OA in several other vertebrae. 1-2 on neuro scale with some tripping. Clearly showing some signs of discomfort even though not in work.
Vet mentioned surgery, though he will not do it; would bring in Grant. Quoted a huge # for the procedure. For numerous reasons in addition to that, I do not want to do the surgery. Debating about injections and have a consult with another vet tomorrow.
OP: Could you message me what the approx cost was? I was literally dumbfounded.

[RosebudLaVie]

DM’ed you!

[candico]

Have personally known two horses that had the surgery probably at least ten years ago. Neither really recovered to what I would say a happy, comfortable being. The one rehabbed at my place and it was not fun seeing him in so much pain. Another that the local vet would brag at being a basket surgery success story “forgot” to put down his landing gear after a jump and I heard it was gruesome to watch. Really hope Grant has improved his methods and that the OP’s horse is one of his success stories, but fully understand why people are still very hesitant to do the surgery. Would be interested if the insurance companies approve coverage. Sorry, but I can’t remember how much it was back then either.

[RosebudLaVie]

I think part of the outcome of the surgery depends on the original health/fitness and neurologic status of the horse in question, but of course there will be unknowns. Dr. Grant is one of the most experienced equine cervical surgeons in the country, and has done this procedure countless numbers of times. I think we have to remember that the nervous system is quite a fragile thing, and we don’t understand enough about the mechanisms of pain and its appropriate treatments in veterinary medicine, although there are continued developments. There are never any guaranteed outcomes. There will be horses that remain in pain or develop progressive neurologic signs after surgery, but I wouldn’t necessarily attribute those outcomes to the methods of the surgery or surgeon, considering it is still considered the best option for horses with spinal cord and nerve root impingement. Only time will tell how each horse will do, but the goal is to improve the horse’s quality of life, when they would otherwise become progressively painful and neurologic. I’m sorry to hear that you’ve known horses where that wasn’t the case.
Yes, my insurance covered the procedure. I am sure that her neck will be excluded from all future coverage.

[candico]

One horse was a competing PSG/I-1 horse that suddenly wasn’t coordinating one direction of his half passes as well. He was so sick and painful afterwards that they went back in thinking they might have left a sponge or something behind. The other was a Third level horse that had previously shown 3’6 hunters and just seemed a bit wonky and stiff to ride. The recovery seemed very painful for him as well and he sadly came back from San Luis extremely distrustful of humans. Neither horse really ever came back to where they were even just prior to the surgery and horse one retired and horse two was donated.

Same owner as horse two had another horse start frequently tripping shortly after purchasing and Grant wanted to do surgery on him as well even though they could only find the slightest impingement when the horse basically had its nose touching its shoulder which actually wound up as having EPSM as being the cause of the tripping and the horse improved dramatically with diet and exercise.

Will ask the local vets now what they think of the procedure now in hindsight. I know the body workers hate it, but I do acknowledge that they could be biased against it due to thinking that their methods of therapeutics would be more effective.

[2tempe]

I have pretty much decided not to do the surgery. First, the clinic vet is recommending not only basket c6-c7 but also a second surgical procedure called a foraminotomy, which opens the space where one of the nerve roots are. It is apparently a newer procedure. The 2 procedures would be done one after another while the horse was anesthetized, so essentially doubling the time the horse in under. This also adds some chunk to the already high bill.
2. My horse has milder but similar issues in other places up his neck. My concern, which was discussed with personal vet is that when lower joint is fused the upper areas could be impacted by the change in how he uses his neck and/or continue to get worse independently. (not exact comparison obviously, but Seattle Slew first had C-6/C-7 done, then the second surgery was C-5/C-6. ) 3. My intent before all this was to sell the horse either this year or next, but even in the best of outcomes, he’s not going to be saleable. We are currently discussing a couple different options to manage his discomfort and letting him be a horse with a buddy in a pasture.

[RAyers]

Working in human spine, a foraminotomy is useless. The outcomes after two years are the same as if you did nothing. In many cases that is only done with fusion or other decompressions but all result in the need for permanent hardware stabilization, which just adds a whole new level of failure. In humans, once you instrument and fuse you chase continued failure of the spine up and down from the instrumented segments for the rest of the patients’ lives.

I am astounded by the push for spine procedures in horses given their failures and lack of permanent fix in humans. Some of these vets need to attend AAOS, SRS, NASS, and IMAST conferences to open their eyes.

[NaturallyHappy]

@RAyers - As a two time Hodgkin’s survivor who had a lot of radiation, do you have ideas how to protect my spine myself? I’ve gotten little to no help from the medical community and have designed my own PT. OP, my apologies for interrupting your thread.

[2tempe]

THANK YOU for this response; it makes me feel much better about my thinking. It is interesting that back surgeons - at least the one I consulted with - are not in any big hurry to do fusions. Now I understand why.

[RAyers]

Doing exactly what you are doing is the best way to protect the spine, exercise, good diet, all those things do more than most. The next thing would be a drug such as Forteo which has been shown to help grow new bone. It is a part of the natural parathyroid (PTH) family.

[Amberley]

@2tempe

a second surgical procedure called a foraminotomy, which opens the space where one of the nerve roots are.

Not to contradict RAyers but but that has been done in Germany for a few years now and I have heard some very successful results and very few bad or no outcomes. Horses that were thought to be wobblers or had a lot of front end problems etc that are now back normal neurologically. Post this question on a German board or group and ask about the endoscopic surgery of the cervical spine stenosis.at Tierklinik Lusche.

I have never heard of a good outcome from basket surgery, I would not do it.

[NaturallyHappy]

@RAyers, this is fascinating. My thyroid was fried by radiation. I’ll follow up. Thank you!!

[RAyers]

@Amberley you aren’t really contradicting me. I come at it in a world with millions of cases of that procedure and at least 30 years of data upon which we can look. A “few years” is unlikely to indicate a success or failure in terms of patient outcomes. The human two year outcome is based off decades of patient data. I suspect in 10 years the equine data will likely show a similar outcome. Foraminotomies don’t actually cure a disease. They simply modify the disease condition for a period of time, and enable other comorbidities to manifest.

[IPEsq]

There are other ways to potentially calm down the nerve roots without surgery. At least, I would be inclined to try some creative medication in that way first. I would also consider retirement and not surgery for a horse who is showing changes at other sites, even if not compressing anything there. General OA at “milder” sites can progress for sure and cause enough problems.

[RosebudLaVie]

This is a good discussion. There is over 30 years worth of data on the basket procedure (and other variations of it), but as @Amberley said they are doing fusion and foraminotomy in Germany with good outcomes. I realize that there is a huge volume of human data, but comparing bipeds to quadripeds isn’t always going to be straightforward. There are new biologics coming available in small animal medicine for the treatment of OA, but again, these do not modify the changes that are already there and causing pathology. Hopefully in the years to come we will have more options for horses, but until then I think that the veterinary world is doing what it can. I provided my horse’s story for others that have been recommended the procedure, not to sway them to do it, but just to provide a thorough case history and firsthand experience, regardless of the outcome (although I obviously want it to be good).

Rose is 2 weeks out from the procedure and returned home at day 12. Her neck remains stiff and in lower head carriage, but she is eating well and has been spicy enough to squeal at her new neighbor (a TINY pony gelding). She puts her head out of her stall and is interactive as usual. She will be in her stall for 45 days, then have an x-ray to get an update on healing, and then she can get handwalked for 10 minutes a day for another month. After that (if all goes well) she’ll be able to go outside in a small paddock, which will be a happy day for us all.

[Lunabear1988]

I hope your horse recovers wonderfully. Thank you for sharing, it’s always interesting to read about different procedures.