Cervical spine arthritis - whose got a horse with it & what are you doing?

[Abbie.S]

No radiographs yet, but myself and a very trusted lameness/sport medicine vet whom I’ve known and used for years both suspect that this horse has C-spine arthritis, specifically around C5-C7. He has a history of unknown injury to the left shoulder with the scars to prove it, and has been quite resistant to lifting the base of his neck, carrying himself equally on both shoulders or assuming any kind of round posture. Further diagnosis and treatment is up to the owner, but suffice it to say (it’s a very long story) I may end up with this horse in my care in the future, so this is as much for my information as to help her make some potential choices.

Anyone have (or had) a horse w/ arthritis in the neck? Give me some details: was it a diagnosis of exclusion or did you get radiographs? Was it injury related or of unknown causation? What were the horse’s “tells” or symptoms? What treatments did you try, and was the horse able to return the type of work you were doing or did you need to change how you rode them/their primary job? Did you end up having to retire (or put horse down) due to problems related to the arthritis? Thanks, all.

[beowulf]

One of my TBs has C6/C7 facet remodeling and arthritis. We diagnosed by x-rays last fall while he was laid up for an unrelated injury. Also diagnosed moderate KS. In work he has some tightness in his neck, flexing at the poll and carrying himself equally on both shoulders - he wants to collapse onto his inside shoulder in both directions and pull himself around turns. He is very willing and very honest but has a hard time with anything above a 1st level frame. He was funny about changes in footing and had a hard time maintaining a canter on a circle without becoming unbalanced and tense. He would stumble occasionally in our grass ring but for a while both myself and instructor thought it was because the footing is so uneven (he does not stumble in sand/dirt rings). He never bucked or reared undersaddle but one thing that keyed me in that something was very wrong despite being sound was that one day he bolted out of the blue with me - it was completely and totally unexpected for the both of us. I dismounted once I stopped him and he was acting as if I had just walloped him across the face with a 2x4 which is so uncharacteristic of him. He’s sensitive but he’s not reactive… so that was a huge clue. We were going along just fine, I was trotting him in a large circle working on getting him to change bend from inside to outside bend and all of the sudden he was in a blind panic. I think maybe the change in bend pinched something that wasn’t hurting before, but when it hurt, it hurt.

Shortly after that episode he had a catastrophic freak paddock injury so while the vet was out treating him, I had him go over his neck and back with ultrasound & x-rays. Found the C6/C7 remodeling right away, and KS - was not surprised about either.

So, I had his neck injected with polyglycan - vet went in 3x on each side. He also had mesotherapy done as well, I think the defensive posturing because his neck hurt caused his back to hurt as well. Opted not to do lig-snip and KS was not severe enough for the bone-shaving surgery, so we changed some stuff (saddle), did mesotherapy & have him on a long/low regime with lots of poles to see if that helps his topline. My vet thinks that the KS soreness is secondary to the C6/C7 and that the horse was protecting himself posture-wise which caused the tenderness in his back - he’s optimistic that the KS can be managed by work & mesotherapy as needed.

Absolutely tremendous improvement when he went back to work. It was like night and day.

The strangest and first thing I noticed was he was standing different. A few days after injection his neck is coming out of his shoulders in a different way, he’s moving better, and he is so much more interested in contact. I always thought the block was me, maybe I wasn’t a good enough rider to get through to him – but each day I am seeing more and more that it was undiagnosed soreness from the neck causing so much of our roadblocks. And our roadblocks were minor stuff, like resistance and tension; but so much of that has gone away in the last few weeks.

We’re not out of the woods yet, he’s almost 1 year out from his catastrophic injury (broken pelvis/ribs). Despite all of this my vet has been very optimistic about our prognosis. We just finished a hunter-pace last weekend (that included some jumping). I am taking it one day at a time with him, but it seems that each day is better and stronger than the last.

[Simkie]

There’s a long thread about Blush’s issues buried in this forum, but briefly:

Diagnosed with C6/C7 arthritis via bone scan and radiographs. Treated with steroid (I think we used triamcinolone) facet injections with excellent results that lasted ~ 6 months. Redid the injections at that point and got two weeks. Retired the horse.

She is 19 now, stable although lame in the field. Does not seem to be in pain but doesn’t swing evenly from behind and seems to have some minor proprioception issues that are most apparent when picking out her hind feet or when she stands for the farrier.

[Abbie.S]

Both of you, thank you so much!

beowulf, the footing thing never even occurred to me…or I should say it didn’t in this context. This horse prefers firmer footing of a grass or packing dirt surface: indoor arenas in particular are problematic, and I think it’s a combination of deep footing and the fact that there’s simply not enough opportunities for long, straight lines…something he needs to feel secure in his balance.

Simkie, how long ago did you post the thread on your mare? I’ll have to go dig it up.

[Simkie]

Years and years. Here it is: https://www.chronofhorse.com/forum/forum/discussion-forums/horse-care/19166-hind-end-weirdness-c-spine-arthritis-3-year-update-post-154

[IPEsq]

How much time you got for my story? LOL It’s well documented in my threads on this board. Ongoing.

Early 2015, behavior changes led us to taking X rays. Horse was unwilling to longe to the left at all. Preferred not to longe period. Under saddle, behavior was erratic. Bucking, balking (to the point of just planting feet), acting like every saddle was varying degrees of wrong (from more of the above behavior to you better get the F off), and he was suddenly very spooky, especially out of his left eye and at things he thought were behind him. He was in training to be a show hunter and only 4 so no serious framing up, but contact in the bridle didn’t seem to make any difference. He barely knew what contact and connection from back to front was anyway at that time. He would occasionally take some knuckling steps on RF, like he just met the ground wrong. He’s NQR on RH in hand/at liberty, but it tends to come and go, occasionally shift to LH, and is rarely seen under saddle.

Diagnosed with OCD at C3-4 on left and arthritic changes at C4-5 and 5-6 on right, plus some irregularity of the occiput on left side near the nuchal bursa. Injected all 3 sites both sides.

We tried a variety of systemic and holistic things, Bute, Previcox, Legend, regular chiro/acupuncture, shockwave at the poll area. Shockwave helped the nuchal bursa, but nothing else did anything for more than a few days, if at all. Injected with HA and triamcinolone. Within 4 weeks, there were no more bad steps on RF, and he was in full work and starting to get back into jumping training. He did tend to go a bit hollow in his back, more so on the left, but he was building fitness nicely.

Unrelated injury and layup for 6 months. Various other problems when getting legged back up. The injury occurred 2 years ago. We shockwaved July 2016. We re-injected last Sept 2016, but results were not good due to the other issues he had brewing (some of them being a consequence of all the time in a stall). Chased our tails till June 2017, with SI pain Dx. Injected, had some good results, for a couple months.

We just re-injected the neck with triamcinolone, but instead of intra-articular HA, we did Legend instead. The theory is that the HA may cause too much of the steroid to diffuse away from the small target area. This time, we found new changes at C2-3 on the right side. The other sites looked like they are maintaining–no worse than images from April 2015. We still injected 6 sites but this time did C2-3, 4-5, 5-6 on right and C3-4, 4-5, and 5-6 on left. It’s been 2.5 weeks now, and on the ground, he is acting like my horse from 2015. First rides under saddle, he wigged out and reared straight up at the walk. That was after one week. So, we have given him more time, some ulcer meds (due to other symptoms), and are starting Adequan. Remains to be seen if he will come back again or if I will have an unrideable 7yo.

I do expect the cervical arthritis will be the factor that determines when he is retired at the least and may possibly be what he winds up being put down for, but he is so accident prone that he could well kill himself in another way. His proprioceptive deficits have not returned since first injections, so I do not think he’s going to be a danger to himself because of his neck (versus his brain!) anytime real soon. But he may not be able to tolerate being ridden.

[Abbie.S]

Thanks, Simkie. I’ll go read through that tonight.

IPEsq: thanks for writing all that out. Does your horse’s temperament lean towards being higher energy/higher sensitivity anyway? I get that feeling from your post but hard to tell for sure. Both yours and Simkie’s cases sound much more advanced than this horse seems to be, but I really appreciate the details…you mentioned your horse got spookier out of his left eye. I had wondered about vision initially with this horse since he’s calm as can be outside in open spaces where there isn’t a lot of shadow but VERY concerned indoors where they are changes in the gradient of the footing (wet spot that looks darker, for example, or a place a horse recently rolled and the footing is flattened out), light peaking through the cracks in the sidewalls or roof to create little light spots, etc., and he also is worse out of his left eye.

[IPEsq]

He gets super spooky about all of those things when his neck is bothering him. He’s not a super chill horse anyway, but there’s definitely a difference in behavior. Ulcers also make him more spooky. He’s also a bit weird about the things he will and won’t spook at. It’s more stuff he hears than sees, but he seemed to think there were more monsters out of his left eye, then he’d scoot and spin to look around and be like, huh, what was I spooking at? He’s pretty good indoors, better usually, because he headshakes some outside. He gets worried the most about being startled by someone going by the door. Most of his spooks are pretty honest and predictable for him, but at first, he would just bolt away a few strides and then literally turn around and act confused. They were unpredictable even for him I guess. We checked his eyes, and it would happen outside and inside.

He is a sensitive horse in some respects yet can also be very dull/lazy. He’s a very unique guy. Some of the dullness is that he will shut down when you keep pressing him and he doesn’t want to play. He refuses to do anything. But, on the one hand, he’s high energy in that when he feels good he has big gaits, he loves to play and romp around, is very in your face kind of personality, and will show that he’s pissed about something with a good temper tantrum that often involves all 4 legs off the ground. But he’s nowhere near “hot”, if that makes any sense. He’s actually quite lazy. When he gets up and spazzed out, it’s anxiety almost 100% of the time. Whether he’s anxious because he’s being sensitive to something physical, or whether it’s sounds that are scary, or he’s just worried about whatever it is we’re doing or things that are distracting…his only bolting, running, other high energy moves are really out of anxiety. When he’s not anxious, he is super duper lazy. And he has a lot of opinions about everything. Which I knew buying him, but adding his physical issues on top of it has been not good. His personality, while challenging but manageable without health issues, makes him all the more difficult when he doesn’t feel 100%. The biggest issue with him is identifying WHAT doesn’t feel 100%, because it’s not always his neck, but he may not hurt badly enough to limp, just badly enough to tell me where I can shove it.

[IPEsq]

Actually, come to think of it, before we injected his neck the first time, he started spooking at and stopping at jumps. Especially indoors if the lighting was weird to him. Some gymnastics that we used to do regularly all of a sudden had monsters living in them. And these were tiny. Planks were the worst. He went a long time without jumping while we were figuring everything out. He was fine with ground poles. When we got back to jumping several months later, he didn’t bat an eye at the plank, didn’t care about fillers, never ever stopped. So there was that weird spookiness too.

[andawaywego]

Curious how long it takes for neck injections to show improvement? Have injected a back before and I know it took a solid 10 days to work, curious if neck will be the same.

[IPEsq]

Minimum 2 weeks. Can be up to 4-6 weeks.

[andawaywego]

@IPEsq

Minimum 2 weeks. Can be up to 4-6 weeks.

Thanks, we are 7 days in and just starting back into very light work.

[IPEsq]

That sounds right for returning to work. Just don’t worry if this week doesn’t seem like there’s any improvement.

[andawaywego]

appreciate that… we actually have no idea if this will help so helpful to have an idea of when to look for improvement

[x-halt-salute]

I have a c-spine arthritis horse too. Rads about 6 years ago (how time flies!) showed some remodeling of the facet joints in C3-4, 4-5, 5-6. Worked with multiple vets during the diagnosis phase and wouldn’t have trusted a diagnosis of exclusion without the radiographic evidence. We injected all 3 joints, both sides, after diagnosis, and then again about a year later, but have not repeated the neck injections since that time (knock on wood). Horse is currently working at 3rd level dressage and seems perfectly sound and content (well, at least when she’s not running up vet bills for displacement colic or systemic vaccine reactions or other unrelated, creative catastrophes).

My horse’s symptoms were ataxia (hind end proprioceptive deficit, especially LH leg), hind end weakness, and loss of balance/panic when striking off in the canter on the right lead. She’s extremely flexible and while she can be a wee bit harder to develop bend and flexion to the right, she never had any stiffness as far as longitudinal stretching or being able to move round and into the bit are concerned. Neuro exam revealed a relatively mild deficit (I think Mayhew grade was ~1.5). Like beowulf, we had a one day out of the blue event that really made it clear we had a problem. I asked for a right lead canter and she threw her head in the air and started sidewinding across the arena in an uncoordinated, out of control, sideways bolt – way out of character for this people-pleaser horse, and she seemed more terrified by it than I was. X-rays showed changes in the facet joint surfaces, worse on the right, and a possibility of mild stenosis at C5-C6. We sent the x-rays to a major vet school for a second opinion but opted not to do a myelogram. The facets were injected with triamcinolone. It took a good 2.5 weeks to see improvement in the hind end, and another week or so before she was really moving o.k. under saddle. But the eventual difference was night and day. We saw hints of the panicky right lead strikeoff and funky hind end movement about a year later and re-injected, with a similar return to work. None of the symptoms have come back since.

When this all started the horse was beginning a career change and was not even ready for training level dressage. She was extremely under-muscled. She also has a history of collapsing when at rest (sleep deprivation) and at the time was living in a 10x10 stall with a dutch door – based on scrapes and other injuries sustained while in at night, we think she was falling into the stall walls and maybe collapsing with her neck over that dutch door. She has a history of getting cast, as well.

I’ve put a lot of energy toward fixing potential contributing factors to inflammation in her neck, and I think that’s kept her from needing more frequent injections. She’s been ridden forward and with her back/core engaged – never allowed to do the “fake outline” thing where they keep their back dropped and arch their neck to pretend to come round. She’s gained a heap of muscle (went up 2 blanket sizes after age 11), but we’ve taken it really slowly training-wise. She has a bigger stall and a huge run-out paddock and hasn’t had issues with falling into walls or getting cast in a few years. She gets extra vitamin E and a glucosamine/chondroitin/HA supplement, for whatever that’s worth. I am thankful for every day that she gets excited to see her bridle come out, and for every day that she comes out of her stall moving her hind legs normally.

[teh_Kibbster]

just put my guy to sleep because of it. I’ve got 2 threads if you search and want to follow the saga from 2013/2014 to last week.

[EEWinterFresh]

My (now) 16yo OTTB has had 2 instances of neck arthritis. The first instance was right when we got him at 12. He was underweight and under muscled, but as he put on weight his neck stayed quite flat and skinny. He had hesitation with bending, and with pushing his neck out and down. We suspected a neck issue, and low and behold, he had arthritis in his T1/T2. We injected, I went on vacation, he hung out in his stall and in turnout, and when I came back to the barn after a week his neck looked twice as big! His movement changed, he was happier, jumping better, and we’ve never had an upper T-spine issue since.
Long story short, he blew out his tendon (he’s VERY accident prone) and was on extended periods of stall rest. When we were bringing him back into work, we found the C-spine issue (C2/C3) which was exacerbated by the period of inactivity. He was VERY SPOOKY and when he would spook, his feet never felt like they were solidly underneath of him. He also had a hard time keeping on muscle, especially the topline. His movement wasn’t super affected, and he still had good flexibility in his neck, although we noticed more chomping on the bit. If I remember correctly, we tried to inject the area (hard to get into the joint due to some spinal cord impingement) which showed minimal, if any, improvement. A few months later, his neurologic symptoms worsened and I felt that it was not the safest decision to ride him.
I was moving to CO anyways and busy with the new job, etc. In desperation, the horse moved with me from NC to CO. His amount of turnout drastically increased, and he got to hang out for a few months while we did some groundwork. Per the recommendation of my vet/chiropractor, I massaged his neck to loosen the muscles that he constantly held tense. On a seemingly unrelated note, we also injected his stifles for the first time… after the stifle injects, he started enjoying his neck massages and he gained more muscle just hanging out than he did when he was in work.
He now has very minimal neurologic symptoms, has a topline, is getting stronger behind, and is happy to be on the contact. We’re now working on training level/first level dressage.

tldr: horse had thoracic and cervical arthritis, injections helped for one and not the other; stall rest sucks for arthritis; biggest improvement came from increased turnout and stifle injections.

[chism]

My experience wasn’t positive. My horse was 21 when he started exhibiting neuro symptoms. It was managed over the next 18 months with steroids, accupuncture and previcox, but it continued to flare occasionally. We lost him this summer at 23.

[Goforward]

My horse had neck rads in August. He has arthritis in C 5-6-7 . He had a lot of weird acute symptoms that lead us to look at his neck but in hindsight, a lot of things had changed with him slowly over the past couple years.
He could no longer canter comfortably under saddle for more than a circle or two. It had always been his best and easiest gait. If he did have a good canter day, he would only canter left. He would pick up the right lead but do a flying change to the left in a couple strides. He also was just generally behind the leg all the time. His old self was super forward,a little on the edge of out of control. It was like someone cut the gas line to the engine. I could no longer ride him more than 3 days in a row. Day 1 was good, day 2 was ok, day 3 was more work for me than him. No point in a 4th day.
The current plan for him is Adequan and Equioxx. I started him on Equioxx daily for a few weeks and I’ve found I’m still getting good results giving it to him every second day for the past couple months. He’s a big guy so the vet recommended 1 and a half tabs as a daily dose.
I don’t think I’ll ever have my super forward horse back but he’s pretty happy for now on this plan. As it progresses we’ll decide when the time is right to inject the joints.

[IPEsq]

@Goforward That’s interesting…losing the canter under saddle is one of the first signs for my horse that the neck is becoming an issue. It’s part of a general lack of forward problem, but he is particularly reluctant to canter. And he used to be forward to borderline out of control as well.