Fasciotomy & neurectomy surgery for PSD: Should I do it?

[tipzythegreat]

My horse is a 14 year old OTTB. Diagnosed with chronic proximal suspensory desmitis in December of 2018.

In the 3 years since diagnosis, he had shockwave 4 times. I consulted with Dr. Carol Gillis. I brought him back sound and he has times where he becomes NQR. I have done rounds of Adequan. I have iraped his hocks and his right stifle. I have injected his SI 2-3 times. He has a specialist farrier and gets chiropracted. He wore special suspensory shoes for months. He’s been on muscle relaxers and equioxx and had periods of stall rest. I have iced, poulticed and clear-leg painted him so many times I can’t tell you how many 10-lb buckets of poultice I’ve been through. His suspensory remained cool and tight for the last 3 years.

Workload was flat only, but working consistently in a frame. Leg yields, shoulder-ins, lengthening and some trot poles. No jumping at all since diagnosis.

The suspensory is now spongey again. He’s incredibly sore in his SI and both his stifles are filled and sore. I’ve x-rayed his stifles, and there’s nothing significant about them. He tries really hard to be straight and in a frame riding but he just can’t hold it. He gets upset when I ask him to work and I know he really hurts. He is a very cuddly and sweet boy.

Yesterday my vet examined him. She said we’ve been chasing and bandaging this for as long as we can, and ultimately the primary injury is his proximal suspensory and is causing him to be sore every where else.

She said we can do surgery: fasciotomy and neurectomy. He doesn’t have dropped fetlocks at all and she says he’s a candidate. He was 3 years ago when we first diagnosed it. I did consider it at the time.

The other options are retirement. His breeder will take him back. She’s about a 2 hour drive. I’ve had my horse for almost 6 years and he’s got me through a divorce and losing my father to cancer. He’s my best friend.

We can also repeat all the therapies and inject everything, but the cost of that would likely exceed the surgery cost.

What would you do? Did you have success or failure with this procedure? Thanks in advance everyone!

[beowulf]

No advice, just lots of jingles for you and your boy.

[tipzythegreat]

Thank you @beowolf

It’s been a really teary couple of days

[Willesdon]

He is 14 and not going to get any younger. Surgery is always risky. I would retire him as he has a good place to go to, and not so far away.

[HJdaydream]

My horse was dx’ed with the same injury 2 years ago. If I had been through the journey you have, I would retire.

My horse was dx’ed at 8 yrs old. The injury was thought to be chronic at the time, and my vet (a top sport horse and race horse vet with his own practice and surgery center) advised against the surgery. He’s not a huge believer, and doesn’t think it has a very good success rate. I was also unwilling to keep my horse on stall rest for very long, as I think it’s bad for his mental health/overall well being.

After 2 years on Dr. Green with very light riding and a conservative rehab program he is back to lightly jumping under saddle. If the injury flares again I will likely just retire him. He is 10 now. This is just my personal opinion. Sending good vibes for your guy.

[beowulf]

It’s important to note, the surgery success rate really seems to depend on the state of the feet and whether the horse can be put on “Dr Green” permanently.

[tipzythegreat]

His feet are in good shape. He had NPA that was resolved some time ago and long toes and short heels. He wears pads on his hind feet now and moves better than ever.

He’d make a lovely trail horse and can still WTC. He is happy to walk around and casually trot around. He just can’t use his body properly comfortably. He isn’t visibly lame to someone who doesn’t know him.

I don’t want to do stall rest and rehab and walking in the dead of winter. But I will do it if it means I can have even another 2-3 years with my horse. I hope that one day I can have my own property to keep him on.

But maybe it’s a pipe dream and I should let him go

[findthedistance]

My n=1, but I had a horse with a successful fasciotomy & neurectomy. He didn’t love his imprisonment, but he was perfect to rehab despite it being dead of winter.

That said, this was a horse with a mystery RF lameness that predated the PSD by several years. He was serviceably sound with creative shoeing for a while and somewhat worse when the hinds got bad enough to notice. We were hopeful that doing the surgery would allow him to use himself better again and take strain off the RF. It turned out that the PSD was masking the RF and he was more lame in front once the hinds healed. Knowing now what I didn’t know then, that lameness probably originated in his neck.

Would I do the surgery on a horse with no other issues? Yes, and likely right off the bat. Would I do the surgery on a horse with a list of other body issues that might or might not resolve after the rehab? Probably not.

[quietann]

Here is a very lengthy thread from the Eventing board:

https://forum.chronofhorse.com/t/proximal-suspensory-surgery-advice-updates-at-end/207809

The thread hasn’t been updated in a while, but has a lot of different peoples’ experiences.

My mare, one of the cases on that thread, is being retired soon, because the old injuries and poor leg conformation have caught up with her – but I got almost 11 years riding her post-surgery. She is 23 and owes me nothing.

[joiedevie99]

I did the surgery and ended up retiring the horse anyway.

[mmeqcenter]

I would retire him, myself. After having twice seen an abscess go unnoticed due to no apparent lameness in a nerved foot, resulting in bone infections and euthanasia, I’m not a fan of neurectomy.

[Gardenhorse]

@mmeqcenter

I would retire him, myself. After having twice seen an abscess go unnoticed due to no apparent lameness in a nerved foot, resulting in bone infections and euthanasia, I’m not a fan of neurectomy.

Neurectomy for suspensory injuries is very different than a neurectomy for navicular. For suspensories, the main nerve supply to the limb/foot is not affected.

My friend did a fasciotomy/neurectomy on her then 11-year old gelding two years ago. Surgery, recovery, and rehab were uncomplicated. He did get SI injections a few months after the surgery as they felt there was still some soreness there from compensating for the suspensory. He is back in full work (4th level dressage) with no issues.

They have learned that the success of the procedure depends a lot on leg conformation. I would definitely be sure to consult with a vet who has done a lot of these surgeries and understands the role of leg conformation in successful outcomes.

[tipzythegreat]

Mine DOES likely have additional body issues. He definitely has a wonky knee – but we are able to manage it… right now…

I am 100% concerned I’m going to do the surgery and he’ll continue to have mysterious issues.

[tipzythegreat]

That’s my biggest fear. Can you tell me more about the before and after the surgery for your horse?

[tipzythegreat]

I would be OK with injecting the SI even if it’s long term. Do you remember any details of the rehab?

My horse would be going up to Michigan State University. My vet has said he is a candidate as he doesn’t have any fetlock drop which would indicate weakness of the suspensory. He doesn’t have straight hocks or anything like that. We think he’s had this injury for years before I even got him (he is off the track)

[joiedevie99]

@tipzythegreat

Can you tell me more about the before and after the surgery for your horse?

It’s been a while - here’s my best recollection of the timeline. He was diagnosed with strained proximal suspensories (right much worse than left) in October. He was 10 y/o and showing small tour dressage. He was mostly sound, but felt flat. In the steep half pass for the GP you could see the lack of stepping under and across with the right hind. In hindsight, I had switched up my spurs in late August because he felt a little sulky to the leg and I think that may have been the start of it.

Also relevant - he’s a worker bee type that will never say no, and he’s a bit straighter than ideal through the hocks. During his career, his SI was always his weak spot.

Because there were no lesions/tears, we started a bit more conservative. We tack walked, injected with PRP or ProStride (don’t remember), and did some shockwave. In December/January he was looking great and we added in a few straight line trots. The first two weeks felt great, then it felt worse. His insurance coverage for the injury was running out that week. We talked options, and they felt the surgery was his best bet.

They got him in the next morning (this was January/February). We did fasciotomy/neurectomy, and also put in stem cells. Surgery itself was easy. He was in the hospital a full week because he spiked a fever after surgery, but he was eating and happy the whole time. We did suspensory shoes and many months of hand walking. During this time, I started to notice his fetlocks dropping a bit more.

We did a slow careful rehab when he was cleared to start back - months of tack walking, then 30 seconds of trot each way, then 1 minute of trot each way, etc.

He did great until about 8 minutes of trot. We injected hocks and SI to help support the muscle building process, and did another round of stem cells and shockwave. He again felt not right after a while. In the end, I shipped him to a friend for a year of Dr. Green. He babysat yearlings and had a blast. He looked great when I picked him up. Many months later, he flunked out of rehab a third time around the same point in trot.

After 3 full years of rehab post surgery at 13, I moved him to a retirement facility. I keep a snaffle and a bareback pad there and sit on him occasionally. He’s 15 now. His fetlocks are noticeably dropped - but not awful looking to someone who didn’t know him before. We he goes full out to chase his friends, he gallops with his hind legs pushing off together - so I suspect there is some minor discomfort somewhere - but he trots sound.

[tipzythegreat]

Thank you. I think this solidifies my choice to retire. I did conservative too – but he DID come sound. But it isn’t just the cost of surgery, is it? It’s injecting the SI and hocks and everything to help protect it until you realize he’s still sore and you’re out of options. And the dropping of the fetlocks post surgery is a real concern.

I appreciate you taking the time to type this out for me

[ndirish07]

I would do the surgery. I have done the surgery except the neurectomy part as my horse wasn’t a candidate for that. Feb 2020 my horse had left hind PSD and did the fasciotomy with PRP, shockwave and class IV laser. He did stall rest for 5 months, but it wasn’t pure stall rest. He was handwalked as a part of his rehab schedule, and then got some gradual time out in a 12 x 12 box that we increased in size. He just wasn’t out in the field with friends. He rehabbed beautifully and is totally sound and sounder than most horses my vet jogs out without issues-- he got the all clear a year ago in October 2020. Since, he’s back competing in dressage (first/second level) and BN eventing competing (schooling Novice and Training SJ). He remains in the toe plate suspensory shoes and hasn’t ever taken a lame step since.

The neurectomy as others as pointed out is entirely different than that done for navicular. It only affects the suspensory and no other structures in the leg.

PM me if you want more info— happy to talk about this more.

[Libby2563]

You might find this old thread of mine helpful: Neurectomy for suspensories in performance horse...why is this okay?. It mentions this study, which breaks down the surgery success rates for horses with no other issues, horses with straight hocks or hyperextending fetlocks, and horses with no other issues: https://pubmed.ncbi.nlm.nih.gov/21883416/

I did end up doing the surgery on my guy and it was very uneventful with an easy recovery. Unfortunately he did not have a happy ending because he ended up having DSLD/ESPA (confirmed by necropsy at the ripe old age of 5, ugh). I don’t regret trying the surgery though because at least I gave him a shot.

[tipzythegreat]

Thank you. I think my horse might be in group 3 as he has a bit of arthritis in his knee and we don’t know 100% this is all that’s wrong with him. He’s so sore in his stifles and SI that we suspect there may be more wrong.

How long was your rehab? If it wasn’t long or agonizing, I would consider it. I’ve just already done 6 months of 2x a day hand walks and only walking under saddle and it was miserable and depressing.