Neurectomy for suspensories in performance horse...why is this okay?

[Action42]

To clarify a small point, the nerves can regrow, sometimes they do and sometimes they don’t.

As a vet, I recommend this procedure when the horse has lameness associated with the suspensory but has very few ultrasonographic changes to the structure of the ligament. The suspensory sits between the splint bones, and when it becomes enlarged, it can be made worse by the “pinching” of the splints on either side. That is why we often do the fasciotomy to allow the suspensory somewhere to go when enlarged that doesn’t generate more pain and inflammation.

The innervation of the proximal suspensory is controlled only by that deep branch of the nerve, so you’re not “nerving” your horse in a way that a palmar digital neurectomy “nerves” a navicular horse. The horse will still have most sensation intact but it will help with the pain during rest and recovery, allowing the horse to properly load the limb and rebuild strength and help the fiber pattern of the healing injury align with the normal fibers.

[Libby2563]

Super helpful clarifications on the nerving! Thanks all!

I am still bummed that this horse is only 4 and really wasn’t working very hard (because: 4) and couldn’t even hold up to that level of work. I’m not sure if that’s a rational way to think about it or not though.

[beau159]

@Libby2563

Super helpful clarifications on the nerving! Thanks all!

I am still bummed that this horse is only 4 and really wasn’t working very hard (because: 4) and couldn’t even hold up to that level of work. I’m not sure if that’s a rational way to think about it or not though.

I hear ya. My horse Red has different problems than yours (heel pain, both front feet) that I’ve been managing since I bought him when he was 6 years old. He too had been pretty much a pasture puff and he started showing faint signs of lameness when I put him into a regular exercise program.

Denerving is an option for him too. He’s going to be 12 next year and I’ve pondered it for him. Granted, he has different things going on than your horse, but I almost feel like 12 is “too young” to start trying to manage him with denerving.

I guess just like some humans, horses are just sometimes born with “defective bodies”. :winkgrin: Sounds like he’s very lucky to have ended up with a caring owner like yourself.

So I can’t offer you any specific advice on the procedure in question, but sounds encouraging from other COTH’ers.

[2tempe]

OP I have a mare w/ hind suspensory issues that I opted to retire. But during the thinking process, I read some things about the surgery and in the interest of more info is better, thought I would share: It has to do w/ the success rate of this surgery. Here is the link https://www.ncbi.nlm.nih.gov/pubmed/21883416. Below is the relevant info; it indicates that decision maker somehow needs to fully understand what is going on w/ the horse, the cause of injury and conformational aspects.

“Follow-up information was acquired for 155 horses that had undergone neurectomy and fasciotomy for treatment of PSD between 2003 and 2008. Success was classified as a horse having been in full work for >1 year post operatively. Horses were divided into 3 groups on the basis of the results of clinical assessment and diagnostic analgesia. Horses in Group 1 had primary PSD and no other musculoskeletal problem. Horses in Group 2 had primary PSD in association with straight hock conformation and/or hyperextension of the metatarsophalangeal joint. Horses in Group 3 had PSD and other problems contributing to lameness or poor performance. [h=4]RESULTS:[/h]
In Group 1, 70 of 90 horses (77.8%) had a successful outcome, whereas in Group 3, 23 of 52 horses (44.2%) returned to full function for >1 year. Complications included iatrogenic damage to the plantar aspect of the suspensory ligament, seroma formation, residual curb-like swellings and the development of white hairs. All horses in Group 2 remained lame.”

[Spotless]

When my gelding (JUST turned 5 at the time, not worked very hard, like your mare) tore a hind suspensory, the only thing we can figure out is that he got cast in his stall. He was just lame one morning and had a scrape on his forehead.

We ended up not having surgery (it healed fine on its own) but definitely considered the neurectomy and fasciotomy for him. If it was completely healed and he was still lame, we likely would have done it. I too thought that nerving was selfish and unnecessary, until it was my horse and his quality of life. Like others have said, it nerves a TINY section, sometimes it grows back and sometimes it doesn’t, and should only be done when the suspensory is healed, but enlarged or scar tissue is pressing on the nerve and causing unnecessary pain.

My gelding was also diagnosed with navicular three years after he tore his suspensory, but once we injected coffin joints and did corrective shoeing he’s been in regular work and completely sound ever since.

[Libby2563]

@2tempe

OP I have a mare w/ hind suspensory issues that I opted to retire. But during the thinking process, I read some things about the surgery and in the interest of more info is better, thought I would share: It has to do w/ the success rate of this surgery. Here is the link https://www.ncbi.nlm.nih.gov/pubmed/21883416. Below is the relevant info; it indicates that decision maker somehow needs to fully understand what is going on w/ the horse, the cause of injury and conformational aspects.

“Follow-up information was acquired for 155 horses that had undergone neurectomy and fasciotomy for treatment of PSD between 2003 and 2008. Success was classified as a horse having been in full work for >1 year post operatively. Horses were divided into 3 groups on the basis of the results of clinical assessment and diagnostic analgesia. Horses in Group 1 had primary PSD and no other musculoskeletal problem. Horses in Group 2 had primary PSD in association with straight hock conformation and/or hyperextension of the metatarsophalangeal joint. Horses in Group 3 had PSD and other problems contributing to lameness or poor performance. [h=4]RESULTS:[/h]
In Group 1, 70 of 90 horses (77.8%) had a successful outcome, whereas in Group 3, 23 of 52 horses (44.2%) returned to full function for >1 year. Complications included iatrogenic damage to the plantar aspect of the suspensory ligament, seroma formation, residual curb-like swellings and the development of white hairs. All horses in Group 2 remained lame.”

Well, crap… I have done a lot of googling but had not found this particular study yet, thank you. According to the vet, my horse does not have straight hocks but does have hyperextension of the fetlocks. I don’t think it’s very extreme, but it’s noticeable enough that it made the vet immediately think PSD. He did say this makes the surgery less likely to be successful but did not make it sound hopeless, like this study does. I don’t think I have particularly good alternatives and I feel like I have to try something since he’s a young, wonderful horse.

If I may ask, did you choose to retire your mare because she fell into one of the groups where surgery is less likely to be successful?

[2tempe]

OP - My mare was diagnosed w/ suspensory desmitis in both hind legs - “possibly” degenerative. This is one of many things she (and I ) have dealt with: Two colic surgeries, one case of enteritis, one case of “wither trauma” which caused her much pain and 8 weeks of nothing on her back, did I mention the stifle inflamation? She is now pushing 16 and I replaced her as my primary dressage horse after missing 3 yrs of showing. She was on lease for a year to a lower level rider, and had come back maybe 5 months prior to this diagnosis. I opted for retirement given the iffy prognosis, the long rehab, the amount of $ I’ve already put into her and the fact that she is not my primary horse. At the moment she’s happy and not noticeably unsound as she flits around the pasture…

[Samantha37]

@Action42 thanks for clarifying!!
I will say that my horse has quite good conformation - not perfect but hind limbs and pelvis are incredibly well put together, so that I’m sure had a hand in our positive outcome.

[findeight]

@Libby2563

I know these aren’t proper conformation shots, but they’re what I have on my phone at the moment. Can anyone comment on the degree of fetlock hyperextension here?

I’ve been watching videos of him trotting in slow-mo too and it doesn’t look much more flexion of the joint than most other horses. Look at this pic of Blue Hors Matine: https://countryrebel.com/blogs/videos/65991811-the-horse-starts-trotting-what-happens-next-will-blow-your-mind (note the comment: “The horse’s ability to memorize this dance and do it so well is amazing! We’ve never seen anything like it!!” :lol:).

Um…is he wearing boots here? Probably be best to pose him for a conformation shot, can’t tell much off these.

[TequilaMockingbird]

My 8 year old mare just had this exact surgery this morning on both hind legs. She was diagnosed in June with blocks, xrays and an ultrasound at Texas A&M. They would have also preferred an MRI but I opted against it because the MRI cost nearly as much as the surgery itself and requires full anesthesia. She went totally sound in both hind legs with the suspensory block.

She had enlargement in both right and left ligaments and a lesion on the right based on the ultrasound findings. She was put on stall rest for 6 weeks and then limited turnout for the remainder. I had two followup ultrasounds done to confirm that both ligaments had fully healed. They required them to be fully healed before doing surgery.

I went ahead with the surgery as it is likely to become a chronic issue without the surgery. The vets told me that once the ligament has been damaged, which causes enlargement, it stays permanently enlarged. That is the point of the fasciotomy, to give the ligament more space.

The surgeon (not the same vet that diagnosed her) did a brief lameness exam when we dropped her off yesterday. He said he will not perform the surgery on any horse that shows dropping in the fetlock. He said it may indicate underlying weakness in the ligament that the surgery cannot fix.

[Libby2563]

@"findeight

Um…is he wearing boots here? Probably be best to pose him for a conformation shot, can’t tell much off these.

Well, in one of the three photos he’s wearing front bell boots but that’s it.

Tequila, thanks for sharing your experience! I hope all goes well with your girl!!

@TequilaMockingbird

The surgeon (not the same vet that diagnosed her) did a brief lameness exam when we dropped her off yesterday. He said he will not perform the surgery on any horse that shows dropping in the fetlock. He said it may indicate underlying weakness in the ligament that the surgery cannot fix.

That makes sense to me too. I’m just not sure what is considered a dropped fetlock, honestly. A lot of the photos online are so extreme (and terrifying) that it’s hard for me to tell how my horse compares to a more mild case. I think I kind of just have to trust that the vet wouldn’t do the surgery if he didn’t think it was the best option, you know? I have a lot of respect for him based on past experiences.

[Montanas_Girl]

@Libby2563

I know these aren’t proper conformation shots, but they’re what I have on my phone at the moment. Can anyone comment on the degree of fetlock hyperextension here?

I’ve been watching videos of him trotting in slow-mo too and it doesn’t look much more flexion of the joint than most other horses. Look at this pic of Blue Hors Matine: https://countryrebel.com/blogs/videos/65991811-the-horse-starts-trotting-what-happens-next-will-blow-your-mind (note the comment: “The horse’s ability to memorize this dance and do it so well is amazing! We’ve never seen anything like it!!” :lol:).

Your guy’s hind pasterns do look long/weak. If the vet has mentioned “hyperflexion”, he’s probably hinting at ESPA (formerly known as DSLD). I don’t want to scare you, but, if that is the case, the prognosis is not good. I just lost a horse to this awful disease, and he did NOT have fetlocks that looked like your horse’s until very, very late in his life. You can read more information about ESPA in this article: https://www.thehorse.com/(F(tOTIdk-Bc1amWNVfRLwa2aKPQhVclry1h1l_lLpqhbxoTzCMBIMCcVWzYrzX0U_mIP4IsS_-Bxq50KvGq3aarQ24liQmys3agwrLo55e5Fp2WShL6QEkVgHpunG1zLBNnqe-D_oiWeyGfoadM3LNtvWga3OApNPLSiwYPK_EGapnFqRuq4Z7hMUoZ3icDr3EWRwahw2))/articles/24705/degenerative-suspensory-ligament-desmitis-update.

I considered the surgery you initially asked about for my horse. I decided against it because, at the time, he was 19 and semi-retired due to a previous front limb injury and Cushing’s Disease. Had he been a younger horse, I would have done the surgery. As others have mentioned, this isn’t the same as the kind of neurectomy performed on Navicular horses. Hind suspensory injuries are incredibly difficult to heal, so every little thing that can help is worth trying!

[quietann]

Had this done on the LH for my little mare back in 2010. The neurectomy was just part of the package to get the best possible result. She definitely has straight hocks, no fetlock drop at all though. I would say her recovery was to ~90%. With a lot of maintenance, she’s remained reasonably sound; for showing, I would not have gone recognized as the chances of her being “a little off” were too high, and the standards for soundness are probably higher at a recognized show than a schooling show. It’s been frustrating at times, but would have been way more frustrating if I had not also been hurt and subsequently reduced my competition aspirations for her.

[halt]

Do you have better confo pictures OP? Taken straight from the side, with no sun glare, or tail or boots obscuring the legs? I don’t see dropped pasterns from the pictures but he is straight behind from what I can make out of the shadows.

Before you do the surgery I would do a nuchal biopsy to 100% rule out ESPA/DSLD.

[Libby2563]

@Montanas_Girl

Your guy’s hind pasterns do look long/weak. If the vet has mentioned “hyperflexion”, he’s probably hinting at ESPA (formerly known as DSLD). I don’t want to scare you, but, if that is the case, the prognosis is not good. I just lost a horse to this awful disease, and he did NOT have fetlocks that looked like your horse’s until very, very late in his life.

So I actually asked the vet directly about DSLD and he said he would not worry about that. That hasn’t entirely stopped me from worrying, but… (Also don’t know why a vet would hint at something like that rather than just coming out and saying it?) He thinks the hyperflexion is just a conformational feature, exacerbated by his size and the fact that he’s been barefoot (he will get shoes all around after the surgery).

I was thinking about asking for a biopsy anyway, to ease my mind if nothing else. The impression that I got from some reading was that it’s not conclusive but the UGA info does make it sound like they can give a pretty solid yes or no.

@halt

Do you have better confo pictures OP? Taken straight from the side, with no sun glare, or tail or boots obscuring the legs? I don’t see dropped pasterns from the pictures but he is straight behind from what I can make out of the shadows.

Before you do the surgery I would do a nuchal biopsy to 100% rule out ESPA/DSLD.

Funny, the vet specifically said that he does not think he is straight behind, though I can see why you’d think that from at least one of the photos. I guess they were a waste of time to post after all but this has been all I can think about for days and I thought anything would be better than nothing (I was at work when I posted the pics so I couldn’t get better ones).

[Busygalincal]

I’ve read the whole thread and was wondering if any or all of this information can also apply to a front leg suspensory? I have a horse who has had a great performance career and the vet recommended this surgery, but on the front leg. This horse has straighter, shorter pasterns and the vet thinks all the wear and tear is cumulative and this horse has had an ongoing suspensory issue that has always been managed, but now it’s getting worse. All the research I found only talks about hind limbs. The vet says they have done many Grand Prix jumpers, front legs, which surprised me.

[the_sandiest_shoes]

I’m facing this diagnosis with my 8 year old and this is the first semi hopeful thing I’ve seen all week. Will DM you once I get the ultrasound done (we came to this diagnosis after a frustrating six weeks of rabbit holes with the vet and US is another delay because of availability / not wanting to exam after blocking).

[Libby2563]

Wow, it’s weird/sad to see this thread again. I did do the neurectomy with zero improvement. Less than a year later I had to euth due to his discomfort. He was actually lame on both hind legs and his left front, which was diagnosed by MRI as a collateral ligament injury and didn’t respond to shockwave and stall rest with handwalking. Postmortem confirmed that he had DSLD, despite the surgeon’s assurances when I asked about it pre-op that he “wouldn’t worry about that.” Definitely lost a lot of faith in vets that year, and a really wonderful young horse too. More here: DSLD "diagnosis" in young, lame horse -- UPDATE post 130, he's gone

@the_sandiest_shoes, wishing you better luck with your horse! I know there are more threads out there with personal experiences about suspensory neurectomies. Do read the study @2tempe cited also.

[SummerRose]

Thank you for sharing your experience again, @Libby2563. I missed these threads the first time around.

I’m very sorry it did not work for your gelding but I appreciate the knowledge and experience you’ve shared.

[the_sandiest_shoes]

Oh god - I’m so so sorry.

I’m actually terrified this might be the case with mine too . Also Hanoverian but coming 9 - there are some other things about her that make me wonder, like the fact her LF has forever been swollen above and often below the fetlock. I will ultrasound the heck out of all legs and ask them to check for this specifically - she has only now been truly lame but since I’ve gotten her at 5, has been intermittently unhappy under saddle.