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PSD surgery - stupid question

One of the PSD surgeries involves a neurectomy.

I know many on here commented on a recent thread regarding navicular that they were morally/ethically opposed to performing a neurectomy in those circumstances, particularly if the horse is returning to work.

Yet, from my understanding, nearly all the horseman electing for the “Fasciotomy with Plantar Neurectomy” version of the surgery for PSD are intending on bringing the horse back into work, and ideally at the level they were at prior to PSD.

Is there something I’m missing, where one neurectomy is ok, and the other is not?

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I think a lot of the hesitance from the other thread stems from:

  1. old style neurectomies were not, uh, great. They were kind of blunt, hit-it-with-a-hammer style cutting the nerve, with lots of potential for side effects. Often the nerves would regrow, so you’re back to square one, plus the inherent risks of surgery. Nowadays, we know more - we do smaller, more targeted surgeries, with larger sections of the nerve cut to limit regrowth.

  2. the ethical quandary of nerving an unsound horse for the sole purpose of continuing to use a horse when maybe they should just be retired (I’m not saying that’s what the other thread’s OP was doing, just that that’s an old issue with neurectomy). In my experience, neurectomy was historically treated as a salvage procedure, a last resort to offer the horse relief from pain. It could be used unethically (nerve the horse so you don’t have to go to all the trouble of fixing the source of pain), but it doesn’t have to be. In some ways, is daily equiox to keep a horse comfortably working all that different? I can see the argument that they are not - both have risks that need to be weighed in terms of the potential benefits.

I think one thing to consider (as I did when my FEI horse had the F&N last August for PSD, and just got the all clear to start cantering), is that PSD is often a chronic condition where inflammation of the ligament creates compartment syndrome, resulting in tremendous pain. The concern there is chronic neuropathic pain that doesn’t go away even once the inflammation is gone (which is why I opted for the neurectomy in addition to fasciotomy, even if it meant no CDIs in our future). When you see people exclaim “the neurectomy doesn’t treat anything!” they are wrong - it absolutely is a treatment for neuropathic pain. How shitty would it be to do the fasciotomy, rehab for a year, then find that the nerve has been permanently damaged, and need either the neurectomy after all or some kind of oral medication (and all the risks inherent in pharmacotherapy).

So, in my mind, both neurectomies are ok under the right circumstances. Not sure why folks from the other thread have such a bee in their bonnet about it. Pain is pain, and nowadays we have a lot of tools to deal with it, and none of those tools are perfect.

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I have nerve pain in my neck from damage from radiation. If I could nerve me, I’d do it in a heartbeat.

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Oh I’m with you! I’m all for doing whatever we can to keep horses happy and in work - when all other options have been exhausted, I’m pro-nerving 100%.

It’s just interesting to me the visceral reaction to nerving in one instance, but not so much in another. The risks appear to be the same to me, in the sense the horse could have a legitimate injury and not know it due to lack of feeling. I was just curious if there’s something I missed between the two cases that make one ok and/or ethical, but not the other.

Another thing I probably could have made more clear is where and what are you nerving - how far up or down the nerve are you targeting? An older vet who has seen the evolution of this procedure would be the best person to ask, but my understanding is we’ve gotten a lot better about more targeted, localized nerving.

Theoretically, at one extreme, you could “nerve” at the spinal cord (like an epidural) (I know you can’t really do this, it’s just a thought exercise), and then really not know if you have another injury in a limb, or you can nerve a teeny tiny little nerve in your figure in which case you would be very well aware of other injuries 99% of the time.

My understanding is that historically we’ve just nerved the bigger nerves, causing, say, most of the foot to be de-nerved. But nowadays we have more knowledge to do more targeted de-nerving, minimizing the chance of off-target effects (i.e., not knowing about other limb injuries).

Also people don’t always update their knowledge of medicine - e.g., electroshock therapy of today’s modern era is very different from what it was 30 years ago, but most people aren’t aware of that, and still see it as a brutish practice (if they know it’s being done at all). It’s similarly used as a “last resort” for people with treatment-resistant depression (i.e., like de-nerving, in some ways).

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There is some risk depending on why you are nerving. For example, I had a horse that developed foot issues. MRI was not promising. Upon discussing with my vets, they’d do stem cell treatments and hope. But said that it might not really get the horse comfortable, and if a year went by without significant improvement, I might have to consider nerving. BUT the risk could be that we might eventually have catastrophic injury to the DDFT but horse wouldn’t show lameness at a stage where maybe the worst would be preventable. Or some nerve function could return and horse back to uncomfortable. Never went down that road because he passed from colic the same day I had this conversation.

I think with PSD, the risk of catastrophe is less. And so doing risk benefit analysis, benefit tends to weigh more in favor of the procedure.

And yes, nerving was used more for caudal foot pain as kind of a big hammer at one point without resolving the underlying issue. Sometimes that’s fine if you just have classic “navicular” syndrome feet. I owned a horse that had been nerved before we got him, who had a nice long career. But maybe not so great if you have a situation where you’d have potential for something like total tendon rupture.

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