Would you all do neck rads on a PPE?

[Libby2563]

Thanks! Most of what I’d read in passing made it sound like there was an established connection to symptoms. I guess it’s not that simple!

Examples:

All You Need to Know About the Hidden C6-C7 Malformation That’s Bringing Horses Down

All You Need to Know About the Hidden C6-C7 Malformation That's Bringing...

“This study has clearly demonstrated that the L.colli muscle has altered its points of attachments and loss of function in the presence of the congenital malformation in C6 and C7. The potential ramifications are neurological dysfunction, loss of performance and potential harm to horse and rider.” (To be fair I see that this says “potential ramifications,” but it still sounds pretty scary!)

Where-have-we-gone-since-2013.pdf

[Jealoushe]

This is so interesting thanks for sharing!

[Xctrygirl]

There are 3 Equine Neurologists in the USA.

Dr. Amy Johnson - New Bolton (PA)

Dr. Steve Reed - Rood and Riddle (KY)

Dr. Monica Aleman - UC Davis (Northern CA)

Those are the folks who know the most and SEE the most.

If the tentative diagnosis was only based on UC Davis’ PNF-H test, that’s not enough to be a ‘tentative diagnosis’. If it’s after a 3 day workup with a Myelogram with CT (Performed in different ways at the 3 corresponding vet clinics above) then it’s more likely to be part of an overall suspicion. But as it’s a disease that can only (Currently) be confirmed through necropsy… there’s not a heck of a lot you can do if it’s not confirmed on necropsy. Research and testing are ongoing but we need time to get to places in the diagnostic process where we are not yet able to be.

Emily

[Xctrygirl]

What I know of the opinions in Europe are beyond disheartening. And this is from speaking to actual friends and asking questions through them to their vets etc. Not related to work.

Short version… They’re is a fair bit of ignoring all the actual evidence from the USA and some/many (?) who don’t think it actually exists. BUT… the issue might be because the “Normal” care and maintaining of horses on that side of the Atlantic is what’s directly causative of the EDM issues. You don’t have foals on acres and acres of forage. Supplementation of Vitamin E is not universal (here either) and people don’t understand what can happen when a developing brain doesn’t get the things it needs to survive and develop as intended.

They can want to call it an “American” issue, but we have just as many non-imports succumbing to it here as imports. And the imports are being put down because they didn’t get what they needed as foals. When they were there. NOT here.

Em

[Xctrygirl]

So doing surgery on ECVM without being able to correlate it to actual neuro symptoms is a bit like a red herring.

I’m not a vet but there seems to be differences on how much they believe EDM and how much we believe/ to the point of being willing to do surgery for ECVM.

Also… are they disclosing these surgeries in the sales process? The way that arthroscopies are sometimes disclosed and sometimes not?

Em

[DownYonder]

@Amberley

Others say it is all bloodlines, others say it’s a larger connective tissue issue.

Are they thinking it is related to the inheritable connective tissue defect Fragile Foal Syndrome (formerly known as Warmblood Fragile Foal Syndrome)? Or are they conflating two completely different conditions?

But wow - if it was proven to somehow be linked to FFS, that could certainly be an eye-opener.

[No1]

Is it possible that this person is confusing ECVM and CVM?

Surgery for CVM has been around for a long time. I can’t even imagine how surgery for ECVM would work? Would you shave off the transposed lamina? Somehow implant missing Michael lamella? It all sounds very complex.

[No1]

I think there is something getting lost in translation or something. This page definitely describes a surgery for horses with CVM (a Wobbler).

I suppose a horse could have both ECVM and CVM, but if it has CVM, that is definitely a widely recognized (possibly severe) neurological condition, insurance companies have covered it for a long time, and there has been surgery to correct it for a long time, as well as various management practices that may prevent/limit the progression. CVM is often associated with a certain body type in young horses.

[Xctrygirl]

100% disagree.

As you can see in this UK based page on Cervical Stabilization surgery for Wobblers, you have to add metal pieces to stabilize the neck.

https://www.rainbowequinehospital.co.uk/wobbler-diagnosis-and-surgery/#:~:text=Wobbler%20Surgery%20(Cervical%20Fusion)%3A&text=The%20surgery%20involves%20fusing%20the,surgery%20twice%20several%20years%20apart.

Additionally here is an article from a new procedure Colorado State is trying.

Again… implanting metal pieces to provide stabilization.

Experiences with a new surgical technique for ‘Wobblers’ horses | Trainer...

The link that Amberly gave us talked about removing things and given what we know of ECVM it would be the surgery to remove the things the body added where they do not belong. No mention of stabilization because there’s no mention of Spinal Cord compression which is the heart of the Wobbler’s diagnosis. And why you need to stabilize things to alleviate the compression occurring.

Em

[No1]

I’m short on time, so I’m going to summarize quickly. I can elaborate later, but:

Stenosis is narrowing which causes pressure on the spinal cord.

Cervical static stenosis is a cause of ‘Wobblers.’ Cervical vertebral instability is another.

It sounds to me that the German website is describing removing part of the vertebrae to eliminate the stenosis.

It’s a surgery for one type of Wobbler, not all types.

As I said, it’s possible to have ECVM and be a Wobbler, but I’m not sure that’s what this website is describing.

[Training_Cupid]

Back to the original question - I did not do any xrays when I bought my horse 9 years ago. He was a cheap ottb, 3 years old retiring apparently sound after 12 starts.
Now, 9 years later he just got his neck injected for mild arthritic changes, his back was fine. I doubt it would have shown up at the time of PPE. Or if it did and I decided not to buy him I would have missed out on many wonderful years.

[RiverBendPol]

If you guys want to really dive into ECVM, please check in with Pam Eckelbarger at https://www.facebook.com/groups/846796842859723. She is the premier researcher in this country, dissecting, studying, learning, teaching. She has one of my horse’s skeletons in her learning centre (He did NOT have ECVM but did have EPSM- so many initials…) And YES, knowing what I do now, I’d say definitely get neck rads. Be sure your vet knows how to get the films for C-6 and C-7. There is a method. I can’t image how surgery would possibly correct that malformation.

[RAyers]

Dear lord! As a scientist who is in spine and who studies failure in spine, the gross generalizations in horses and lack of data is astounding!

In humans we know that the 2 year outcome for ANY decompression/fusion is 80% with subsequent revisions throughout the patient’s life. I published a paper last year that describes the failure of hardware in humans is pretty close to 40% after 2 years. When I say FAILURE, I mean the patient is incapable of tolerating the presence of the instrumentation (whether it is fracture, PJK/PJF,… is irrelevant).

After 20 years with MILLIONS of human spines imaged across the world, we still can NOT define what a normal human spine is! How can one person working in equine anatomy make the claims about horses? Eckelbarger can’t and we can not make assumptions based on her work. We have several huge spine registries in AAOS, ISSG,…that seek to define what is a normal spine.

In the end, equine spine understanding is at BEST where human spine was 25 years ago.

[CindyCRNA]

So I just bought a nice OTTB mare . 5 years off the track. Absolutely a love of a mare nicely put together. Was doing a PPE at an equine clinic and asked about doing neck rads and the vet said the same thing. He said it’s not as easy to get rads where you needle to neck mass at the base (I’m paraphrasing) . He also added you can see something on rads that look awful but give the horse zero problems throughout their life. So we declined.

[MadTrotter]

Had a PPE vet say the same exact, as in, it’s really hard to get decent views of the neck in the field, and needs to be done under sedation, and then sent to a specialist. She did take, at no charge to me, a few views to look for anything truly catastrophic. I’m sure there are plenty of vets who will gladly take our $$$ and do all the views our hearts desire.

That said, I do believe in taking the “traditional”rads for a baseline, and sometimes you’re buying a complete question mark. I get passing on anything suspicious if it’s a sales horse with no chain of ownership or record you can check. But a horse you know, or your trainer knows, doing the job for years with no issues, then maybe you don’t view a few shadows quite the same way.

[MadTrotter]

@RAyers

Dear lord! As a scientist who is in spine and studies failure in spine, the gross generalizations and lack of data is astounding!

I mostly agree with this line of reasoning, and I guess the devil’s advocate argument would be, “well a huge proportion of people live with back pain, a large percentage of those report decline in quality of life and health”. And as you say, it’s difficult to extrapolate human reasons for back pain, everything from our unique evolutionary deal with the devil to give us free hands and bipedalism, as well as modern lifestyles that contribute to back pain…and compare all this with a horse.

And it’s difficult to draw the line between what imaging shows and how pain is expressed.

I think those of us who have ridden to a certain level know that all elite athletes, equine too, will have to deal with some pain somewhere along the line, and we have….decent modalities to deal with a lot of it. And some individuals have a higher pain threshold.

[Old_Mac_Donald]

I got neck rads done when I wanted to bring a horse back into jumping work. I’d had her read by an animal communicator (yeh yeh, laugh now) who said “right side of her neck hurts”. I knew this; the mare was and is super touchy about the base of her neck being touched. Doing up chest straps on her rug is a battle. Thought it was just sore muscles.

Had rads done, sent to a large clinic south for reading. “No problem”. Took the mare to one grid clinic. Was so hairy I said “I quit”. This is scary.

Mare has been just trail riding for a few years. Out of curiosity I sent the rads to Pam. Mare has missing tubercule on RH of C6.

Boom. Everyone said my horse was just strong and keen, bit her up, hold her. Poor bloody horse, and luckily for me I am a coward and quit her jumping or god knows what might have happened.

Get neck rads. Get them read by a second opinion.

My mare has never been able to consistently take the right rein. We believe her dam had it too but to a lesser extent.

[wanderlust]

@Old_Mac_Donald

Had rads done, sent to a large clinic south for reading. “No problem”. Took the mare to one grid clinic. Was so hairy I said “I quit”. This is scary.

Mare has been just trail riding for a few years. Out of curiosity I sent the rads to Pam. Mare has missing tubercule on RH of C6.

A couple years back, when my import was showing intermittent neuro signs, we sent him for a myelogram and MRI at a private clinic. The radiologist noted the transposition of c6 onto c7 and that there may be clinical signs associated with this. The major university veterinary hospital who did his initial assessment and neck rads did not note or think anything of this initially other than he had more arthritis than they would have expected at his age, but were extremely dubious that ECVM would be the cause of any issues when I flagged it for them after the MRI. He ended up having other things causing the neuro issues, but I have my laymans hypothesis that the frequent front-end tripping was more related to ECVM.

I have also had a horse whose neck arthritis caused issues over time, and another that we found had a small OCD at C7 that was the likely cause of his resistance to bend right literally from the time he was backed and was years of frustration for us both. So yeah, I do neck rads on everything now.

[TotB]

I’ve had too many wobblers in my life to not get the rads done. Those, and chips and arthritis that make them painful. At least if I know I can manage it, I think it’s worth knowing.

I just got a CT Myelogram report back from my dynamic wobbler and I’m saving up for surgery.

[SBrentnall]

I just got a CT myelogram report on my horse and it shows ECVM. And I had full neck, back and leg x-rays done 5 years ago when I bought him.