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Tie-back surgery...the good, the bad, the ugly

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  • Tie-back surgery...the good, the bad, the ugly

    My 10yo gelding is a roarer. He was a rescue horse and is now back to full health and is fit as a fiddle.

    I have been putting off tie back surgery more or less because until he got up to weight and fit i really had no idea what kind of horse I had. Now that I know I have a GREAT one, I am considering it.

    I want to hear all of your experiences...the good, bad, ugly...did it work, did it not work, etc.

    He is insured. Also, if anyone can recommend a clinic/vet in N. GA that would be great.

    My vet can scope him but doesnt have the facility to do the surgery and I really dont like the 2 vets she recommended.
    Never Ride Faster Than Your Guardian Angel Can Fly
    Way Back Texas~04/20/90-09/17/08
    Green Alligator "Captain"

  • #2
    I don't have personal experience, but my husband's horse is a roarer. He was training for the track, they did either tie-back or tie-forward, and it didn't work. Then, he was a young girl's hunter, but he was roaring, so they did the opposite surgery of the one already done, and it didn't work

    It's a good thing for us, though, because we got a free, fabulous horse for my husband

    Good luck with your guy. Is he so bad that it affects his athleticism? If not, and you aren't doing a sport where roaring matters, you might want to just let him be.
    "If you can't feed 'em, don't breed 'em."


    • #3
      Bumping up; I have the same questions!


      • #4
        I have never seen one that worked....
        "You can't really debate with someone who has a prescient invisible friend"


        • #5
          I understand there are two ways - the tie back and the lasered one. I believe these days the lasered one is the preferred method because (and this came from a vet), the tie backs do tend to loosen over time and will likely need to be redone.

          I've actually heard more success stories w/the surgery (either tie back or laser) than not.

          "If you have the time, spend it. If you have a hand, lend it. If you have the money, give it. If you have a heart, share it." by me


          • #6
            I have a horse back in the States (for sale actually) that is a roarer. It never bothered me and it doesn't bother him (he evented and now is on his way to being an upper level dressage horse) so we never did it. I heard all of these things about how complicated it is to feed/stable your horse afterwards that it didn't seem worth it. On the other hand, I rode a horse here that had the tie back surgery and he doesn't roar but his whinny sounds completely wheezy and ridiculous! It seemed to have worked but I never heard how he sounded before.


            • #7
              I only personally know of one and it didn't work. Friend did the tie back (at very good vet school) and horse returned to roaring within a year. I think the new owner did the other surgery. I saw the horse show this summer--definitely roars. Also stiff in the neck, which may or may not be related...
              DIY Journey of Remodeling the Farmette: http://weownblackacre.blogspot.com/


              • #8
                Originally posted by mroades View Post
                I have never seen one that worked....
                By "worked" do you mean taken away the sound, or improved airway function?


                • #9
                  either...the ones I know that had the laser procedure just flat out didnt work, and the ones that had the tie back also didnt work...and a couple of them have gone on to have serious complications.

                  To me its not worth the risks..
                  "You can't really debate with someone who has a prescient invisible friend"


                  • #10
                    Dr Cheetum at Cornell does a "tie front" that he came up with.It's supposed to be quite the success.


                    • Original Poster

                      It does seem as though I have heard of more surgeries that didnt work or ones that resulted in complications afterward than of ones that did work.

                      My bet has recommended a vet at Auburn should I decide to go ahead.

                      He is getting scoped next week, so once we have that we will be able to better decide, I am just trying to arm myself with as much info as I can.

                      My horse does it when galloping on his own in his field...head carriage does not matter in his case. It does get louder the more tired he gets or the more hot and humid it is.

                      Some judges have not cared and not dinged us because of it and some have, so thats a toss up.
                      Never Ride Faster Than Your Guardian Angel Can Fly
                      Way Back Texas~04/20/90-09/17/08
                      Green Alligator "Captain"


                      • Original Poster

                        This is some info my Vet sent me this evening:

                        Sent from the Diagnostic Imaging Atlas Page 1 of 3
                        Phone: a
                        Whistling and Roaring in Horses
                        The terms 'whistler' and 'roarer' are used to describe horses that make an abnormal respiratory noise
                        during exercise. The noise is heard during inspiration (i.e., breathing in) and may be anything from a high
                        pitched soft whistle to a harsh 'roar'.
                        What causes the noise?
                        With each breath, air is taken in through the
                        nostrils and passes via the nasal passages to the
                        throat (pharynx), which is a dynamic and
                        muscular tube. From here it passes through a
                        cartilaginous valve, the larynx, before entering
                        the windpipe (trachea) and lungs. During
                        exercise, the nostrils dilate and the horse
                        extends its head and neck, further opening the
                        pharynx and larynx to take in more air.
                        Anything that interferes with the smooth
                        passage of this increased airflow may result in
                        the horse making an audible noise and
                        performing poorly.
                        Laryngeal hemiplegia (one-sided paralysis) is the most common cause of horses making abnormal noises
                        during inspiration at fast exercise. The noise is caused by partial or total paralysis of one (usually the left)
                        side of the larynx. The condition occurs mainly in larger horses with long necks, because it is thought that
                        this conformation can predispose to injury to the long nerve (recurrent laryngeal nerve) that opens and
                        closes the left side of their larynx. Nevertheless, it can be seen in smaller horses and ponies, either
                        spontaneously or following a perivascular injection or other injury to the nerve.
                        In mild cases the noise may only be heard during strenuous exercise but in severe cases the noise may be
                        heard even during trotting. Exercise intolerance (i.e., getting tired quickly) may be a feature of the disease
                        as the horse often has difficulty inhaling enough air through the incompetent larynx. The condition is
                        usually progressive and worsens with time. In a horse with severe paralysis, the laryngeal airway may
                        collapse during strenuous exercise causing severe respiratory embarrassment.
                        How can the diagnosis be confirmed?
                        Your veterinarian will listen to your horse exercising on the lunge and, if necessary, while ridden at fast
                        exercise, in an attempt to hear an abnormal inspiratory noise. This will usually be followed by an
                        endoscopic examination, i.e., a flexible endoscope is passed through the nose, into the pharynx, to look at
                        the larynx as the horse breathes. Both sides of the larynx should open and close completely, symmetrically
                        and in synchrony. In an affected horse, usually the left side of the larynx moves sluggishly and
                        incompletely, 'hanging' into the larynx and obstructing air flow. In the most subtly affected horses, an
                        endoscopic examination may need to be performed while the horse is exercising on a high-speed treadmill,
                        Whistling and in Horses
                        Sent from the Diagnostic Imaging Atlas Page 2 of 3
                        in order to confirm the diagnosis. To make matters more confusing, the endoscopic appearance of the
                        larynx of some horses appears to vary from time to time, for these, multiple examinations may be required
                        with opinions from more than one experienced veterinarian, before a final diagnosis can be made.
                        What treatment is available?
                        Horses used for hacking or less strenuous work can often
                        cope without treatment. It is important to keep their
                        respiratory tract healthy, particularly avoiding infections
                        and allergies by good management (i.e., low dust, good
                        ventilation, proper vaccination regime etc.).
                        In moderately affected cases, a surgical procedure may
                        help although the paralysis as such is incurable. The most
                        simple operation that is known as "Hobday's operation"
                        involves the removal of a piece of laryngeal tissue
                        (laryngeal ventricle and vocal cord) which streamlines the
                        laryngeal airway, improving the passage of air. Although
                        this is conventionally carried out with the horse under a general anesthetic, it can also be performed with
                        the horse in the standing position, under a local anesthetic using a laser. In more severe cases, this
                        relatively simple operation is much less effective and a 'tie-back' operation is often recommended. This
                        more elaborate operation places special sutures in the paralyzed side of the larynx to pull and hold it open.
                        A 'Hobday' operation is often performed at the same time so that the resulting internal scar additionally
                        helps to hold the paralyzed side open, even if the sutures fail to retain their strength over time.
                        In a horse in which a "tie back" has failed, or is not an option for other reasons, a brass or plastic
                        tracheotomy tube may be inserted into the windpipe to allow air to bypass the larynx completely. The
                        tracheotomy tube and wound must be carefully managed and removed and cleaned daily, to prevent
                        infection and secondary complications. The tube is very visible and many people understandably find it
                        unacceptable for aesthetic reasons. More importantly it is not a very aerodynamic solution to this tricky
                        What other conditions cause horses to make abnormal noises during
                        There are several other conditions that may cause a horse to make an abnormal inspiratory noise.
                        1. Lymphoid hyperplasia is a term used to describe a condition where lymphoid (immune) tissue lining
                        the pharynx becomes inflamed and nodules form. It is a condition affecting young horses and most cases
                        improve with age.
                        2. Soft palate displacement is a disease that usually affects racehorses and causes a "gurgling" noise
                        and severe exercise intolerance usually near the end of a race. It can be difficult to confirm endoscopically
                        and requires examination during treadmill exercise. A variety of surgical treatments are available for this
                        frustrating condition but most of them only carry a modest success rate.
                        3. Cysts (fluid-filled sacs) may form beneath the epiglottis. The epiglottis is a triangular cartilage at the
                        base of the larynx that usually sits on the floor of the pharynx during breathing. Its job is to prevent food
                        material from going down 'the wrong way' i.e., down the wind pipe. If a cyst forms under it, the epiglottis is
                        pushed up and it obstructs the opening of the larynx causing a noise. Large cysts require surgical
                        How can be confirmed?
                        Sent from the Diagnostic Imaging Atlas Page 3 of 3
                        treatment to remove them.
                        4. Infections, tumors etc., in the nostrils or nasal passages may result in the horse making an abnormal
                        5. Epiglottic entrapment is a term used to describe a condition where the epiglottis is trapped under an
                        abnormal fold of tissue that causes a noise. Treatment consists of cutting the abnormal tissue and is
                        performed with the horse either standing under a local anesthetic or under general anesthesia.
                        6. Congenital problems are conditions of the pharynx and larynx that are present from birth. An
                        abnormally narrow pharynx may narrow the airway and may result in a horse making an abnormal noise.
                        Abnormalities causing displacement of supporting structures of the pharynx may have a similar effect. In
                        general terms, these conditions cannot be treated.
                        What should I do if I think my horse is a whistler or roarer?
                        If your horse has started to make an abnormal noise while breathing, you should ask your vet to examine
                        it. Your veterinarian will need to hear the noise so it will be necessary to ride or lunge the horse. After
                        performing a general clinical examination, to help rule out other illness, an endoscopic examination should
                        reveal most of the conditions described above and is the best way to diagnose diseases of the nasal
                        passages, larynx, pharynx and windpipe. In cases that are marginally affected or where the diagnosis
                        remains unclear, it may be necessary to have the horse scoped during fast exercise on a treadmill. This
                        can only be performed at a small number of specialized centres but may be very useful in racing or
                        eventing horses that are suffering from marginal loss of performance.
                        Most experts agree that laryngeal hemiplegia, or at least the conformational predisposition to it, is a
                        heritable condition.
                        Never Ride Faster Than Your Guardian Angel Can Fly
                        Way Back Texas~04/20/90-09/17/08
                        Green Alligator "Captain"


                        • #13
                          I don't even want to know what respiratory embarassment is but I would never do a tie back unless absolutely necessary. If he is able to do the job you want him to do I would let it go. There are a lifetime's worth of complications that come with the procedure. They are very prone to aspiration pneumonia.
                          McDowell Racing Stables

                          Home Away From Home


                          • Original Poster

                            I REALLY do appreciate everyone being so HONEST about this. I have received so much information and input from PM's and emails...it really is great to hear from those who have been through this!!!

                            At this point, I figure I will get him scoped...that wont hurt to do at all and then I will have a positive diagnosis. If its just a career change...from hunters to jumpers, then that's fine, I can live with that. I in no way want to put him in ANY danger, or waste $$$$$ for that matter.

                            Thanks again!!

                            Here is a video from a show...you can actually hear him (over my trainers directions!) This was his last class and it was so stinking hot!

                            Never Ride Faster Than Your Guardian Angel Can Fly
                            Way Back Texas~04/20/90-09/17/08
                            Green Alligator "Captain"


                            • #15
                              Your horse looks very sweet!

                              So I have personally had good luck with tie back surgery. I have a hunter that had one like 7 years ago not long before I bought him. I don't know what procedure he had done (it was done in Europe) but it has not affected him at all.

                              All that being said, particularly for a horse competing in a sport where roaring isn't an unsoundness, I'd be more concerned with respiratory function than the actual noise. If you are feeling like he is not able to breathe as well as he needs to then I'd consider surgery but I'd not do the surgery just to treat the noise. You don't always eliminate the noise and there are complications that of course can arise, so there needs to be a big benefit to the quality of life and function of the horse to consider it. Scoping and a stress test is a good place to start


                              • #16
                                I have only had any contact with a tie back twice.

                                Once was an OTTB who had it done when he was 12. It didn't "take" and he immediately went back to roaring. No complications, just didn't work.

                                I own a horse that had a tieback when he was younger. No side effects. Worked perfectly. Doesn't roar. Needs no special maintenance. Only visual evidence is a tiny scar behind his ear.
                                "The Son Dee Times" "Sustained" "Somerset" "Franklin Square"


                                • #17
                                  Does your guy really need the surgery?

                                  My young guy was a mild grade 1 roarer and did not have the surgery, but you couldn't hear him much unless he was nervous or really unfit... Was never an issue.
                                  View my photographs at www.horsephotoguy.zenfolio.com


                                  • #18
                                    Just vetted one that had the surgery and it had completely failed.


                                    • Original Poster

                                      He is getting scoped on Tuesday, so I will know more then. At this point I dont know what grade he is or how restricted his air flow is.

                                      My main goal is to keep him happy and healthy...if its as simple as a move from hunters to jumpers great, if it means no heavy work, then I'll deal.

                                      Just to give you more info about this horse, this was him when I brought him home in March:


                                      This was him at the show Sunday...

                                      Never Ride Faster Than Your Guardian Angel Can Fly
                                      Way Back Texas~04/20/90-09/17/08
                                      Green Alligator "Captain"


                                      • #20
                                        If he is doing what he is doing in the second pic comfortably, no way would I do the surgery. He looks awesome by the way.
                                        McDowell Racing Stables

                                        Home Away From Home