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A slew of neurectomy questions. Please post if you've had experience!

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  • A slew of neurectomy questions. Please post if you've had experience!

    Obviously posted under an alias because it's a bit of a touchy subject. I have a very nice horse that has been battling a problem in one of his front feet. My very good vet, who I trust, has suggested that a neurectomy might be the best option. The vet also told me, which I was surprised to hear, that the nerves usually regrow and the procedure might have to be done every year or more! That was news to me, and perhaps I'm only remembering neurectomies from my childhood which were a different procedure?! I associated a finality with nerving. Hence this post... I am very curious to hear, good and bad, from those who had had the procedure done...

    1. Did you experience regrowth of the nerves/did the horse regain feeling in his foot and experience pain?

    2. How quickly did that happen?

    3. What was the reason for the neurectomy (what diagnosis of disease for the horse)?

    4. How old was the horse when the neurectomy was performed?

    5. Did the horse return to work? If so, was it the same level as before/after the neurectomy?

    6. Did your horse experience any complications?

    7. Did you have the standing or fully sedated version of the surgery?

    8. Where did you get it done?

    9. Did you do a second (or third or fourth) neurectomy following regrowth, and did you have success with that surgery?

    10. Roughly, what was the cost for the surgery.

    Thank you in advance. This is a really hard decision and it's difficult to get information that is down-to-earth. I know this is just anecdotal, but I want to hear from COTHers how things have gone for them. I am hoping to get a really wide range of honest experiences to inform my decision.
  • Original Poster

    #2
    Nobody? I searched the archive and saw lots of past threads with posters whose horses had neurectomies but a lot of those didn't have the specific information I was wondering about (most significantly-- regrowth). Anyone?

    Comment


    • #3
      Originally posted by CothAlias View Post
      1. Did you experience regrowth of the nerves/did the horse regain feeling in his foot and experience pain?

      2. How quickly did that happen?

      3. What was the reason for the neurectomy (what diagnosis of disease for the horse)?

      4. How old was the horse when the neurectomy was performed?

      5. Did the horse return to work? If so, was it the same level as before/after the neurectomy?

      6. Did your horse experience any complications?

      7. Did you have the standing or fully sedated version of the surgery?

      8. Where did you get it done?

      9. Did you do a second (or third or fourth) neurectomy following regrowth, and did you have success with that surgery?

      10. Roughly, what was the cost for the surgery.
      1. No
      2. N/A
      3. Chronic heel pain not manageable with any of the usual interventions. Exhausted shoeing options, and repetetive nerve blocks were the only thing that did work. Underlying pathologies that would have disqualified him as a candidate were ruled out.
      4. 15 or 16? Having a hard time remembering. It's been 5ish years ago. maybe 6.
      5. Sort of. Prior to the neurectomy, horse was lame at the walk even just turned out to pasture, and thus had been retired before the procedure. Procedure was basically a "last resort." I have ridden him and do still ride him today, but he has not returned to competition. That is not related to soundness though. He has mental issues and I have a lack of time, but soundness is not the reason he is no longer competing.
      6. None
      7. Standing
      8. I'll PM if you want that info, but I would recommend that you go to a highly experienced vet for this. It is my own personal opinion that the technique used can minimize the risk of complications down the road.
      9. No, and the vet that performed the neurectomy did not tell me that nerves may regrow and/or reconnect and that the surgery may have to be repeated. I have heard that from other sources but not from the vet who did the surgery.
      10. A couple hundred per leg. The vet I used will only do them bi-laterally. It involved an overnight at the hospital, but was definitely under $1k.

      Additional thoughts/considerations:
      My vet did tell me that a very real consequence of this procedure is rupture and complete failure of the DDFT. If that happens the horse is euthanized. Usually, that is due to pathology (ragged navicular bone sawing away at the tendon, and the lack of pain resulting from the neurectomy allowing the horse to move more and accelerate that shredding process). Obviously if that is an underlying issue you shouldn't do the surgery, and your vet wouldn't recommend it. However, the vet did tell me that it can and did happen without that pathology present.

      Aftercare was minimal. Stall rest for a few weeks and paint the sutured area with a mixture of DMSO/cortisone 2x a day (vet said this was to reduce the risk of neuromas...perhaps it was just something for me to do while he was on stall rest?), wrapped for the first week to keep clean.

      The procedure can be a little bit of a crapshoot just by the nature of nerves. If there is a branch of the nerve just above where the surgeon makes the cut, obviously the horse may still have feeling and the procedure won't be successful. Of course they don't want to cut too aggressively and leave the horse with too little feeling in the hoof. Again, I think this is where a very experienced surgeon can help to reduce the risks, but you should be aware this could happen.

      My horse does not trip or stumble and has feeling in his feet. He is and has been sound since the procedure, and I do credit the neurectomy with my being able to transition him to being barefoot which was necessary to undo some damage done by years of bad shoeing.

      I didn't expect it to be a miracle, but it did help my horse go from being a head-bobbing lame pasture pet to a serviceably sound animal. He obviously still suffers from age-related deterioration (hock/knee arthritis) but he is still going strong at 20 years of age.

      Comment


      • #4
        RF annular ligament cut 18 months ago...done standing...no complications, no regrowth, horse has returned to same level as prior to the surgery...so far so good.

        Comment


        • #5
          An older gelding (I think 20) at a barn I worked at had 2 neurectomies. He was standing for #2...I was holding him and I passed out. The whole plan was to keep the horse sound and comfortable without bute. Well, the plan failed and he had to be put back on bute for maintainence in order to be sound for light riding shortly after he recovered from the neurectomy. Basically, they could have just kept going with the bute and skipped neurectomy #2. The owner spent the $ and was right back where she started before the neurectomy.

          At the same barn, another older gelding was a fancy adult eq horse turned school horse. He had a neurectomy and was able to perform as a low key lesson horse ridden mostly walk trot 5x/week.

          Still at the same barn, a former 3' hunter by the time I arrived. I knew the mare as a 5 year old & she had lameness issues. Eventually, she had a neurectomy, went back to showing, another neurectomy, back to showing....and so on, and so on. By the time the mare was a teen, I do not know how many surgeries she had, but she did not stay sound with any work. She foundered.

          I don't know anything about price. These are just the horses I experiences I had. Hope I was able to offer some help.
          Good luck
          Beth

          Comment


          • #6
            Originally posted by CothAlias View Post

            1. Did you experience regrowth of the nerves/did the horse regain feeling in his foot and experience pain?

            2. How quickly did that happen?

            3. What was the reason for the neurectomy (what diagnosis of disease for the horse)?

            4. How old was the horse when the neurectomy was performed?

            5. Did the horse return to work? If so, was it the same level as before/after the neurectomy?

            6. Did your horse experience any complications?

            7. Did you have the standing or fully sedated version of the surgery?

            8. Where did you get it done?

            9. Did you do a second (or third or fourth) neurectomy following regrowth, and did you have success with that surgery?

            10. Roughly, what was the cost for the surgery.
            1 & 2) I've heard from one vet that the nerves DO grow back and from another that it's impossible, so quite a big debate among professionals. My QH remained quite sound for about a year until he developed DSLD.

            3) navicular syndrome

            4) 15

            5) W-T-C and trail sound. It was my decision to not return him to the same level of work as before, but he could have done it.

            6) No complications whatsoever.

            7) fully sedated

            8) Quakertown Vet Clinic

            9) No

            10) Seven years ago, I think around $700.

            Comment


            • #7
              I will answer from a therapeutic farriers standpoint,familiar with a number of denerved horses, rather than horse owner who owned a horse that had one.
              Obviously posted under an alias because it's a bit of a touchy subject. I have a very nice horse that has been battling a problem in one of his front feet. My very good vet, who I trust, has suggested that a neurectomy might be the best option. The vet also told me, which I was surprised to hear, that the nerves usually regrow and the procedure might have to be done every year or more!
              There are various ways to do the procedure and one in particular,developed in California years ago, is supposed to lessen the chance for regrowth. It is where a section of the nerve is stripped out.

              1. Did you experience regrowth of the nerves/did the horse regain feeling in his foot and experience pain?
              I have known a couple (out of maybe a couple dozen I have been familiar with) that had regrowth or worse yet grew very painful neuromas at the surgery site.
              2. How quickly did that happen?
              one to three years after initial surgery.
              3. What was the reason for the neurectomy (what diagnosis of disease for the horse)?
              Everything from so called "navicular syndrome"(which can be due to anything in pain around the navicular area of the foot) to actual navicular disease involving severely deteriorated navicular bones.

              4. How old was the horse when the neurectomy was performed?
              I have known horses as young as ten or so and much older, twenties.
              5. Did the horse return to work? If so, was it the same level as before/after the neurectomy?
              Some did . some didn't.

              6. Did your horse have complications?
              Most had complications later on. Everything from regrowth of the nerves , neuromas, deep flexor tendons detaching from the coffin bone, infected tendons, to serious recurrent abscesses. sloughed hooves. dead horses.


              7. Did you have the standing or fully sedated version of the surgery?

              8. Where did you get it done?
              Obviously because I am talking about multiple cases I can not answer these.
              9. Did you do a second (or third or fourth) neurectomy following regrowth, and did you have success with that surgery?
              I know a couple that had second surgeries with mixed to poor results.
              10. Roughly, what was the cost for the surgery.
              cant say.

              Thank you in advance. This is a really hard decision and it's difficult to get information that is down-to-earth. I know this is just anecdotal, but I want to hear from COTHers how things have gone for them. I am hoping to get a really wide range of honest experiences to inform my decision.

              Based on what I know and have seen first hand about navicular syndrome and neurectomies, the ONLY horse I would ever consider it on is a fully retired horse with diagnosed severe deterioration of the bone itself. I would do it only to make the horse a more comfortable pasture pet. When you see an Xray of a denerved hoof where the flexor tendon has severed, or torn completely off the bottom of the coffin bone, and seen the results of that, then you have seen what can happen on a denerved horse who is still being worked. I have seen too many disasters from neurectomies to recommend one on any horse who is expected to continue in work. The sad thing is that there is SO much that can be done with trimming and shoeing to help these horses. And even sadder is that some vets haven't a clue that improper foot trimming and improper shoeing, sometimes from extremely experienced and expensive farriers, is the cause in the first place.

              As well as improper riding. Toe first landing is a huge contributor and that is one reason why so many WP barns are doing so many joint injections every year and have so many"navicular" horses. it's sick what that kind of riding does to them.
              Patty Stiller CNBBT,CNBF,CLS, CE
              Natural Balance Certified Lameness Specialist ,instructor.
              www.hoofcareonline.com

              Comment


              • #8
                1. Did you experience regrowth of the nerves/did the horse regain feeling in his foot and experience pain?


                No.

                2. How quickly did that happen?

                Didn't. Horse nerved at 19 and was put down at 25 due to a pasture injury.

                3. What was the reason for the neurectomy (what diagnosis of disease for the horse)?

                The horse was lame. X-ray's show navicular changes and blocked sound. Decision was made to nerve him when he wasn't eating due to bute. In long run cheaper to have the surgery then due to the cost of the drugs.

                4. How old was the horse when the neurectomy was performed?

                19
                5. Did the horse return to work? If so, was it the same level as before/after the neurectomy?

                He was retired but not due to the navicular disease but due to suspensory injuries but was ridden the day before the accident.
                6. Did your horse experience any complications?

                No.
                7. Did you have the standing or fully sedated version of the surgery?

                Standing.
                8. Where did you get it done?

                Cleveland. PM if you want name of Vet.

                9. Did you do a second (or third or fourth) neurectomy following regrowth, and did you have success with that surgery?

                No regrowth 6 years in.
                10. Roughly, what was the cost for the surgery.

                $300 - 2001.

                Comment


                • #9
                  I have no experience with this. In regards to the deep digital flexor tendon concern my lameness specialist surgeon prefers to do an MRI to evaluate the condition of the soft tissues in the foot before doing a neurectomy. Not possible for everyone but an MRI will give allow you to make the most informed choice.

                  Comment


                  • #10
                    I've not undergone this procedure with with any of my horses but seriously considered it with my previous competition horse to make him pasture sound (or at least more comfortable). We've tried many other options out there but since no one can definitively diagnose his problem, it makes it hard to treat!

                    At this point, I opted out of it for a few reasons. I have been told by almost every vet I've spoken to that there is a chance the nerves will start growing back and cause very painful neuromas at the end of the cut nerves. It was also quite expensive in my area (MD/VA) running roughly $1000-$2000. There was extensive rehab afterwards - 2-3 mos stall rest, followed by hand walking, etc. Most of the vets I spoke with recommended that it be done in a clinic as opposed to at the farm to ensure property technique (anesthetized completely as opposed to standing), sterlization, etc. Aside from the neuromas, there was the chance that the nerve regrowth would enable feeling again. In addition to all this, when you have a nerved horse, you aren't correcting the problem, you are only inhibiting the pain response. Fine for some horses but I guess it depends on your intended use. You also have to be more careful/diligent with hoof care since if they step on a nail, etc they can't feel it, thus can't tell you.

                    I ended up not doing it (mostly because I'm not sure it would help him) but have considered another option called a chemical neurectomy. As I understand it, it's basically like doing a nerve block that a vet may do for diagnostics, etc only with a longer lasting chemical than lidocaine - the drug they use lasts 2-3 months. It's less expensive but also less permanent. The only problem I experienced with this option is that many vets wouldn't do it - possibly worried that a seller is trying to hide problems from buyer?

                    Comment

                    • Original Poster

                      #11
                      I am so grateful for all the info... for the sake of clarity, I am going to ask specific questions of specific posters (don't know how to multiquote on this site)...

                      Comment

                      • Original Poster

                        #12
                        Originally posted by meaty ogre View Post
                        I'll PM if you want that info, but I would recommend that you go to a highly experienced vet for this. It is my own personal opinion that the technique used can minimize the risk of complications down the road.
                        I am within driving distance of two "major" clinics. I don't know if you or anyone else considered going to a clinic versus an individual veterinarian. I think both clinics do the procedure under general anestesia. I am leaning a bit towards standing because the horse already went through general for an MRI not long ago, and I hate to do that to him again.

                        Originally posted by meaty ogre View Post
                        No, and the vet that performed the neurectomy did not tell me that nerves may regrow and/or reconnect and that the surgery may have to be repeated. I have heard that from other sources but not from the vet who did the surgery.
                        This is my main fear. That I'll go through the trauma of making the decision and having the surgery... and it won't last and the horse will be lame again in under a year. That's why I am trying to understand why some nurectomies seem to be "permanent" (yours lasted 5-6 years, I'd consider that pretty permanent) and others last under a year. Is it the type of procedure? Age of the horse? After-care? I can stomach doing this, if it's the only option, but I can't handle doing this as "maintenence" (every year or so).

                        Originally posted by meaty ogre View Post
                        Additional thoughts/considerations:
                        My vet did tell me that a very real consequence of this procedure is rupture and complete failure of the DDFT. If that happens the horse is euthanized. Usually, that is due to pathology (ragged navicular bone sawing away at the tendon, and the lack of pain resulting from the neurectomy allowing the horse to move more and accelerate that shredding process). Obviously if that is an underlying issue you shouldn't do the surgery, and your vet wouldn't recommend it. However, the vet did tell me that it can and did happen without that pathology present.
                        Here's my BIG question on this (to you and everyone else). If this is the underlying pathology, and it's bony and there's nothing that can be done to stop/revese it-- then isn't this going to happen REGARDLESS of whether the neurctomy is done? The only difference is that the horse might start feeling it when it's less severe and you can put the horse down earlier? But either way these changes are happening, you can't stop them, and when they get bad enough-- it's the end? If that's the case-- I guess I don't see the problem giving the horse some additional pain-free time before the inevitable.

                        Or does riding hasten the changes? My understanding was that they were bony, degenerative, and out of our control. Short of tying the horse up so he can't move at all-- he's going to move on turnout and the bone is going to wear on the soft tissue. Is riding somehow WORSE than the horse moving on its own?

                        I ask genuinely about this. My horse has had extensive x-rays, an ultrasound, and an MRI, and this pathology wasn't seen-- but it's one of the things I hear most commonly when I discuss neurectomy with people-- so I guess I want to know whether this is potentially inevitable and neither hastened nor caused by the neurectomy-- or whether the neurectomy somehow speeds up the process.

                        Meaty, thanks for sharing your story. Which sounds like the best possible outcome, actually

                        Comment

                        • Original Poster

                          #13
                          Originally posted by Blue Star View Post
                          RF annular ligament cut 18 months ago...done standing...no complications, no regrowth, horse has returned to same level as prior to the surgery...so far so good.
                          How old was the horse? Georgraphically what area are you?

                          Or I guess maybe it's easier to ask posters who had a GOOD experience to PM me their vet's name if they are in the mid-atlantic area?

                          Comment

                          • Original Poster

                            #14
                            Originally posted by Florida Gator
                            I don't have personal experience with having a neurectomy done on any of my animals, but peripheral nerves (i.e. any nerves outside of the spinal cord itself and those found in the brain) do tend to re-grow nicely, so if that is your main concern, I wouldn't be too terribly worried...
                            rerowth is a NEGATIVE side effect.

                            Comment

                            • Original Poster

                              #15
                              Originally posted by Invite View Post
                              An older gelding (I think 20) at a barn I worked at had 2 neurectomies. He was standing for #2...I was holding him and I passed out. The whole plan was to keep the horse sound and comfortable without bute. Well, the plan failed and he had to be put back on bute for maintainence in order to be sound for light riding shortly after he recovered from the neurectomy. Basically, they could have just kept going with the bute and skipped neurectomy #2. The owner spent the $ and was right back where she started before the neurectomy.
                              I understand that it's possible that the neurectomy could not work because the surgery doesn't cut the nerve that's actually feeing to that area, but I figure it's worth one try to see if it works.

                              Originally posted by Invite View Post
                              Still at the same barn, a former 3' hunter by the time I arrived. I knew the mare as a 5 year old & she had lameness issues. Eventually, she had a neurectomy, went back to showing, another neurectomy, back to showing....and so on, and so on. By the time the mare was a teen, I do not know how many surgeries she had, but she did not stay sound with any work. She foundered.
                              This I could not do

                              Comment

                              • Original Poster

                                #16
                                Originally posted by c5rose View Post
                                1 & 2) I've heard from one vet that the nerves DO grow back and from another that it's impossible, so quite a big debate among professionals. My QH remained quite sound for about a year until he developed DSLD.
                                Do you know why the vet thinked the nerves could NOT regrow? The vet who did your horse's surgery, was he the one who did not think regrowth was possible.

                                Comment

                                • Original Poster

                                  #17
                                  Originally posted by Patty Stiller View Post
                                  There are various ways to do the procedure and one in particular,developed in California years ago, is supposed to lessen the chance for regrowth. It is where a section of the nerve is stripped out.
                                  Any idea who does this different procedure? I'd like to research that.

                                  Originally posted by Patty Stiller View Post
                                  I have known a couple (out of maybe a couple dozen I have been familiar with) that had regrowth or worse yet grew very painful neuromas at the surgery site.
                                  Out of how many?

                                  My understanding was that neuromas usually occur immediately following surgery, not years later?

                                  Originally posted by Patty Stiller View Post
                                  Most had complications later on. Everything from regrowth of the nerves , neuromas, deep flexor tendons detaching from the coffin bone, infected tendons, to serious recurrent abscesses. sloughed hooves. dead horses.
                                  Could you maybe address my question in my reply to meaty ogre whether a lot of these things would happen anyway, and the neurecomy might mask them but not cause them? And whether many of these things could even be addressed if caught earlier? I suppose an infection or abcess you could catch/treat earlier-- but not the other issues?

                                  Originally posted by Patty Stiller View Post
                                  The sad thing is that there is SO much that can be done with trimming and shoeing to help these horses. And even sadder is that some vets haven't a clue that improper foot trimming and improper shoeing, sometimes from extremely experienced and expensive farriers, is the cause in the first place.
                                  My farrier is considered one of the best in the country. Before I go questioning his technique, I'd be curious to know (generally obviously, since you don't know my horse specifically) how you think a horse ought to be shod to help with heel pain.

                                  Comment

                                  • Original Poster

                                    #18
                                    Originally posted by czgm7r View Post
                                    1. Did you experience regrowth of the nerves/did the horse regain feeling in his foot and experience pain?


                                    No.

                                    2. How quickly did that happen?

                                    Didn't. Horse nerved at 19 and was put down at 25 due to a pasture injury.

                                    3. What was the reason for the neurectomy (what diagnosis of disease for the horse)?

                                    The horse was lame. X-ray's show navicular changes and blocked sound. Decision was made to nerve him when he wasn't eating due to bute. In long run cheaper to have the surgery then due to the cost of the drugs.

                                    4. How old was the horse when the neurectomy was performed?

                                    19
                                    5. Did the horse return to work? If so, was it the same level as before/after the neurectomy?

                                    He was retired but not due to the navicular disease but due to suspensory injuries but was ridden the day before the accident.
                                    6. Did your horse experience any complications?

                                    No.
                                    7. Did you have the standing or fully sedated version of the surgery?

                                    Standing.
                                    8. Where did you get it done?

                                    Cleveland. PM if you want name of Vet.

                                    9. Did you do a second (or third or fourth) neurectomy following regrowth, and did you have success with that surgery?

                                    No regrowth 6 years in.
                                    10. Roughly, what was the cost for the surgery.

                                    $300 - 2001.
                                    Thanks for sharing this info. I am a bit far from Cleveland.

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                                    • Original Poster

                                      #19
                                      Originally posted by Fharoah View Post
                                      I have no experience with this. In regards to the deep digital flexor tendon concern my lameness specialist surgeon prefers to do an MRI to evaluate the condition of the soft tissues in the foot before doing a neurectomy. Not possible for everyone but an MRI will give allow you to make the most informed choice.
                                      I appreciate you mentioning this. The horse has had an MRI. I wouldn't feel comfortable going forward without one.

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                                      • Original Poster

                                        #20
                                        Originally posted by RooMB4 View Post
                                        I've not undergone this procedure with with any of my horses but seriously considered it with my previous competition horse to make him pasture sound (or at least more comfortable). We've tried many other options out there but since no one can definitively diagnose his problem, it makes it hard to treat!

                                        At this point, I opted out of it for a few reasons. I have been told by almost every vet I've spoken to that there is a chance the nerves will start growing back and cause very painful neuromas at the end of the cut nerves. It was also quite expensive in my area (MD/VA) running roughly $1000-$2000. There was extensive rehab afterwards - 2-3 mos stall rest, followed by hand walking, etc. Most of the vets I spoke with recommended that it be done in a clinic as opposed to at the farm to ensure property technique (anesthetized completely as opposed to standing), sterlization, etc. Aside from the neuromas, there was the chance that the nerve regrowth would enable feeling again. In addition to all this, when you have a nerved horse, you aren't correcting the problem, you are only inhibiting the pain response. Fine for some horses but I guess it depends on your intended use. You also have to be more careful/diligent with hoof care since if they step on a nail, etc they can't feel it, thus can't tell you.

                                        I ended up not doing it (mostly because I'm not sure it would help him) but have considered another option called a chemical neurectomy. As I understand it, it's basically like doing a nerve block that a vet may do for diagnostics, etc only with a longer lasting chemical than lidocaine - the drug they use lasts 2-3 months. It's less expensive but also less permanent. The only problem I experienced with this option is that many vets wouldn't do it - possibly worried that a seller is trying to hide problems from buyer?
                                        This is radically different from what I was told when I spoke with my vet. He recommended a week of stall rest until the sutures healed and the chance of infection had gone down, and then introduce turnout and work (if we decide not to retire the horse). The vet also seemed to think neuromas were totally different than nerve regrowth and are unrelated.

                                        I had not heard of the chemical version of the procedure and I am intruged. Do you know what chemical and/or what vets are doing this so I can research futher?

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