Case History 3 - FRENCHIE

Frenchie is a six year old racehorse. He was presented to us with a history of having taken a bad fall in his last race, three weeks previously. Following the fall the horse showed marked wastage of his hypaxial muscles in his thoraco-lumbar region. Although Frenchie was not displaying significant lameness he was palpably sore in his back. We decided to radiograph his thoraco-lumbar vertebrae to see if we could find an explanation for the muscle wastage. The wastage implied local tissue damage, possible nerve damage and loss of function.

As you can see, the radiograph shows marked overlapping of  the spinous processes of two thoracic vertebra and this was just where the horse seemed painful. A bone scan confirmed that this area was very active and the likely cause of the problem. We took further radiographs and did ultrasound scans of the area to see if we could detect a fracture. We could not convincingly demonstrate one but could not exclude the possibility. The horse’s back had not been x-rayed before so we had no way of knowing what the degree of overlap of the spine was prior to the fall. It was clear that his posture had changed significantly with the back dipping (lordosis) more  and so it is likely that things had worsened.

Our options were to leave the area alone and allow the situation to stabilise or to remove the over-riding spine now in order to make the horse more comfortable. The downside of waiting was that Frenchie had already lost significant muscle mass and we were concerned that if we didn’t quickly restore function it would be an impossible task to rebuild the strength and mobility of his spine. Our concerns over surgery were that there might be a fracture even though we couldn’t image one and that it might extend down to the vertebral body. If that was the case, the spinal cord could be compromised if we operated. One thing was for sure, a general anaesthetic was out of the question as if we did discover a fracture the horse could displace things further when he woke up.

After considering all the options we decided to do a standing surgical exploration of the affected area. This is not as scary a procedure as it sounds. We are quite able to have the horse essentially knocked-out but still on his feet. Caroline is very skilled at giving just the right amount of drugs to control the sedation and pain but not let the horse get too wobbly. These surgeries are done in the stocks so that the horse is pretty confined and controllable.

Surgery went really well; there was no fracture just a severely over-ridden and traumatised spinous process. We removed this using an oscillating bone saw driven by compressed air. The ideal is to take out most of the length of the spine so as to free up as much space as possible. From the Surgeon’s point of view doing this procedure in the standing horse is actually easier than if they are lying down. The wound healed quickly and Frenchie immediately became much happier; he had been quite grumpy and aggressive prior to surgery as he was obviously in pain.

We began hand walking the horse as soon as the staples were removed 12 days after the operation. He did one week of this type of exercise before we started him on our treadmill. This machine is ideal for this type of rehabilitation as we can do very controlled exercise either on the flat or on a gradient. Over the next few weeks Frenchie progressed well and we were able to start some trot work. In order to work on his lateral flexion we also did some lungeing work in our round pen. As soon as Frenchie had started to build some tissue and strengthen we started to develop his outline using a Pessoa when lungeing and side reins on the treadmill. Frenchie was a very good patient and really enjoyed his work. He was with us for three months in total and left looking like a different horse. Frenchie is continuing his rehab work at home and is also getting some well-earned rest time in the field. Below is a recent picture of him and we will look forward to him returning to the racecourse later this year.