2. NEURECTOMY
• A neurectomy is a type of nerve block involving the severing or
removal of a nerve.
• Neurectomy (palmar digital neurectomy) is a surgical procedure in
which a portion of the nerve supply to the foot of the horse is cut or
removed for the treatment of heel pain or navicular disease.
• This surgery is performed in rare cases of severe chronic pain where
no other treatments have been successful.
3. NEURECTOMY
• Currently, neurectomy is recommended only as a last resort when
other treatment options have been performed, the horse has become
refractory to other treatments and a soft-tissue injury has not been
found on an MRI.
• If the lameness does not localize to the heels, then a neurectomy
procedure will not be successful and the horse may remain lame.
4. INDICATIONS OF NEURECTOMY
I. Splints: Splints is allignment characterized by a hard, bony swelling,
usually on the inside of a front leg, lying between the splint and cannon
bone or on the splint bone itself.
5. INDICATIONS OF NEURECTOMY
II. Navicular Disease: The result is the inflammation or degeneration of
the navicular bone and its surrounding tissues, typically in the front
feet of the horse. This disease can lead to significant or disabling
lameness of a horse.
6. INDICATIONS OF NEURECTOMY
III. Ring Bone:
Ringbone in horses refers to a painful condition characterized by new
bone growth. It affects either the pastern joint or the coffin joint.
7. NEURECTOMY OF LIMBS
• The term palmer refers to palm of Hand.
• Palm of forelimb is called Volar
• Palm of hindlimb is called planter.
8. ANAESTHESIA
Local Anesthetics
2% Procaine, 2-4 ml.
Injected perineurally.
Needle: 25 gauge
Site of Injection
Palpate lateral and medial palmer neurovascular bundles.
Place needle axial to collateral cartilage as low in foot as possible.
Can also be performed with limbs held up or horse standing on nerve
too.
9.
10. ANAESTHESIA
Blocks the palmer region of foot and sole.
I. Navicular bone
II. Navicular bursa
III. Digital Cushion
IV. Sole , Heels
V. Coffin Joint.
14. SURGICAL TECHNIQUE
Make a vertical incision about an inch long along the length passing
through the skin, subcutaneous fascia and deep fascia.
The edges are separated and depth is palpated with fingers to
identify the cord of vessels and then they are raised on tenaculum.
If the structures are not immediately apparent then support and
pressure from the under surface of leg may push them into view.
The nerve is identified by yellow colour and longitudinal striations
and about an inch is removed and wound is sutured
15.
16.
17. SURGICAL TECHNIQUE
Differentiating nerve from vein and blood vessel should be done.
A vein has bluish or purple colour whereas blood vessel will appear
pale at that spot after raising with tenaculum due to displacement of
blood.
The palmar digital nerve is first divided proximally and then distally.
The skin wound is closed by interrupted appositional suture.
18. COMPLICATIONS OF SURGERY
Complications of this neurectomy can include the following.
Formation of a painful neuroma, or ball of nerves at the surgery site.
Sloughing of the foot.
Luxation of the coffin joint.
Rupture of the deep digital flexor tendon. It can occur if the lameness has
not been properly localized to the navicular bone alone. The procedure is
also not permanent as the nerves can grow back and the disease process
that caused the lameness still continues.
Horses that have a neurectomy procedure need to be observed carefully as
they will lose sensation in the heels. So if they step on a nail, for instance,
they will not feel the foreign object in the foot.
