A Case Study following an Equine with Cervical Facet Joint Disease


● 15 year old, Thoroughbred, Gelding
● Long term history of OA bilaterally in C5-6 and C6-7
● Was given to current owner April 2010 when treatments no longer worked
● Used for light jumping and pleasure with no notable neck problems until 2014
● June 4, 2014: found with stiff neck, swollen on the right side and unable to lower head to eat
● Decreased neck rom side to side and downward
● Circling to right difficult
● When circled left both hind toes dragged
● Worse on right hind
● Thought to be lameness and not neurological
● Radiographic changes are static from 2006

Diagnosis: Cervical facet joint disease

Treatment 6/14/14


● C5-6 and C6-7 bilateral facet joint injection with 40 mg
● Depo-Medrol and 250 mg amikacin
● Gabapentin 10 tabs q 12 hrs for 10 days
● Banamine 500 mg bid x 2 day then 250 mg ban bid x 3 to 5 days

Results

● No improvement – Still unable to move head left or right or up and down
● Alternative therapies and massage did not help
● Suffering from sleep deprivation as he was unable to lay down
since injury on 6/4
● Fed in raised hay net as he could not eat off the ground
Scheduled for euthanasia on 7/14/14 due to poor prognosis and quality of life.

Exam on 7/13/14

Static Exam:
● Unable to bend neck in any direction
● More painful on right than left side of neck and upper than lower neck
● Warmth, edema and pain to palpation of lumbar dorsal spinous
● processes

Ultrasound Exam – key findings:
● Right caudal C2 avulsion fracture
● Lumbar dorsal spinous processes have avulsion fractures at the supraspinous ligament attachment on L2, L3 and L4

Treatment with Radial ESWT 7/14/14 – Neck, lumbar, hocks treated

Day 2 post-tx: minimal improvement
7/19/15: neck, lumbar, hocks
● Day 5 post tx #1: Significant improvement by this day

● Day 1 post tx #2: Huge improvement
○ Hay and grain were moved to the ground versus being raised
○ Trotted in turnout without any lame steps
● Day 6 post tx #2: Rolled


Exercise
Done in a slow progressive manner to build strength and enable early identification of any neurologic deficits.

8/23/14:
● Lunged at walk and trot with saddle to determine if it would trigger muscle spasms and neck stiffness
● Turnout

8/30/14:
● Started riding:
○ Every other day for two weeks at walk and trot then gradually added canter
and increased exercise period

10/20/14:
● Started once weekly “play day” over poles

“All horses deserve, at least once in their lives, to be loved by a little girl.
Or, in Ricky’s case, a 60 year old woman”. – Stephanie Hextrum aka Ricky’s Mom