A withers fistula refers to any disease of the horse's withers that is accompanied by inflammation and fistula formation.
The withers are located between the shoulder blades and represent the transition from the cervical to the thoracic spine of the horse. The nuchal ligament, which runs from the back of the horse's head along the cervical spine towards the horse's back, begins here. The withers are made up of the spinous processes of the front thoracic vertebrae, which can be up to 30 cm long. At the highest point of these processes, the withers are covered by a bursa, which cushions the movements between the tendons and bones.
The cause of inflammation in the withers area is often poorly fitting saddles or harnesses, which lead to permanent irritation of the bursa. Even the smallest wounds, bruises, or punctures can cause these inflammations to become infected and lead to abscesses or fistulas. Depending on the location of the fistula, prolonged inflammation can lead to necrosis (tissue death) of the neck ligament, fascia (connective tissue), cartilage caps, and bony ends of the spinous processes.
At the onset of the disease, only slight swelling in the withers area is usually observed. In some cases, the lymphatic vessels appear as circular patterns on the surrounding skin. As the disease progresses, purulent discharge may emerge from fistula openings on the sides of the withers and run down the chest wall. This results in hair loss and weeping skin inflammation. Affected horses show signs of severe pain in the area of the inflammation and difficulty in moving their front limbs.
In most cases, the veterinarian can make a diagnosis based on the clinical symptoms and your preliminary report. By probing the fistula canal, the veterinarian can get an initial impression of the extent and location of the fistula.
However, to determine the exact location and course of a fistula, it is necessary to fill the fistula with a contrast agent and then perform an X-ray examination. The X-ray image can also be used to determine whether any bone structures have already been affected.
Treatment depends on the extent and severity of the disease. In most cases, local rinsing and cleaning treatments are combined with the general administration of high-dose antibiotics. In order to provide targeted treatment, the choice of the right antibiotic should be determined by an antibiogram (a laboratory test to determine the sensitivity of microbial pathogens to antibiotics) if possible.
In severe cases and those that do not heal with conservative therapy, surgical intervention may also be necessary. The fistula is opened and cleaned using special incisions.
The chances of recovery depend greatly on the extent of the disease and the time of diagnosis. Superficial fistulas with only minor tissue changes usually heal with consistent and intensive treatment, whereas deeper fistulas involving the fascia (connective tissue) or pocket formation often do not heal completely even after intensive treatment lasting several months.
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Thanks to a much greater awareness of the importance of a well-fitting saddle or harness, withers fistulas are much less common today than in the past. Have the fit of your saddle or harness checked regularly by a specialist to prevent pressure points or chafing around the withers. In the event of open wounds or punctures in the withers area, it is advisable to refrain from using a saddle, lunging girth or harness for a certain period of time to prevent additional irritation and allow injuries to heal without complications.
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