AUTUMN 2015 ISSUE
EQUINE MATTERS
10
KISSING SPINES
Figure 2 – X-ray showing needles in place
between DSPs
Figure 3 – X-ray showing mild kissing
spines
Diagnosis
The clinical examination may include trotting
up and lunging on firm and soft surfaces,
possibly with saddle on. If it is safe to do so,
the horse may be assessed when ridden,
perhaps by the owner and another rider,
for example, a veterinary nurse or instructor.
Any other orthopaedic causes of poor
performance, for example, lameness, should
also be investigated. This is particularly
important as low grade, chronic hind limb
lameness will, in time, lead to signs of
back pain.
X-rays (radiographs) are helpful in assessing
the bones of the back, and an ultrasound scan
can be helpful to image the soft tissues/
ligaments/muscles as well as the surface of
the bones and some joints.
(Figures 3 and 4)
.
Kissing spines can be readily imaged with
x-rays, but not all horses with kissing spines
will have signs of back pain – the x-ray
findings may be incidental. That is, the
condition is present, but of little/no
significance to the horse at that time.
If an area of suspicion is found, it is helpful to
observe the horse lunged and/or ridden
before and after the infiltration of local
anaesthetic into the area.
This is a very useful technique which
anaesthetises an area to allow the significance
of any abnormal imaging to be determined.
For example, if kissing spines are suspected
from the x-rays, and local anaesthetic is
injected into the area, if the horse then
moves/is ridden much better after this, there
is a strong likelihood that the kissing spines
are clinically significant.
If this is not possible, or the results are not clear,
a bone scan may be the next diagnostic step.
A bone scan/scintigraphy is a technique
where a very small amount of a radioactive
substance is injected into the horse’s vein,
before using a sensitive camera to scan the
area under investigation. If there is a
significant amount of bone remodelling in a
diseased area, this will attract an accumulation
of the radioactive material. These localised
’hotspots’ are then detected by the camera.
A bone scan only gives an indication to where
the problem is. If a hotspot is found, and its
position corresponds with kissing spines on
x-rays, it is likely the condition is clinically
significant.
Treatment and management
Medical and surgical treatments exist. Usually,
medical treatment may only be successful for
subtle, mild lesions. Extensive, severe lesions
will almost certainly require surgery.
Medical treatments can include injection of
steroid into the area of concern. This is often
followed by a period of rest, then physiotherapy
to build up the back muscles again. Shock
wave therapy may also be used.
There are two surgical options commonly
used
:
1. Cutting the ligament between the DSPs
This is done under standing sedation and
local anaesthetic,
(Figure 1)
. Needles are
placed, as markers, into the tissues between
the DSPs and, once their position is checked
by x-rays,
(Figure 2)
, the surgeon will make
small 1-2cm incisions adjacent to the marker
needles. Scissors are then introduced between
the DSPs and the ligaments are cut. The horse
is left with several, small incisions and healing
is usually fairly rapid and uneventful. Wound
aftercare is minimal.
2. Removing the DSPs
This can be done under general anaesthesia
or standing sedation and local anaesthesia.
This surgery usually involves a larger incision
along the middle of the horse’s spine and the
DSPs which are causing the problem are
removed. Sometimes, alternate DSPs are
removed to reduce the surgical trauma. There
is a larger wound and this will require more
time to heal.
With both surgeries, one of the key elements
of success is to carefully follow the aftercare
and rehabilitation instructions. Physiotherapy
is used in most cases to improve blood flow,
reduce pain, increase range of movement
and reduce scarring/fibrosis in the area.
Lunging exercise with training aids, for
example, a ‘pessoa’, may be recommended.
Accurate saddle fit is important once the
horse returns to ridden exercise. The use of
a mounting block in the future may also be
recommended.
Conclusion
Kissing spines is a common incidental, and
clinical, finding. A thorough investigation will
confirm the significance of the findings. Once
an accurate diagnosis is made, there are
treatment options available. The majority of
horses can return to full athletic function.
Figure 4 – Horse undergoing back radiography
Summary
●
Variable signs of disease, from
subtle to severe
●
Common finding on x-rays
●
Further investigation needed to
accurately diagnose
●
Treatment options are available
●
Most horses return to full athletic
function