Previous Page  11 / 24 Next Page
Information
Show Menu
Previous Page 11 / 24 Next Page
Page Background

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