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11

EQUINE MATTERS

'Cruiser' a 13 year old 2 star eventer

presented for problems in right canter, general

stiffness and stuffiness riding with a marked

loss of topline. Despite a well fitting saddle,

regular physiotherapy and good riding he

was struggling in his work and was very

painful on back palpation.

Radiographs of his back revealed impinging

dorsal spinous processes ('kissing spines') in 8

places along his back.

(Figure 1)

Given the

extent of the changes, his owner elected for

surgical

management of his 'kissing spines'. He also

had mild changes in his hock and sacroiliac

joint, these were medicated after surgery.

Interspinous ligament desmotomy is a surgical

technique whereby the ligaments in between

the dorsal spinous processes in the back are

cut.

(Figure 2 and 3)

A small incision is made

to one side of the back and a small portal

made through which the ligaments can be

incised. The

current theory by which the surgery treats

kissing spines is that by releasing tension in

the interspinous ligament this in turn reduces

stimulation of nerve endings in the ligament

attachment to the dorsal spinous process. A

feature of the surgical procedure that was not

initially predicted was a clear enlargement of

the interspinous space post-operatively. The

surgery is minimally invasive and performed

standing in stocks.

A key feature of the success of the surgery is

the management after surgery. 'Cruiser' was

placed on box rest to allow the skin incisions

to heal,

(Figure 4)

however the day after

surgery he began gentle exercise on a

horse-walker. After 2 weeks he started

walking exercise

on the lunge as well as walking using a

Pessoa training aid. By 6 weeks post

surgery, 'Cruiser' was walking for 2 hours

a day and lunging for an hour a day in

walk and trot over poles.

In addition to surgical management of his

'kissing spines' he was treated with

physiotherapy, acupuncture and chiropractic

treatments. He was fed from the ground to

encourage his back to open up and

performed carrot stretching exercises daily.

Cruiser won his first event 12 weeks after

surgery.

ISLD SURGERY

Veterinary surgeon

Fiona Elliott

XLEquine practice

Hook Norton

Veterinary Group

Case study...

Interspinous ligament

desmotomy

Fiona Elliott BVSc MRCVS,

Hook Norton Veterinary Group

Figure 2

Needle placement prior to

surgical incision

Figure 1

X-ray of his spine prior to surgery

Figure 3

An incision is made to one

side of the affected interspinous space

Figure 4

Incision site post-operatively