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