H&H question of the week: My horse has been diagnosed with kissing spines — how do I manage it and what should I expect?

Rick Farr B.Sc (Hons), B.V.Sc, MRCVS of Farr & Pursey Equine Veterinary Services gives his expert advice on kissing spines

Q: “My horse has just been diagnosed with kissing spines and I am still reeling a little bit. I’m looking for advice on how to manage it and what to expect. I’ve had lots of  “I’m sure he’ll be fine”, “Don’t give up”, “My friend’s horse has had the operation and looks amazing now”, but no real first-hand experiences, even if they’re negative. I’d just like a balanced view of what to expect. Everyone is so well-meaning and I am very grateful to them but it’s different observing someone putting their horse through all that and nursing them through it etc. than being the person actually doing it. I also bought him to do more than potter about at unaffiliated level. I’m by no means a great rider but he was a relatively costly horse (for me anyway) and was purchased as a schoolmaster for me to progress on. At the moment he’s gone from pinging 1m20 like it’s nothing to slamming the brakes on at 90cm (obviously due to pain and this was prior to the diagnosis and the first thing that led us to believe there was a problem, we obviously stopped jumping him as soon as we realised there was a potential issue) and not being able to canter without changing behind on the right rein, to name just a few issues.

He is only nine-years-old and also went blind in one eye very unexpectedly and without any apparent cause earlier this year. That may well be irrelevant but just to put it into perspective. I have owned him a year and in that time he has spent the past five months out of work. I adore him and I’m not trying to be overly negative but just trying to put the whole situation into context. He was five-stage vetted before we bought him and passed with flying colours so, while I know they’re not infallible, I wasn’t anticipating having to deal with all this in such a short time (mind you, who does?). He is having steroid injections today and I am going to speak to the vet about it properly later.”

A: Kissing spines, more technically known as ‘Overriding Dorsal Spinous Processes’ (ORDSPs) are quite often diagnosed when a horse exhibits pain on palpation of the back or poor performance issues and subsequently has X-rays of the back taken.

At this point I should add a cautionary note: the literature suggests that up to 34% of horses (which tend to be over-represented by Thoroughbreds) may show signs of ORDSPs on X-rays but do not exhibit any clinical signs as a result of them. Therefore, pain on back palpation and performance issues should be fully investigated before finalising a diagnosis of ORDSPs as many other sources of lameness may be the primary issue and the back pain could be secondary.

There has been some anecdotal evidence also suggesting that excessive training, especially when the horse is young, may even exacerbate ORDSPs as the horse does not have the muscular core or back strength to cope with the work undertaken; this serves to emphasise my advice of gradual training for youngstock.

So, if you have a diagnosis of ORDSPs, what options are available? If I was asked this question several years ago I would have said there are two treatments available; now I would say there are three options but I only usually advise one of these. Sounds a little odd, however there is a good reason why…

The use of steroid injections to treat ORDSPs was always the mainstream treatment and this does still work in the vast majority of cases. However, this treatment is often short-lived and there is a limit to the amount of steroid you can inject into a horse’s back.

Historically, if medication, a controlled exercise programme and physiotherapy did not work, most patients were then referred for surgery for removal of the problematic spinous process(es), or were retired if the horse was too painful to be ridden. This option is still available; however, this is an absolute last resort in my opinion and very few cases warrant such an invasive treatment.

Continued below…

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Therefore my main advice in these cases is now to consider a technique called an Interspinous Ligament Desmotomy (ISLD). This is a minimally-invasive surgery, done under standing sedation, in which some of the ligaments between the spinous processes in the back are cut through a very small incision (usually less than 1-2 cm). Cutting a ligament may sound a little excessive, however this technique has been gaining increasing popularity amongst surgeons due to being minimally- invasive and horses are often back into work within 6-8 weeks. Anecdotally, it seems to result in a longer positive outcome. I would even go as far to say that this would be my treatment of choice for any horse within my family.

All cases should be treated as individuals and one treatment does not suit all. Therefore discussions between you and your vet are essential before proceeding with any treatment modality. As a final word I would also like to say that medication/surgery are not the one-stop cure. Structured training programmes and good physiotherapy are a must in all cases.