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Kissing Spine Surgery

Kissing spine is the name of a condition that can be a source of severe back pain in horses, often rendering them uncomfortable and unfit for their intended use. "Kissing spine" is the lay man's term for impingement of the dorsal spinous processes of the vertebrae. This condition results when the dorsal spinous process of one vertebra impinges upon that of the adjacent vertebrae. This often occurs in the mid to caudal thoracic region (under and just behind where most saddles sits). Clinically, we often appreciate spasm and severe pain on palpation of the epaxial muscles in the region. Outward deformation or regional hyperextension of the back is rarely noted. Some chronically affected horses will lose their muscled top-line. Radiographs show dorsal processes too close to one another, often with marked regional bone remodeling. Sclerosis (increased bone deposition) is almost always present at the impinging margins, but lysis (bone resorption) and bone cyst formation may also occur. Owners often complain of back sensitivity noted during grooming and saddling. These horses generally demonstrate intermittent bad behavior under saddle, often correlating with movements that make them hyperextend the back. For example, a jumper may kick out, buck, or pin their ears on landing from a jump as the back hyper-extends and causes pain. A barrel horse may buck or run out as the back is hyper-extended to sharply round a barrel. But even trail horses may demonstrate pain and agitation simply from the downward weight of a rider forcing the back into a hyper-extended position. It is important to also note that these lesions may be detected in some horses who are otherwise clinically normal and have no problems under saddle (considered an incidental finding). Because of this, careful interpretation of the clinical history and clinical findings is encouraged to work through accurately diagnosing back pain in the horse. One of the most helpful tools is regional anesthesia immediately adjacent to the kissing spine lesions. If this ameliorates the symptoms, a veterinarian may move forward with greater confidence that the kissing spine lesion is the true clinical problem. Currently, no intervention is recommended for kissing spines that are asymptomatic. Their detection in the asymptomatic horse on prepurchase exams has created much controversy. Treatment for kissing spines starts with conservative measures including stretches, physical therapy and cortisone injections. Injections may be performed with radiographic or ultrasound guidance to confirm accurate placement. If conservative measures yield only transient improvement, surgical intervention may be warranted. Surgery may be performed under standing sedation or under general anesthesia depending on the individual horse and the procedure elected. In general, the standing procedure is reserved for minor cases where cutting the ligament between two kissing spines is performed to create extra space. In more severe cases, an osteoplasty under general anesthesia is performed to remodel and remove excess bone from the impinging dorsal spinous processes. Prognosis is considered good. This report highlights a severely painful horse who had become unable to perform his sport where conservative measures were unsuccessful, but surgery allowed complete return to athletic activity