Case of dorsal spinous process impingement (kissing spines)
The following video demonstrates a recent case of kissing spines seen at our clinic. Beware it is quite graphic. If time allows please read the text that follows. It will give you a more in depth understanding of the condition. We have also compiled a further video at the end which shows exactly how the surgery is performed in the standing patient.
This horse presented with a history of bucking and bunny hopping at canter when ridden.
A thorough clinical examination and a full lameness examination was performed at our clinic at Plum Park Farm.
The gelding was sound in a straight line and was flexion test negative. He was also sound on a circle on both a hard surface and a soft surface. Under saddle he put in a small buck during upward transitions and became disunited at canter.
He found palpation of his lumbar sacral muscles particularly painful and this induced significant muscle spasm.
This history and clinical findings were suggestive of primary back pain.
Radiographs (x rays) were taken of the thoracic and lumbar spinal processes using our digital radiography system.
These revealed narrowing of several interspinous spaces which are apparent on the x ray below.
Marked radiolucencies (holes in the bone) and sclerosis (bone thickening) of the spinal processes can be seen in this X ray.
The horse was referred for scintigraphy to confirm the diagnosis and to rule out any unidentified concurrent pathology: see the scintigraphic image.
These cases can be treated medically or surgically but due to the severity of the lesions the surgical route was pursued.
The cornerstones of medical management are a combination of rest, infiltration of the interspinal process space with long acting steroid (methyl prednisolone) and physiotherapy.
This case was treated surgically at Towcester Veterinary Centre Equine Clinic by removing the tops of the offending impinging spinal processes. The number and location of the processes to resect were determined by the results of the radiography and scintigraphy.
The horse was sedated and restrained in our stocks. Sedation was maintained using a continuous infusion of sedative in saline (i.e. a drip attached to an intravenous catheter). The operation was performed on the standing sedated animal in order to remove the risk of a general anaesthetic.
Local anaesthetic was infiltrated around the affected DSPs and surrounding soft tissues.
An incision is made through the skin and subcutaneous tissues.
The affected DSPs are exposed and the tops of the processes are resected using a hand held oscillating saw.
Every other process is removed not every single one.
X rays are taken during the operation and show the resected spinal processes
Appearance of wound 2 days post surgery
The following video shows in more detail how the surgery is performed. Not for the faint hearted as it contains graphic surgical scenes.