Conquering Kissing Spine

If youre around a lot of horse owners kissing spine may seem like the new disease du jour. Its hard to find a barn that doesnt have at least one owner who has had the vet utter the words as a possible diagnosis for a wide variety of clinical signs.
The expression of kissing spine is often not clear cut the horse may shift his weight when groomed over his back or be reluctant to be saddled. He may not stand to be mounted or may bolt when the rider places weight in the saddle. The horse may buck rear or kick out repeatedly.

Less obvious signs can be a horse that is stiff under saddle or one that is consistently hollow or tosses his head. He may be reluctant to go forward or have trouble picking up the correct lead or maintaining a true threebeat canter under saddle. While many of these issues can be caused by other problems kissing spine shouldnt be ruled out without a veterinary investigation
A Sweet Name for a Sour Problem
True to its name kissing spine occurs when the bony projections called dorsal spinous processes or DSPs on a horses vertebrae rub or impinge on each other causing pain and changes in the bones and ligaments that attach to them explains Liberty Getman DVM an associate surgeon at Tennessee Equine Hospital. Getman graduated from the University of Florida before completing a residency at the University of Pennsylvania she is specifically interested in lameness and orthopedic surgery.
Kissing spine is suspected when a horse shows significant consistent pain when light pressure is placed on the lumbar and lower thoracic spine Getman explains. The condition is often most painful when the horse is wearing a saddle the afflicted horse is often sound but displays behavioral problems when ridden. The condition
can greatly affect a horses performance.
Some cases are so severe that the DSPs can overlap by as much as 50 percent says Lauren Luedke DVM Dipl. ACVSLA a Colorado State University graduate who completed her residency at Cornell University before becoming a surgeon at Manor Equine Hospital in Maryland.
Interestingly horses diagnosed with kissing spine exhibit varying degrees of painand the degree of abnormality does not always dictate the level of pain says Luedke.
For example there are some horses with severe changes and minimal back pain and some horses with mild radiographic changes with marked back pain she explains.
Kissing spine can be diagnosed using a combination of methods but each will begin with a clinical exam. Based on exam results radiographs can be used to confirm findings as evident by impingement and bone remodeling of one or more of the dorsal spinous processes says Luedke. In more complex cases nuclear scintigraphy bone scans can be useful in detecting active bone remodeling indicating that DSP impingement is a primary problem.

Blocking the sites of impingement with carbocaine a numbing agent may be useful. However because some horses can have radiographic changes visible on Xray without clinical signs Luedke stresses that its important to analyze findings collectively to arrive at a diagnosis.
Kissing Spine
Kissing Spine
Kissing Spine Prognosis and Treatments
The prognosis for horses with kissing spine is fair to good with appropriate management according to Luedke.
Getman agrees.
Its important to remember that horses with kissing spine have an excellent prognosis for life and that the prognosis can be goodtoexcellent for athletic performance she says. The severity of the disease and how many sites are impinging influence prognosis.
Treatment of the condition can range from back injections to surgical removal of the bone that is impinging and causing pain. Luedke says that treatment often begins with the administration of antiinflammatories and muscle relaxers and a steroid injection between the impinged DSPs. Injections are not a oneanddone solution however.
The hope is that the injections last for six months to a year but in more severe cases the injections may only last a couple months says Luedke.
Getman also often recommends chiropractic adjustment acupuncture and mesotherapy to horses in her care that are affected by kissing spine. Mesotherapy involves injecting small amounts of compounds into the middle layer of skin using very fine needles its often used for pain management.
If medical therapies are unsuccessful surgery is an option. The more conservative surgery is known as an interspinous ligament desmotomy or keyhole surgery. This minimally invasive procedure cuts the ligament that connects the two affected spinous processes to each other explains Luedke and can be done in multiple areas. This surgery allows more room between the DSPs and likely transects the nerve to eliminate pain.
A more invasive surgical option is a cranial wedge ostectomy which removes the impinged bone and requires more extensive incisions and rehabilitation. The type of surgery pursued is often dictated by the severity of disease in cases where the DSPs are overlapping cranial wedge ostectomy is the preferred surgery.
Though horses affected by kissing spine experience the most pain when they are under saddle most can have athletic careers if their pain can be managed says Luedke.
Some horses with explosive behavior may be too dangerous to ride even after their kissing spine issue is resolved she notes. She says that the earlier pain a horse experiences from kissing spine is managed the less likely he is to learn the explosive behavior associated with the back pain.
Luedke concurs.
My experience so far is that horses with DSP impingement requiring surgery have done very well postoperatively she says.
She adds that there is one piece of the kissing spine puzzle that has not yet been tested.
We dont know yet know what happens to these horses 10 years from now says Luedke. Is there any recurrence of disease or can it occur at other locations? Or do the horses continue to do well because we have taken away the pain component allowing them to use their back properly and maintain muscle strength?
A Note on Rehabilitation
Kirsten Johnson owner of Kentucky Equine Sports Medicine and Rehabilitation Center KESMARC in Versailles Ky which offers multiple treatments for a variety of conditions from which a horse may be recuperating.
These
include a hyperbaric chamber a pool an underwater treadmill and a cold saltwater spa among others. Each of these has its place in the rehabilitation of various injuries ailments and surgeries but Johnson has had extremely good results in horses suffering from kissing spine using a combination of treatments.
Ive had success with horses with very poor prognoses with doing a good chiropractic adjustment saddle fit and backstrengthening exercises she says. Ive had horses that were going to be euthanized go back to lead quality productive lives.
One often overlooked facet of kissing spine pain management is saddle fit according to Johnson. Also compensatory pain is a concern.
Once the horse starts hurting other things go wrong she says. Rehabilitation is focused on not only retraining the body but also on hopefully making improvements there in terms of strengthening and lifting the back. You also have to focus on retraining the brainand doing it safely she says of horses that may have developed dangerous habits resulting from perpetual pain.
The water does a very good job of letting horses reap the benefits of it use while forgetting everything that hurts she notes. Whether the horse goes on the underwater treadmill or swims is dependent on the horse his age and his discipline she says. For horses that come to KESMARC for rehab for kissing spine Johnson says she often sees marked results in 90 days.
Though kissing spine may seem like a death knell for a horses athletic career it often is not. A veterinarian focused on a correct diagnosis and treatment for the individual horse is key as is a welldefined strategic plan to bring the horse back into work.