Monday 14th of June 2021
Vet Advice

Kissing Spines and Back Pain

By Chris Neal MRCVS, Scott Dunn’s Equine Clinic

More correctly known as impinging Dorsal Spinous Processes (DSP’s), Kissing Spines are a common cause of back pain in horses and usually affect the area under the saddle (T10-T18 vertebrae). Symptoms can range from severe muscle pain and reluctance to go forward, to mild behavioural changes often attributed to ‘cold-backing’.

When they are strongly suspected, radiographs are taken to grade their severity. However, it is important to note that a lot of mild-moderate cases are not significant despite the presence of back pain. Therefore assessing for signs of lameness and tack fit, injecting targeted local anaesthetic around the suspect spines, or sending the horse for advanced imaging techniques (eg. Scintigraphy/Bone Scan) are often used to prove their importance.

How can we treat or prevent them?

Broadly speaking, horses with kissing spines can be separated into two groups. Those affected early on in life (<5years old) and could be considered as genetically predisposed and those that have developed the condition later on in life (>5years old). This is important as it influences our options when it comes to prevention and management.

In humans with back pain, the majority of treatment focusses on posture and strengthening muscular support rather than medical or surgical treatment. Instead of a period of rest, we as humans, focus on loading and strengthening exercises to improve back stability. Interestingly, using a similar approach in horses has resulted in excellent results after 6 weeks of active, unsaddled resistance exercise. Type of exercise is exceptionally important and consists of carrot stretches, tight figure of eight manoeuvres and rein backs (amongst other things).

These can be supplemented with long reining, Equi-Band/Equi-Core resistance aids (these have excellent results and can be a good ‘yard’ purchase), Pessoa (when used correctly) or water treadmills (Equine Rebalance at Wellington Riding). Incorporating some of these into your horse’s routine is a good way to try to prevent the impinging spines from causing recurrent issues.

In more severe cases, or to allow horses to work through back pain, medication or more intensive treatment modalities may be used. We often inject long acting steroids, which help reduce inflammation and pain, targeting them around the impinging DSP’s. However, in certain cases (e.g. sports horses competing at FEI level), these can remain detectable for up to 5 months. Therefore, other treatments such as Sarapin (anecdotally can be used to reduce nerve pain), acupuncture or shockwave therapy can be used adjunctively.

We have acquired a brand new focussed shockwave therapy that specifically targets the affected spinous process and are seeing excellent results in these patients. We also often use transcutaneous electrical nerve stimulation (faradic) treatments with the help of our rehabilitation nurses Ami and Laura. These use electrical impulses to directly stimulate and grow the under developed muscles, a technique used historically in human athletes to promote strength, over a course of 4-6 weeks.

Despite all of this adjunctive treatment (both preventative and therapeutic), sometimes the only way to treat the condition is surgery – especially when the condition is thought to be genetic. Interspinous ligament desmotomy, a quick and non-invasive treatment that takes 10mins, can be used in mild-moderate non responsive cases with on over 70% success rate. More severe cases or those thought to have a genetic basis, can have an ostectomy (removal of the spinous process), however, this is very invasive and requires a long lay-off period of around 6 months.

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