A new technique for subtotal (cranial wedge) ostectomy in the treatment of impinging/overriding spinous processes: description of technique and outcome of 25 cases.
Authors: Jacklin B D, Minshall G J, Wright I M
Journal: Equine veterinary journal
Summary
# Editorial Summary: Subtotal Ostectomy for Overriding Spinous Processes Overriding spinous processes in the thoracolumbar region present a persistent management challenge, particularly in performance horses where conservative therapy has failed or competition drug restrictions limit pharmacological options. Jacklin and colleagues retrospectively evaluated a novel surgical approach—subtotal (cranial wedge) ostectomy—performed on 25 horses at Newmarket Equine Hospital between 2009 and 2011, assessing both functional recovery and cosmetic outcomes alongside operative metrics. The technique proved remarkably effective, with 78.9% of cases returning to full work and a further 18.2% showing improvement, whilst 81.8% of owners reported an excellent cosmetic result and surgery time remained short (median 30 minutes, range 20–70 minutes) with zero intra- or post-operative complications documented. Importantly, outcomes were independent of the number of processes resected or radiographic severity, suggesting that selective removal of only the impinging portions—rather than complete amputation—is sufficient for clinical resolution. For practitioners selecting surgical candidates, this technique offers meaningful advantages over traditional amputation approaches: faster operative time, preserved spinal contour, reduced complication risk, and functional outcomes equivalent to more invasive procedures, making it a valuable option for competition horses or those where back aesthetics carry commercial significance.
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Practical Takeaways
- •Subtotal cranial wedge ostectomy offers a less invasive alternative to complete spinous process amputation, preserving spinal contour while achieving comparable functional results in treating overriding SPs
- •This technique is suitable for competition horses unable to use systemic medications due to withdrawal periods, with rapid surgery time enabling quick recovery
- •The procedure's high success rate (97.1% improvement or resolution) and absence of complications make it a reliable surgical option when conservative therapy fails in horses with severe impinging spinous processes
Key Findings
- •78.9% of horses achieved complete resolution of clinical signs and returned to full work, with an additional 18.2% showing improvement
- •Subtotal cranial wedge ostectomy achieved excellent cosmetic outcome in 81.8% of cases and good outcome in remaining cases
- •Median surgical time was 30 minutes (range 20-70 min) with zero intra- or post-operative complications reported
- •Outcome was independent of the number of spinous processes resected or radiographic grade of impingement severity