A controlled study evaluating a novel surgical treatment for kissing spines in standing sedated horses.
Authors: Coomer Richard P C, McKane Shaun A, Smith Naomi, Vandeweerd Jean-Michel E
Journal: Veterinary surgery : VS
Summary
Kissing spines, or overriding dorsal spinous processes (ORDSP), represent a common source of back pain in performance horses, yet optimal treatment strategies remain debated. Coomer and colleagues compared two approaches in 68 horses: intralesional corticosteroid injection (methylprednisolone acetate into affected interspinous spaces, n=38) versus interspinous ligament desmotomy (ISLD) using Mayo scissors (n=37), with both groups following identical controlled exercise protocols and returning to work within 3–6 weeks. Whilst 89% of medically treated horses and 95% of surgically treated horses initially resolved clinical signs of back pain, long-term outcomes diverged substantially: back pain recurred in 50% of the medical group (19/38 cases) but in none of the surgical group (0/37 cases), making ISLD approximately 24 times more likely to achieve sustained resolution. Post-operative radiographs in 19 surgical cases demonstrated significant widening of interspinous spaces, suggesting genuine structural improvement rather than merely symptom management. For equine professionals managing horses with radiographically confirmed ORDSP and associated back pain, these findings suggest that ISLD offers superior durability compared to corticosteroid injection, particularly for performance animals where recurrent lameness is costly and clinically significant.
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Practical Takeaways
- •ISLD offers superior long-term outcomes compared to corticosteroid injection for ORDSP-related back pain, with no recurrence in surgical cases versus 56% recurrence in medical cases
- •Horses can return to work 3-6 weeks post-ISLD with sustained pain relief and radiographic evidence of space widening
- •Consider surgical intervention early for horses with ORDSP and back pain, as it eliminates recurrence risk that persists with medical management alone
Key Findings
- •95% of horses treated surgically with interspinous ligament desmotomy (ISLD) initially resolved back pain signs compared to 89% with intralesional corticosteroid injection
- •Recurrence of back pain occurred in 19/34 (56%) medical cases versus 0/35 (0%) surgical cases
- •Horses undergoing ISLD were 24 times more likely to experience long-term resolution of back pain (OR 24; 95%CI: 5-115; P <0.0001)
- •Surgical cases showed significant widening of interspinous spaces on repeat radiographs (P <0.0001)