Long-term prognosis for return to athletic function after interspinous ligament desmotomy for treatment of impinging and overriding dorsal spinous processes in horses: 71 cases (2012-2017).
Authors: Prisk Amanda J, García-López José M
Journal: Veterinary surgery : VS
Summary
Impinging and overriding dorsal spinous processes (ORDSP) represent a significant cause of back pain in performance horses, and interspinous ligament desmotomy (ISLD) has become an established surgical intervention; this retrospective analysis of 71 cases treated between 2012–2017 sought to establish realistic long-term prognosis and identify whether imaging severity correlated with outcome. Over a median follow-up period of 35 months, 91.1% of horses (51/56) returned to some level of ridden work, though only 52.9% (27/51) achieved their pre-injury performance level or better—a finding notably more conservative than previously published reports. Recurrent back pain accounted for approximately 38% of cases that failed to return to previous work, whilst unassociated lameness explained the remainder, suggesting that ORDSP may coexist with other performance-limiting conditions that warrant independent investigation. Importantly, neither radiographic grade, scintigraphic grade, nor the number of affected interspinous spaces predicted outcome, indicating that imaging severity alone should not be used to counsel owners on prognosis. Whilst 79–82% of owners reported satisfaction and willingness to recommend ISLD, equine professionals should counsel clients realistically that whilst functional recovery is likely, return to previous performance level is not guaranteed, and concurrent musculoskeletal pathology should be thoroughly investigated before attributing poor outcome solely to ORDSP.
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Practical Takeaways
- •ISLD is a reasonable treatment option for ORDSP, with ~91% of horses returning to some work and 79% of owners satisfied with results
- •Manage owner expectations: only ~53% return to their previous performance level; discuss that imaging severity doesn't predict outcome
- •Plan for ~35 months follow-up; recurrent back pain (37.5% of cases) and concurrent lameness should be screened for post-operatively
Key Findings
- •91.1% of 56 horses with follow-up returned to some level of performance after interspinous ligament desmotomy (ISLD)
- •52.9% of returning horses achieved equivalent or higher performance level; 47.1% returned to lower performance levels
- •Recurrent back pain and unrelated lameness each accounted for 37.5% of cases returning to lower performance
- •Radiographic and scintigraphic severity grades did not significantly predict return to performance outcomes