Diagnosis and management of impinging spinous processes
Authors: Fiske-Jackson Andy
Journal: UK-Vet Equine
Summary
# Editorial Summary: Diagnosis and Management of Impinging Spinous Processes Impinging spinous processes (ISP) remain the most commonly diagnosed cause of back pain in performance horses, yet the underlying pain mechanisms are incompletely understood, making accurate diagnosis and appropriate treatment selection critical for practitioners. Fiske-Jackson's review emphasises the importance of a methodical diagnostic approach: excluding concurrent lameness through thorough orthopaedic examination, using diagnostic anaesthesia to confirm the spinous processes as the pain source, and obtaining radiographic confirmation of bony contact or remodelling—with nuclear scintigraphy available as an adjunctive imaging tool when required. Both subtotal ostectomy of the affected spinous processes and interspinous ligament desmotomy demonstrate good clinical success rates, though the paper acknowledges that surgical outcomes depend heavily on case selection and surgeon experience rather than technique alone. Corticosteroid injections play a dual role in the ISP management pathway, serving both as a therapeutic intervention and as a diagnostic aid to confirm clinical significance before pursuing surgical intervention. For equine professionals, this reinforces that ISP diagnosis demands a systematic elimination of other pain sources and objective confirmation before committing to surgery, whilst recognising that both established surgical approaches remain viable options with comparable outcomes when appropriately selected.
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Practical Takeaways
- •Don't assume back pain is ISP—rule out lameness and use diagnostic blocks before imaging to confirm clinically significant kissing spines
- •Corticosteroid injections serve both therapeutic and diagnostic roles in ISP management
- •Two proven surgical options exist (ostectomy vs. desmotomy); choice depends on case specifics and surgeon experience—discuss both with your vet
Key Findings
- •Impinging spinous processes (ISP) is the most common diagnosis in equine back problems affecting performance
- •Diagnostic workup should include lameness exclusion, diagnostic anaesthesia, and radiography to secure ISP diagnosis
- •Nuclear scintigraphy can be utilized as an additional diagnostic tool for ISP
- •Both subtotal ostectomy and interspinous ligament desmotomy show good success rates for surgical management of ISP