A new technique to treat kissing spines in horses is transforming the way veterinarians assess and manage back pain in horses, British veterinarian Dr Bruce Bladon says.
Kissing spines or overriding dorsal spinous processes (ORDSP) most commonly affects the area where the saddle is placed, and can be a source of chronic back pain and performance issues in horses. It can be difficult to treat and manage successfully.
Bladon said the minimally invasive surgery known as the ‘Coomer’ technique’ has been the key innovation in kissing spines surgery in recent years.
“The surgery is relatively straightforward and postoperatively horses make very good progress,” Bladon said.
The technique was pioneered by British veterinarian Richard Coomer in 2012, and involves making a 1cm incision near the spine and cutting the interspinous ligament (ISL).
Bladon said it was normal for horses to show significant postoperative pain following conventional open surgery of the dorsal spinous process. “However, with this relatively new technique, postoperative pain is unusual, horses are discharged the following day with oral antibiotics and the recovery time is much faster,” he said.
A horse with kissing spines may show no behaviour or clinical signs of the disease, or alternatively, a horse with kissing spines may display bucking, rearing, tensing during saddling, ‘limited impulsion’ or ‘jumping flat’ and a generally depressive demeanour.
“There are a range of tests that can be conducted to identify kissing spines. Unfortunately, the majority will require extensive interpretation and that may vary considerably,” Bladon said.
“With the use of radiographs, we are able to select the interspinous spaces for surgery. The minimally invasive technique has almost completely replaced open surgery as it achieves the desired result with the added bonus of a faster recovery time.
“Sadly, though as a result, we’ve seen a huge increase in the number of clients demanding surgery with less emphasis on diagnosis for horses with back pain. We’ve seen clients too quickly jump straight to the option of surgery rather than spending the time and effort to diagnose other issues such as any underlying lameness,” he said.
Bladon says that based on his experience, the results of kissing spine surgery are consistently quite encouraging. But he warns that any type of surgery still carries a level of risk and it’s important to manage client expectations from the outset.
“Of the minimally invasive kissing spine surgeries we’ve conducted, we’ve had 83% return to ridden activity, of which 46% returned to the original levels of activity. However, 37% did go on to develop other lameness problems, querying whether these were the underlying problem.
“But it doesn’t mean the procedure is foolproof. As with any type of equine surgery, postoperative infection is still a risk. We had a situation where a client started legal action after the horse developed swelling and focal pain. We’ve also had cases of wound and postoperative infection that has required further treatment after the conventional open surgery.
“Despite this, for me as an equine vet, it’s extremely satisfying when I conduct follow-ups on kissing spines cases and hear regularly how the procedure has transformed a horse’s personality from being miserable to now a delight to own. In one case, the owner said the minimally invasive surgery was ‘the most successful operation they had ever had done’.
“This seemed a little surprising considering they had a horse with a colon torsion, one of the worst forms of surgical colic, which was still alive three years later,” he said.
Dr Bruce Bladon will talk about the Coomer Technique at this year’s Equine Veterinarians Australia Bain Fallon Conference, in Melbourne from July 17 to 21.