Case Study: Kissing Spines in a 13-Year-Old Thoroughbred Gelding
Background Information:
- Breed: Thoroughbred
- Age: 13 years old
- Sex: Gelding
- Discipline: Show jumping. Previous racing history.
- Owner: An experienced amateur rider who competes in county show jumping events.
Presenting Complaint:
The gelding was presented a history of intermittent performance issues, including an intolerance to work, bucking, and difficulty with collected gaits, particularly during jumping sessions. He also showed signs of sensitivity when saddled and during grooming, often displaying discomfort when the area around the withers and lower back was touched.
History:
Several years of good performance in his jumping was met by six month of a gradually decreasing level of performance. Subsequently, an increase in resistance during training was being experienced, most noticeably when asked to collect his gait/movement or jumping higher fences (90cm upwards) and then jump refusals started to be seen on a more frequent basis, followed by bucking when asked to go up into canter.
The owner also reported that the gelding had become more reactive to saddle fitting, showing signs of discomfort, such as pinning his ears, swishing his tail, and sometimes even kicking out. Despite regular saddle checks and adjustments by a qualified saddle fitter, the problem persisted.
Physical Examination:
Upon examination, the gelding appeared to be in good overall condition, with a well-maintained coat and normal vital signs. However, palpation of the back revealed significant discomfort along the thoracolumbar region, particularly over the spinous processes in the mid-back area. The horse exhibited muscle tension (more so on the left) and sensitivity when pressure was applied to these areas. A lameness examination did not reveal any significant abnormalities in limb movement, but the horse's stride was somewhat shortened and appeared stiff in the hocks, and there was an obvious reluctance to engage the hindquarters, especially during the canter.
Diagnostic Imaging:
Given the clinical signs and history, the veterinarian recommended further diagnostic imaging to assess the condition of his spine. Radiographs of the thoracolumbar region were taken, revealing the presence of "kissing spines" or impinging dorsal spinous processes (DSPs). The radiographs showed that several of the dorsal spinous processes were in close proximity, particularly in the T14 to T17 region.
Diagnosis:
The diagnosis of kissing spines (impingement of the dorsal spinous processes) was confirmed based on the radiographic findings and clinical presentation.
Treatment Plan:
The treatment plan was multifaceted and aimed at relieving pain, improving mobility, and focusing on a return to pre-injury function or as close to it as possible.
1. Medical Management:
- Anti-inflammatory Medications: he was prescribed a course of non-steroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and manage pain.
- Muscle Relaxants: To alleviate muscle tension and spasms, a short course of muscle relaxants was administered.
2. Injections:
- Corticosteroid Injections: Corticosteroids were injected directly into the affected areas around the impinging spinous processes to reduce inflammation and pain.
3. Rehabilitation:
- Rest and Controlled Exercise: he was given a period of rest, followed by a carefully controlled exercise program focusing on building core strength and improving back flexibility. Long reining in a long and low frame, as well as specific physiotherapy exercises, were incorporated to encourage proper movement and relieve pressure on the impinging spinous processes.
- Saddle Fitting: A thorough reassessment of his saddle was conducted to ensure optimal fit and to prevent further exacerbation of the condition.
4. Alternative Therapies:
- TENS Machine - this acted as another form of pain relieve.
- Physiotherapy: Regular sessions with myself as physiotherapist were scheduled to maintain spinal alignment and improve overall mobility.
5. Surgical Intervention:
- Conservative management was the initial approach, in this case we were able to avoid a surgical option known as "Interspinous Ligament Desmotomy" (ISLD) or subtotal ostectomy. This surgery involves cutting the interspinous ligament to relieve the impingement between the spinous processes. Although some horses do go through this surgical intervention and recover, like all surgical approaches there are pros and cons and in this case we really wanted to avoid this type of surgery.
Outcome:
Over the following months, he responded well to the treatment plan. His pain was significantly reduced, and he gradually returned to work with a more positive reaction to his work and regained his level of performance. The controlled exercise program and regular physiotherapy sessions were key in maintaining his progress. Although he does require ongoing management and occasional adjustments to his exercise regimen, he was able to return to competition at a lower level without the previous signs of discomfort.
Conclusion:
Kissing spines is a common condition in performance horses that can significantly impact their ability to work comfortably. Early diagnosis and a tailored treatment plan are crucial for managing the condition effectively. In this gelding's case, a combination of medical management, injections, controlled rehabilitation, and alternative therapies allowed for a successful return to work. Ongoing monitoring and management will be essential to ensure his long-term well-being and performance.
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