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KISSING SPINES IN HORSES

 * What are Kissing Spines?
 * Signs and Symptoms of Kissing Spines in Horses
 * Diagnosing Kissing Spines in Horses
 * Treatment of Kissing Spines in Horses
 * Medical Therapy
 * Kissing Spines Surgery
 * Kissing Spines Rehabilitation and Physical Therapy
 * Prognosis for Horses with Kissing Spines

Updated August 8, 2022




WHAT ARE KISSING SPINES?

Officially known as “overriding dorsal spinous processes” or “spinous process
impingement” this term describes the touching or “kissing” of the long, thin
bones that project upward from the vertebrae of the spinal column in the horse’s
back.

These bony prominences start at the horse’s withers with the first thoracic
vertebra (T1) and continue to the point of the hip with the last lumbar vertebra
(L6), with T13 – T18 being the most commonly affected. In fact, most Kissing
Spines are seen between T14 - T15 and T15 - T16, where the slant of the spinous
processes change direction from a slight angle backward to a slight angle
forward. This is also directly underneath where the rider sits.

In this radiograph, the dorsal spinous processes are in alignment with roughly
equal spacing. In this radiograph of a horse who has been diagnosed with kissing
spines by his veterinarian, you can note the impinged areas with narrowed
spacing and bony remodeling.


WHAT HORSES MAY BE AFFECTED BY KISSING SPINES

Kissing Spines are the most common cause of primary back pain in the horse, and
seem more prevalent in thoroughbreds, horses five years of age and under, and
dressage horses. The condition also occurs in warmbloods and quarter horses, as
well as horses that jump, including hunters, jumpers, and event horses. In some
cases, problems develop after a fall or other injury, but more often it is the
conformation of the horse (short back) or the vertebrae themselves (narrow
interspinal spaces) that is involved.

Recently, a team of researchers has identified a genetic component to Kissing
Spines in thoroughbreds, warmbloods, and quarter horses. One group of genes
affects whether or not a horse will develop the condition at all, while two
other groups of genes affect the severity of the condition. In addition, the
researchers noted that a horse’s height has a very strong impact on the chances
a horse will develop Kissing Spines (i.e. taller horses have an increased
chance), while sex and age do not appear to be as closely associated as once
thought.




SIGNS AND SYMPTOMS OF KISSING SPINES IN HORSES

There are several reasons why a diagnosis of Kissing Spines in horses can be
challenging. First, not every horse with spinous process impingement on X-ray
shows acute back pain. Second, there is no one clinical sign that clearly points
to Kissing Spines as the cause. Rather, the horse’s trainer, owner, and
veterinarian must work together as a team to identify behavior, performance, and
discomfort issues that together tell a story of primary back pain. Third, some
indications that a horse may be dealing with Kissing Spines are subtle and may
be interpreted as behavior or training issues.

Here are examples of some of the signs that have been identified in horses
diagnosed with this condition:

 * Shows anxiety on the crossties such as shifting weight, bowel movements, etc
 * Resents grooming, especially over the back area
 * Drops or dips the back when the saddle is placed on it
 * Acts irritable or bites the air or the crossties when the girth is tightened
 * Makes it difficult to mount
 * “Scoots” forward as soon as mounted
 * Changes from normal temperament, demeanor, and even facial expression while
   working or being prepared to work
 * Has back stiffness or is hollow and inverted
 * Demonstrates a resistance to work such as refusing jumps or being “behind the
   leg”
 * Bucks, rears, bolts, kicks out, tosses the head, shies
 * Unwilling to go “on the bit” or execute smooth transitions
 * Struggles to pick up or maintain the canter, the correct lead, or a proper
   three-beat gait; cross-canters, has a disunited canter, or breaks from the
   canter
 * Loss of muscle mass across the topline
 * Reluctant to roll or lie down

Since many of these signs can be due to a behavioral or training issue - or a
medical condition unrelated to the back - it is important to carefully document
observations like these and share this detailed history with a vet so that they
can come up with the most appropriate diagnostic testing and treatment plan.


DIAGNOSING KISSING SPINES IN HORSES

With a long list of behavioral, performance, and soundness signs possibly
pointing to Kissing Spines in horses, it’s important to confirm the condition or
rule it out in order to start appropriate treatment. The diagnosis of any
disease or condition starts with the veterinarian taking a complete history,
which means sitting down with the owner and trainer and talking through their
observations. Signalment – or age, breed, gender – is also critical to forming a
diagnosis.

Next, the vet performs a complete physical examination of the horse that
includes hands-on palpation of the entire body, including the back. A thorough
and systematic lameness exam follows, and may include observing the horse while
in motion in-hand, on the lunge-line, and under saddle, as long as it is safe.

Some vets perform a nerve block (i.e. inject local anesthetic) in the back area
and repeat the lameness exam, but this may not be a reliable test for Kissing
Spines. Radiographic images (X-rays) are considered the gold standard for
confirming this condition, with nuclear scintigraphy (bone scan), thermography,
and ultrasound also contributing valuable information that can be helpful in
formulating a treatment plan.


TREATMENT OF KISSING SPINES IN HORSES

Treatment of Kissing Spines starts with making the horse more comfortable,
followed by a program of physical therapy to strengthen back and abdominal
muscles, stabilize the posture, and improve mobility. Relieving the pain
associated with Kissing Spines can be approached medically or surgically, and
before recommending the best options for a particular case, the veterinarian
will take into account many factors, such as:

 * The severity of the case, as indicated by the clinical signs as well as the
   X-ray findings
 * The availability of certain treatments in the area
 * The owner’s budget (time and money)
 * The horse’s current and future use

For example, a two-year-old racehorse with five “kissing” spinous processes that
can no longer be saddled without pain might be managed differently than a
six-year-old dressage horse with subtle performance issues and one narrowed
interspinous space.


MEDICAL THERAPY

Unless the Kissing Spines is very advanced, most veterinarians will likely
recommend starting with a conservative, medical approach to the treatment of
this condition. Methods to control the pain and inflammation and therefore break
the muscle spasm cycle and restore motion include:

 * injecting corticosteroids directly into the interspinal spaces
 * mesotherapy (a pain-dampening technique of injections that stimulate the
   mesoderm, the middle layer of the skin)
 * shock wave therapy
 * therapeutic ultrasound
 * non-steroidal anti-inflammatory drugs (NSAIDs)
 * muscle relaxants
 * chiropractic (veterinary medical manipulation)
 * acupuncture

A vet may use one or more of these options depending on the case and his or her
record of success with a particular treatment or combination of treatments.
Every case is different and some horses will respond better to one type of
therapy than another. If the horse does not improve with medical therapy or the
condition recurs quickly, then surgical therapy may be recommended.


KISSING SPINES SURGERY

Veterinarians may recommend surgery for Kissing Spines as the first treatment
option or after an unsuccessful course of medical and physical therapy. There
are two different surgical procedures available. The veterinary “team” made up
of the referring vet and the surgeon will recommend the one, or a combination of
surgical treatments, that is most suitable for the horse and situation.

Parts of the bony spinous processes themselves are removed, basically shaving
off or taking out some of the bone to widen the space. This can be done under
general anesthesia or standing sedation and a local nerve block. It is
considered the more invasive and costly of the two procedures and requires a
longer recovery and rehabilitation time.

A procedure known as Interspinous Ligament Desmotomy, or ISLD, can be performed
while the horse is standing. This involves cutting the ligaments that connect
the affected spinous processes. It is generally less invasive, less costly, and
some horses return to work in as little as six weeks.

Regardless of which surgical procedure was performed – or whether medical
therapy was elected – all horses treated for Kissing Spine will need physical
therapy for long-term improvement.


KISSING SPINES REHABILITATION AND PHYSICAL THERAPY

The goal of physical therapy or rehabilitation is to safely and slowly get the
horse moving in a manner that rebuilds the back and abdominal muscles, expands
range of motion, and educates the horse’s body on how to carry itself and a
rider correctly. The specific rehab program for an individual horse will depend
on the medical or surgical procedures performed, but most begin with a period of
hand walking, followed by lunging (usually with a “postural aid device” such as
a lunging system). Then, a gradual re-introduction under saddle with an
experienced and balanced rider.

Some physical therapy programs incorporate poles or cavaletti. At all stages, it
is generally recommended to work the horse in a long and low frame that lifts
the back and lowers the neck. It is also critically important to ensure that the
saddle fits properly.


PROGNOSIS FOR HORSES WITH KISSING SPINES

While every case is different, the majority of horses with Kissing Spine that
are diagnosed, treated, and rehabbed appropriately are able to return to work.
Some will be able to perform at their previous level while others may need a
step down in order to remain comfortable. While the formal physical therapy
program may have ended, trainers and riders should continue schooling horses in
a frame that encourages a rounding of the back, self-carriage, and balance.

Research into Kissing Spines is ongoing, with one project being the development
of models to help identify horses at risk for the condition. This may lead to
more appropriate career choices and even early diagnosis and treatment. Owners
are urged to strongly consider not breeding horses with Kissing Spines, now that
a genetic component has been identified.

--------------------------------------------------------------------------------

SmartPak strongly encourages you to consult your veterinarian regarding specific
questions about your horse's health. This information is not intended to
diagnose or treat any disease, and is purely educational.

Article First Published June 2012

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