This article is sponsored by Platinum Performance. It was originally published here: https://www.platinumperformance.com/articles/kissing-spines.html
Veterinary Medicine Has Evolved Its Definition, Diagnostics, Treatment Protocols, and Rehabilitation Techniques
Kissing Spines, more scientifically known as impingement of the dorsal spinous processes, is a condition that has grown in relevance and impact throughout the last two decades with improved diagnostics and education. It’s hard not to feel a horse’s pain after taking just one look at an x-ray that indicates Kissing Spines. The condition can diminish athletic performance and render a horse unusable in severe cases, while other cases with the ugliest x-rays can experience no pain or performance implications. While still shrouded in some level of mystery, Kissing Spines is known to be conformational and most likely genetic. When spinous processes are conformationally close together they will inevitably contact, with that continual contact causing the modeling changes that are classically seen on radiographs.
What we know of Kissing Spines is its mechanism within the equine body, the common clinical signs exhibited by affected horses, an ever-evolving list of treatment modalities currently in use, and critical management protocols that can keep afflicted horses comfortably thriving and in competition.
“I’ll tell you that there have been countless horses for eons of years that have been wasted because nobody knew the back was the issue, and nobody knew how to fix it.”
— Cliff Honnas, DVM, DACVS, Texas Equine Hospital
Defining Kissing Spines
Though Kissing Spines can be seen clearly in diagnostic imaging, truly understanding the nuances of the condition and how it can vary patient-to-patient is where things become less well-defined. Dr. Cliff Honnas, equine veterinarian, surgeon, and founder of the widely respected Texas Equine Hospital in Bryan, Texas, is a sought-after authority figure in all things related to this condition, especially concerning its surgical treatment. “Kissing Spines is a condition where the dorsal spinous processes are too close together,” he explains simply. “These are the bones that make up the backbone of the horse directly underneath the saddle.” Normal horses should typically have a five millimeter or larger space between those bones, depending on the breed and size of the animal in question. In Kissing Spines cases, however, that space can be minimally to drastically narrowed until those bones are close together, touching, or overriding.
Dr. Cooper Williams, a revered sport horse practitioner, certified instructor with the globally recognized ISELP (International Society of Equine Locomotor Pathology), and founder of Equine Sports Medicine of Maryland, sees a large number of high-level equine athletes impacted by Kissing Spines. “I’m typically seeing these cases elevated to me as a second, third, or fourth opinion,” says Dr. Williams of the challenges that sometimes surround this condition. “I explain this condition to clients like this — every vertebra in the back region can be compared to a fence post standing vertically. The fence posts are all interconnected and between each one you have interspinous ligaments. Along the top, you have the supraspinous ligament that connects them all. Then you have muscles that attach to the sides of these spinous processes or fence posts. These fence posts are usually nicely spaced in the normal horse, but, in the case of Kissing Spines, they’re too close together or crowded right up against each other,” he says, painting a simple visual picture of an otherwise complicated condition.
While there are numerous conditions impacting the equine back, the diagnosis of Kissing Spines has increased fairly dramatically in recent years thanks to improved diagnostic techniques coupled with a greater focus on veterinary education. “Depending on who you choose to believe in the literature, Kissing Spines along with dorsal articular facet arthritis will account for 50 to 70 percent of orthopedic back problems,” says Dr. Kent Allen, sports medicine practitioner, founder of Virginia Equine Imaging, FEI Olympic-level veterinarian, current Vice President and Executive Director of ISELP, and Chairman of the USEF (United States Equestrian Federation) Veterinary Committee. “The horse, which of course has a horizontal back as opposed to a human’s vertical back, doesn’t have disk problems like we do but rather has bony orthopedic problems that impact the way they bend, extend, and jump, such as Kissing Spines and arthritis of the dorsal articular facets,” explains Dr. Allen. “In terms of Kissing Spines specifically, its location is most commonly from the base of the withers back to the thoracolumbar junction, from T16 back to L2-3. In contrast, arthritis of the articular area will often occur further back, about three inches forward to three inches behind the rear of an English Saddle.” While the general location and disease process have become more solidified, the clinical presentations exhibited by affected horses are wide-ranging and can create significant diagnostic and treatment challenges for veterinarians.
“The horse, which of course has a horizontal back as opposed to a human’s vertical back, doesn’t have disk problems like we do, but rather has bony orthopedic problems that impact the way they bend, extend and jump, such as Kissing Spines and arthritis of the dorsal articular facets.”
— Dr. Kent Allen, DVM, ISELP, Virginia Equine Imaging
Defining Kissing Spines
A condition where the dorsal spinous processes are too close together. Typically horses have about a five millimeter space between those bones; however, in Kissing Spines cases, that space is narrowed until those bones are close together, touching or overriding.
The Surgical Approach
While many cases can be treated medically with varying degrees of success — some minimal and some exceptional — surgical intervention can yield tremendous results for Kissing Spines cases. There are two different types of surgeries being performed for the condition.
Whether surgery is a viable option or not for a Kissing Spines case, there are ongoing management considerations that can directly impact the horse’s comfort and ability to perform and compete successfully, including how one rides and warms up the horse.
Check back on YourDressage soon for the next parts in this series on Kissing Spines!
by Jessie Bengoa,