A controlled study evaluating a novel surgical treatment for kissing spines in standing sedated horses.
OBJECTIVE
To compare the results of a novel minimally invasive surgical technique with intralesional corticosteroid medication, as treatment for overriding dorsal spinous processes (ORDSP) in horses.


METHODS
Retrospective controlled clinical case series.


METHODS
Horses (n = 68) with ORDSP.


METHODS
ORDSP was diagnosed based on history, clinical, and radiographic examination. All narrowed spaces were treated. Horses undergoing medical treatment had methylprednisolone acetate injected directly in the affected space under radiographic control. Surgical cases had interspinous ligament desmotomy (ISLD) using Mayo scissors; supraspinous ligaments were left intact. All horses had the same controlled exercise plan and returned to work 3-6 weeks after treatment.


RESULTS
Methylprednisolone was administered in 1-7 spaces in 38 cases, compared with ISLD in 3-8 spaces in 37 cases. Thirty-four horses (89%) treated medically initially resolved signs of back compared with 35 horses (95%) treated surgically. From these, back pain recurred in 19 medical cases and in none of the surgical cases. Horses having ISLD were 24 times more likely to experience long-term resolution of signs of back pain (OR 24; 95%CI: 5-115; P = < .0001). Repeat radiographs in 19 surgical cases indicated that interspinous spaces widened significantly postoperatively (P = < .0001).


CONCLUSIONS
This surgical technique allowed horses with back pain and radiographic ORDSP to return to work without further clinical signs of back pain and to show radiographic evidence of improvement.
Cotts Equine Hospital, Narberth, United Kingdom. richcoomer@hotmail.com
Richard P C
RP
Coomer
Shaun A
SA
McKane
Naomi
N
Smith
Jean-Michel E
JM
Vandeweerd
D000779:Anesthetics, Local / Q000494:pharmacology; D000818:Animals; D001416:Back Pain / Q000188:drug therapy / Q000601:surgery / Q000662:veterinary; D006734:Horse Diseases / Q000188:drug therapy / Q000601:surgery*; D006736:Horses; D006993:Hypnotics and Sedatives / Q000494:pharmacology; D007093:Imidazoles / Q000494:pharmacology; D008159:Lumbar Vertebrae / Q000601:surgery*; D008619:Mepivacaine / Q000494:pharmacology; D019637:Orthopedic Procedures / Q000379:methods / Q000662:veterinary*; D012008:Recurrence; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000662:veterinary*; D013904:Thoracic Vertebrae / Q000601:surgery*
D000779:Anesthetics, Local; D006993:Hypnotics and Sedatives; D007093:Imidazoles; C041255:detomidine; D008619:Mepivacaine