Kissing Spine and a few other issues (also in comp riders)

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Kelpie

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Bear with me, this is a bit long winded.....

...... basically I ended up falling in love with a beautiful young warmblood before getting her vetted. During the vetting, although she "passed" the 5 stage vetting (albeit noted that her stride was a little short behind, but not uneven), on x-rays, we found that she had mild kissing spines, changes to her feet (in particular large sidebones to the outside of each front foot), and mild changes to hocks and fetlock. Now, I know, how many horses would you x-ray and find potential issues on but still be apparently sound, particularly older horses, but she is only 5, rising 6. As I say, though, I'd already fallen in love with her..... so following a deal with her owners and a promise to never pass her on, said horse came home with me yesterday :)

The vets that did the vetting did say the horse could be a candidate for a fairly new KS operation where they go in on keyhole surgery and basically chip off a bit of the spiney processes and make the gaps bigger. However, as she's still so young it could be a good idea to hold fire on doing that for maybe a year, while potentially her skeleton is still changing anyway (for better or worse). Also, at the moment she has no obvious pain and other than being arguably a little short behind, you wouldn't really know she has all these issues that showed up on x-ray.

At the moment I'm thinking to really just get to know her over at least the next 6-9 months before thinking further about operations, etc, and then maybe x-ray again and see where we are. However, I have a million and one questions going through my head at the moment on how best to try and manage her and keep her sound. Obviously I'll be seeking the advice of vets/ physio's/ chiro's/ my farrier, etc, etc, but also I really think it's helpful to find out information and stories from people used to managing their own KS horses (or those of clients). So, basically, I'd be really grateful if you could throw any information you have at me!

The main questions running through my mind at the moment are:

What to look for to know if the KS is causing her any pain? At the moment there are no obvious pain points to the touch and no behavioural indications of pain - in fact, one of the reasons I fell in love with her so much is that she is a horse that just wants to say yes to you (which I guess could be a blessing and a curse - as will she say yes when really she's in pain and doing herself damage??).

What work to do with her in the meantime? - presumably lots of long and low, and I've heard also pole work to get her to use her tummy muscles well? Any other exercises to help? Or things to avoid?

What about jumping? Thus far she's done dressage and can pop a cross pole OK but hasn't really had any jumping training. Ideally I'd have liked her as an event horse, but of course I totally realise she may never be and if she isn't she isn't (and indeed if she ends up being a pet at some point, then she'll just be a very pretty pet!).

Also what about hacking...... I have heard going uphill can be useful but am worried about down-hill causing unwanted pressure?

With regard to turnout, I'd have thought that lots of turnout would be useful but with all the mud at the moment, how worried should I be about her being anywhere she might slip? We do have a hard standing turnout area to use but it's not the same as a nice big (albeit muddy) field.....

Should I worry about the effect of travel too much? (head up higher in the lorry?)

Her foot balance could be improved, I think, and probably the sidebone would speak to that. I'm tempted to think about the barefoot route but don't want that to cloud any issues relating to the KS so am in a real quandry on whether to give barefoot a go with her (all my others are barefoot - bar one shod for the eventing season).

Also, thinking ahead longer term about the possibility of the KS operation, has anyone got any experiences of the same operation where they just chip away a bit of the edge of the spiney process to create a bigger gap (rather than the more traditional operation of just taking out the whole process)? I am wondering if I should think about doing this before any pain becomes obvious or whether in fact because there is a chance it might not bother her at all, I just continue to wait and see? Or could she be carrying herself differently anyway because of the KS and this has already caused the changes to her hocks, etc?

Any useful input much appreciated, thanks.
 
Oh golly I am not very good at answering all these points however:-

My horse had that very operation. I had only had him 6 months. I cannot advise therefore on waiting as he demonstrated severe behaviour suddenly and the biggest problem I have had is managing his pain memory. He is lovely now but it's been a hell of a journey diagnosed Sep 2012 and operated on shortly after. He couldn't cope with the pain but must have been hiding it for a while.

If you are on Facebook there is a group Horses with Kissing Spine join it.

I would say every horse is different and there are owners who have successfully managed it without the op I couldn't as he was not coping and I now have the cuddly cheeky chap back with just the odd hiccup. A lot of our issues were because his behaviour ruined my confidence and I have had to build that back up and learn to trust him.


Ok now looking through your post - raised pole work v good and lunging in a Pessoa or equiami. Get a physio involved in advising you. Do lots of carrot stretches to keep her supple.

Hacking yes I was advised working correctly up and downhill if you are concerned about downhill pop off and walk her.

Lots of turnout as much as possible foot balance yes definitely get that sorted.

Tho not sure jumping is a good idea I will let others advise. The most important thing is to get her working correctly as they learn to hold themselves to avoid discomfort.
 
The advice that you have been given is the opposite of the advice I was given for kissing spines in my seven year old. My vet told me that the sooner it was done the better, because the damage can start to affect the main body of the vertebra.

Mine had the new operation. They don't chip off any bone, they just slice the ligaments between the processes. That loosens them but it also denerves the gaps. I was back on board in six weeks. The change in the horse's movement has been nothing short of astounding.

But the mental scars of working in pain for years are something that are still affecting him. So I would not leave her in pain, even if she is hiding it well as mine did. I would find £1500 and have it done immediately.
 
Fibble, thank you for sharing..... out of interest did you try the injections first or did you go straight to the operation? Also, how did it work out for you in terms of the healing process/ rehab, etc?

cptrayes, that's interesting we have been told different things. Could it be because my mare is that little bit younger? Or was your vet saying that whatever age, just go ahead and do it? I've noticed some of your other posts on your horse's surgery and it seems to have been an out and out success, which is really encouraging. May I ask what vet you used as I'd be really interested in a chat with him/ showing him the x-rays, etc? Also, for the new operation, I'm trying to get my head around why cutting the ligament wouldn't somehow weaken the back?
 
OP if you email your X-rays to Cotts they will have a look and talk to you about the ligament snip. When my boy was diagnosed with KS I sent X-rays to a number of vets, all of whom were very happy to discuss them. Mine was not a candidate for this op as his processes were mushroom shaped & overlapped on top & the ligament snip would not have created a big enough gap so he had 4 processes removed in June last year. He's been great since apart from a hiccup when he was grumpy due to his saddle no longer fitting. He wasn't in pain with the KS, he just had no flexibility in his back. He also had problems with his feet & is now barefoot.
The rehab is much quicker with the ligament snip than with processes being removed.
 
Kelpie said:
Fibble, thank you for sharing..... out of interest did you try the injections first or did you go straight to the operation? Also, how did it work out for you in terms of the healing process/ rehab, etc?

cptrayes, that's interesting we have been told different things. Could it be because my mare is that little bit younger? Or was your vet saying that whatever age, just go ahead and do it? I've noticed some of your other posts on your horse's surgery and it seems to have been an out and out success, which is really encouraging. May I ask what vet you used as I'd be really interested in a chat with him/ showing him the x-rays, etc? Also, for the new operation, I'm trying to get my head around why cutting the ligament wouldn't somehow weaken the back?
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The ligaments between the processes are cut but there is a big one right over the top which isn't touched, so there is no stability issue.

The surgeon who did it was Graham Monroe but I can't trace any contact number for him. He is a freelance. Cott's is your best bet for advice.

It's any age, I think. He has done a three year old.

My horse had no hock or sacroiliac issues. There is a less certain outcome with horses that do. In terms of his physical movement, the difference is outstanding.
 
Hi Kelpie Injections werent even suggested and he was so obviously unhappy I went had operation as soon as I could.

By now you have read my blog and the biggest hurdle has been managing his pain memory and to be honest the rehab becomes almost a full time job. I went into it all very naive. on a good point we have a lovely close relationship built over months of groundwork and stretching.
 
Flibble said:
Hi Kelpie Injections werent even suggested and he was so obviously unhappy I went had operation as soon as I could.

By now you have read my blog and the biggest hurdle has been managing his pain memory and to be honest the rehab becomes almost a full time job. I went into it all very naive. on a good point we have a lovely close relationship built over months of groundwork and stretching.
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I would echo this. After fourteen weeks I still dread getting on in case today he is worried about pain. I have to stress that from his back muscle tone and his movement he is completely cured and also that he is becoming less jumpy every day. But I too wish I had known how badly our combined lack of confidence was going to affect things. I am effectively re-backing a flighty four year old, not what I wanted to be doing at my age :(
 
Thank you cptrayes, and Fibble (nice blog, by the way).

It does really worry me that I don't want to wait to do something and then end up having a pain reaction and regretting it..... but equally I don't want to put her through surgery without clear reason. For sure I will monitor her closely though and I'll not be slow to operate if needed.
 
Kelpie said:
Thank you cptrayes, and Fibble (nice blog, by the way).

It does really worry me that I don't want to wait to do something and then end up having a pain reaction and regretting it..... but equally I don't want to put her through surgery without clear reason. For sure I will monitor her closely though and I'll not be slow to operate if needed.
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The surgery is really simple. Standing sedation with a few keyholes. No swelling to speak of. A few staples. Bute for a couple of days. I didn't even box rest mine, he was back in the field after twelve days, when the staples were out.
 
My TB was diagnosed with KS.
Symptoms where a sore back (where the back of the saddle sits) - secondary symptom to her KS
Refused to work correctly from behind
When worked with side reins over raised poles or anything that made her work long and low she would buck violently on the lunge
She started refusing jumps
On the other hand she was happy to pootle along out hacking and was fine so long as she wasnt schooled.
After she was diagnosed (with x ray) we found it was affecting 2 areas of spinal processors that where touching. She also had a roach back. Also she was diagnosed with bone spavins.
She wasnt insured and TBH she was a stress head anyway and hated being in so would not have been fair to put her through the op, the vet said she was a ticking time bomb and could expolde at any given time and probably safer to retire (at 6) so i turned her out but sadly after 6 months she lost a load of weight and she started losing all muscle tone on her back end and she resembled a whippet shape? plus she came in hopping lame (spavins) so i decided it was kinder to PTS.
Sorry if its doom and gloom but just wanted to share my experience.
I would get the op done asap as can worsen and best to get it sooner rather than later.
 
Sorry to point this out, but if this was found on your vetting, your insurance probably wont cover this, do you have the funds for a KS op and the associated recovery?
 
I would wait and monitor her carefully .
X-rays wont be to expenstive a way to do this as you know exactly where to X-ray .
I would be getting a really good physio to work with you to develop her as well as possible .
Just because a vet has operated on a three year old does not mean it desirable and relevant to your horse .
You need to have a really really good farrier on the job if the horse is shod .
And a good saddler
I would give her six months development under very careful supervision then regroup with all the professionals involved .
You need to work with a trainer who will help you to carefully and methodically develop the horse.
My kissing spines horse that I kept ( I had another who I PTS as soon a it was diagnosed ) was in his late teens and it was an old age wear and tear thing he was well controlled with Tildren and jabs into the area and physio he did very very well but not really relevant to yours as he was an old boy .
She's not going to be cheap to develop but is you have clicked with her I understand why you have gone for it.
Get the right people to support you and good luck.
 
christine48 said:
I'd be more worried about the side bone,hock & fetlock changes at such an early age rather than the kissing spines.
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They may have happened as a result of carrying herself wrongly to avoid pain from the kissing spines. Cott's reckon that 60% of horses with kissing spines also have PSD, SI strain, or both.
 
Goldenstar said:
Or it's the other way round that's my vets view .
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Maybe it's both. Certainly 40% of horses show that kissing spines have other causes. The trouble is that no-one knows, isn't it?

If your vet thinks it's only one way, I think s/he's wrong.

Would anyone have guessed that my horse would lose a very marked outward swing of the knee in a front leg once his back was fixed?
 
Goldenstar said:
Yes apsolutly because of the way the muscles work it would not suprise me at all.
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So I take it that it also would not surprise you if kissing spines cause PSD and. SI issues in some cases and not the other way round? I think we are agreeing, I'm just not sure?
 
cptrayes said:
So I take it that it also would not surprise you if kissing spines cause PSD and. SI issues in some cases and not the other way round? I think we are agreeing, I'm just not sure?
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No it would not suprise me .
On leg swinging type things it's extremely common for big moving large horses to show what i call them gait hiccups if they have even a small amount of discomfort in the back .
 
Don't worry, I am aware not covered under insurance but fortunately I have a very good job.....

It feels a bit like unpicking an onion ..... Everything is connected, I have no doubt, but what bit of the onion to unpick first!?
 
I don't have much experience of kissing spines and I guess every case needs evaluating on its own merits, but my 4 year old has a kissing spine on X-ray. This was discovered after investigations due to violent bucking when asked to canter. However, his problems are actually due to the over-developed stiff back muscles (ex-raceer). In hind sight he did have a roached back appearance and stood with hind feet too far under him, also forged quite a bit even when loose in field. Have spent last 6 months remodelling his back - lots of stretching, suppling, learning to ride in a much better way. Now have a happy horse, can do basic baby flatwork in an outline that would pass a prelim dressage test. Introduced lateral work in hand and now under saddle, use a massage pad daily. No longer forges unless tense, loves jumping and we use this to help develop suppleness too so lots of grids both loose jumping and under saddle. Do all the physio, saddler, very good regular shoeing, carrot stretches. All positive and we will see how far we go. Loosening the soft tissue has probably releived the pressure on the DSPs, which you probably can achieve much quicker and in much more advanced cases by cutting the ligament. Best consult with vets though, but get a range of opinions and not just from the surgeons!
 
Thanks whizzywig, that sounds very encouraging :) Do you think in your case the stiff back muscles caused the KS or visa versa?

It's quite a learning curve for me at the moment but right now my girl does appear to be sound so I'm really trying to work on gymnastic riding/ physio, etc, etc, to develop the right muscles more, in the hope that we may never need surgery.

Also, I keep musing over the surgery...... if the surgery to cut the ligaments works, then can one achieve the same effect (albeit over a long period of time) by doing enough work on stretching exercises? I'd guess not in severe cases but perhaps in mild cases? Just a muse......
 
There is a world of difference between one kissing spine and three or more.

With one inpingement there is room for the spinal processes to move apart. With three inpingements, there is no room for the one in the middle to move apart, it's stuck because of the ones on either side of it. I'm sure your horse was resolved by proper work Whizzywig, well done with that, too. I think yours has three Kelpie? That may be a totally different kettle of fish.

Knowing how simple the operation is, I wonder if you won't end up over time taking multiple lots of x rays that in the end will cost you more than if you just had the tendons snipped now? My other worry is whether compensating for the back will cause hock and/or sacroiliac issues over time. Genuine horses tolerate an awful lot without letting us know :(

You can tell I'm a fan of this operation, can't you :) ??
 
For mine I think it was the early career in training that puts them in a posture to cause the DSPs to rub and the developing musculature keeps them in that posture. However, different scenario to yours. I agree with the other post about asking Cotts re: ligature surgery. I would also try and contact Sven Kold (I think is part of Bushey Equine Vets, Glocs / Sommerset area) who is the expert in removing the bony processes. When you contact him also try and get the contact details of the German Vet who is an expert in back and hind leg lambness. He does clinics every quarter in the UK and it may be suitable if your case isn't too severe, but Sven would be best to advise. Most big referral practices will have a back expert, a surgeon plus someone else who will be expert at diagnosing and medicating. You should consult both. You may only be able to get general info without a referral from your own vets though. One thing I would say is not to delay with involving a expert vet as you may need medication or something to be able to make any process. You might be trying to stretch etc a locked horse which could result in more damage and the added risk of mental scaring. Also beware gadgets at this stage - fixing in one position may cause more strain and pain. Probably advisable to get suppleness and flexibility first rather than strength, but again your vets and physios will be best placed to advise. I have used lunging on gentle slopes and undulating pasture with good effect - you can really see the back free up and the different bits start to move, but again this was a couple of months into the process.
Good luck!
 
My horse has kissing spines which were considered too numerous for the standard surgery. I bought him in March 2011, he passed a 5 stage vetting but it became obvious there was a problem in early 2012. He had a steroid injection in the summer of 2012 which helped him and got us through the winter in pretty good shape. However in early 2013 I had him re-assessed and it was obvious the injection had worn off and I was referred to 3 Counties in Tewkesbury (where we'd got the original diagnosis) as a possible candidate for the ligament surgery. He had the surgery in July 2013 and I have to say it did knock him for six really - more mentally than physically I think and although the rehab process went well it took him quite a while to come back to himself. He looked very poor in his skin and posture (the physio felt that it was probably the first time in ages he'd been completely pain free and had effectively "let himself go" and everything had sagged) but suddenly in early October the muscles had been rebuilt, he was carrying himself properly and was much more relaxed. We have completed 13 days hunting (it would be more if the ground wasn't so wet!) and at a 3 month check last month the physio found no evidence of any discomfort in his back at all and has effectively discharged him. I will be continuing treatment every 3-4 months to keep an eye on it but she was thrilled with him.

It is a fairly new surgery and no-one knows how long the effects will last, but I had no alternative and am so relieved that he is pain free and really enjoying himself properly for the first time in several years. I would not hesitate to research the surgery if I were you - don't take the chance that your horse might be in pain.
 
The vetting (and x-rays) were actually done at Sven's practice .... not by Sven himself but by one of the other vets there - though she did then also show the x-rays to her colleagues, including the chap that often does the KS surgery (his favoured approach is to basically chip off some of the bone, rather than remove the whole process). I must admit I didn't realise at the time that I was lucky enough to be at one of the practices specialising in KS. Of course, though, a vetting is different from a lameness work-up. They were a bit marginal about whether to operate - as they explained to me, generally when they see a horse, it's already showing up behavioural problem/ lameness, which leads to the investigation where they then find KS as a culprit and it that had been the process for my girlie then they'd be saying operate but as in my girlie's case there are no obvious problems then it is a bit of a different situation. That, plus the fact that she is still growing so that could affect her back, meant that on balance they were in favour of waiting. Hence my plan of seeing how far we can get with physio/ appropriate riding in the meantime and then x-raying again later in the year.

wizzywig, if you knew me in "real life" you'd know why your comment about beware gadgets made me chuckle....... I do a lot of Philippe Karl training and in that school of riding, using any sort of gadgetry is just about the 8th deadliest sin ;) So I totally agree with you and am all over training for flexibility, etc :)

cptrayes, although it's 3 affected processes, in fact they are not all together. There is one process which shows some calcification, which the vets explained to me would be evidence of touching - albeit the process next to it showed no remodelling and on x-ray they were not touching (though that could just be her stance at the time of x-ray, etc). Then slightly further down the back, there are two other gaps which are basically not as big as the vets would like. I imagine if all 3 problem areas were next to each other you'd be right and we'd have more of an issue, but fortunately we're not in that situation. You're right, though, she is a really nice horse and I'd simply hate to think that she's tolerating pain that she doesn't have to. It's such a hard one, though - the more I research into it, the more it just seems that each case is so different. There does also seem to be some statistics around there being quite a high number of horses would have KS that don't actually cause them any problems. So I don't know - on the one hand if they are troubling her I don't want to hesitate to do something about it but on the other hand I don't want to put her through surgery without good reason. Don't you just wish horses could talk?!

I took girlie for her first lesson today with my eventing trainer and she was actually pretty happy her movement was OK :) (and my event trainer is pretty hot on soundness). Interestingly, my trainer cautioned against overcooking the long and low type stuff as it was putting her on her forehand - stretches yes, but no kicking her head along with her front feet ;) I've also booked for my regular vet to come have a look see and will also be booking my regular horse Chiro and my horse physio to come have a look see. If they're all happy with her then I think that will mean for now I stick with the plan of seeing where we are in 6 months or so and in the meantime being careful to manage her and how I work her appropriately. If, though, they're not happy with her, I'll probably get my vet to speak direct to Sven's practice with me there or something, and discuss surgery.

I'll massively continue to look out for any signs of issues, though - and it's really helpful to hear other people's stories, to compare against my own girl's situation and to help me plan for what the future may hold.
 
Kelpie said:
The vetting (and x-rays) were actually done at Sven's practice .... not by Sven himself but by one of the other vets there - though she did then also show the x-rays to her colleagues, including the chap that often does the KS surgery (his favoured approach is to basically chip off some of the bone, rather than remove the whole process). I must admit I didn't realise at the time that I was lucky enough to be at one of the practices specialising in KS. Of course, though, a vetting is different from a lameness work-up. They were a bit marginal about whether to operate - as they explained to me, generally when they see a horse, it's already showing up behavioural problem/ lameness, which leads to the investigation where they then find KS as a culprit and it that had been the process for my girlie then they'd be saying operate but as in my girlie's case there are no obvious problems then it is a bit of a different situation. That, plus the fact that she is still growing so that could affect her back, meant that on balance they were in favour of waiting. Hence my plan of seeing how far we can get with physio/ appropriate riding in the meantime and then x-raying again later in the year.

wizzywig, if you knew me in "real life" you'd know why your comment about beware gadgets made me chuckle....... I do a lot of Philippe Karl training and in that school of riding, using any sort of gadgetry is just about the 8th deadliest sin ;) So I totally agree with you and am all over training for flexibility, etc :)

cptrayes, although it's 3 affected processes, in fact they are not all together. There is one process which shows some calcification, which the vets explained to me would be evidence of touching - albeit the process next to it showed no remodelling and on x-ray they were not touching (though that could just be her stance at the time of x-ray, etc). Then slightly further down the back, there are two other gaps which are basically not as big as the vets would like. I imagine if all 3 problem areas were next to each other you'd be right and we'd have more of an issue, but fortunately we're not in that situation. You're right, though, she is a really nice horse and I'd simply hate to think that she's tolerating pain that she doesn't have to. It's such a hard one, though - the more I research into it, the more it just seems that each case is so different. There does also seem to be some statistics around there being quite a high number of horses would have KS that don't actually cause them any problems. So I don't know - on the one hand if they are troubling her I don't want to hesitate to do something about it but on the other hand I don't want to put her through surgery without good reason. Don't you just wish horses could talk?!

I took girlie for her first lesson today with my eventing trainer and she was actually pretty happy her movement was OK :) (and my event trainer is pretty hot on soundness). Interestingly, my trainer cautioned against overcooking the long and low type stuff as it was putting her on her forehand - stretches yes, but no kicking her head along with her front feet ;) I've also booked for my regular vet to come have a look see and will also be booking my regular horse Chiro and my horse physio to come have a look see. If they're all happy with her then I think that will mean for now I stick with the plan of seeing where we are in 6 months or so and in the meantime being careful to manage her and how I work her appropriately. If, though, they're not happy with her, I'll probably get my vet to speak direct to Sven's practice with me there or something, and discuss surgery.

I'll massively continue to look out for any signs of issues, though - and it's really helpful to hear other people's stories, to compare against my own girl's situation and to help me plan for what the future may hold.
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Well with that additional info, I would do exactly what you are doing. I got it goes well, you obviously love the horse to have bought her.

What was it that caused someone (I'm not sure if it was you) to have her back x rayed?
 
Thanks cptrayes .... Ironically it was my own paranoia wanting the xrays ... In effect I was getting another horse as my mare has PSD so I really wanted something that was definately sound! Doh! What can I say! I listen way too much to the little girl inside me that just falls in love with certain horses! ;)
 
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