Kissing Spine Standing Operation – before, during & after care

Avid readers will be up to speed with Dustry’s lameness diagnosis, but if you’ve just discovered my blog and want to know the history it’s here.

He went for his kissing spine operation in Lambourn at Valley Equine Hospital. It’s a great facility and pretty local to me, but unfortunately it doesn’t exactly hold happy memories. The last visit I had there in 2011 was with Soap who as a result of an injury sustained in the field had to be PTS and we drove home with an empty lorry :(

Brushing off thoughts of the past I dropped Dustry off for his operation on the Sunday evening, he sniffed around the box, then tucked into his hay and seemed happy as Larry in his temporary home.

Due in for his operation on Tuesday 12th July I was checking my phone relentlessly for signs of an update from the vet. When the update did arrive it was NOT what I, or the vet had expected. Dustry was having standing surgery because he was a good candidate for this technique but during the administration of the local aesthetic things started to go awry. As it turned out unbeknown to anyone he was allergic to the drug being used (Lidocaine) and became hyper-aesthetic and the surgery had to be abandoned.

He was closely monitored from this point onward in order to make sure that he returned to being ‘clinically normal’ and the side affects of the allergic reaction to the drug had worn off. Thankfully he was able to proceed with the surgery the next day using a different drug with no complications – phew!

I now have the name Lidocaine etched in my mind, his regular vets have been informed about this allergy and I’ve put a sticker on his passport with the allergy warning. Things with horses never do run smoothly!

So a day later than planned (Weds 13th July) his surgery took place. During the operation Dustry had a wedge ostectomy performed on 8 adjacent DSPs (Dorsal Spinous Processes) using a bone saw via a midline approach through the supraspinous ligament.

What that means in layman’s terms is that 8 of the spinal processes that come off of his vertebral bodies above his spinal cord and point upwards towards the sky were reduced in width in order to create more space between each bone. This increased space between the bones eliminates the ‘kissing’ effect of the spinous processes which were too close/touching previously.

This picture nicely illustrates a horse’s spine (image from scienceofmotion.com). I have drawn a thick white line along the actual spinal cord, from the neck to the tail. The thinner blue line circles the DSPs that come off the spinal cord. It is these bones in Dustry’s back (just behind the withers and under the saddle) that were close/touching and causing him discomfort. (ignore the black box on the image)

spine

To diagnose KS amongst other tests vet’s take a radio-graph so that they can see the location of the bones and any damage/activity on the bones. Over active areas of bone show up as bright white ‘hot spots’ on the image.

This is a radio-graph of a healthy back, with good anatomy (taken from here). You can see on the image that the bones are all well spaced apart and there are no bright white ‘hot spots’.

3demodorsal_spinous_processes_0001

For comparison these are Dustry’s radio-graphs before his operation. Images going down the page in order from head to tail direction.

dustry pre op0002

dustry pre op0003

dustry pre op0004

As you can see in places there is virtually no space between the bones, and some areas have bright white regions which indicates bone activity/damage.

In contrast after his operation his DSPs now look like this.

dustry post op0001

dustry post op0002

dustry post op0003

You can see the surgical straight edge to the bones where they have been cut away, and the clear space that now exists between each DSP. The little white lines at the top of the picture that you can see most clearly in the 2nd image are the staples holding the incision closed. Once removed these sections of bone will not regrow and the gap they leave behind will gradually become filled with fibrous tissue.

As well as the many conversations with my vets I had before deciding to go ahead with this I also read up a lot online before sending him for the procedure. I trawled through a mix of medical journals, veterinary websites, forums, and facebook groups to get a good idea of the bigger picture. I wanted to understand medically and anatomically the implications and outcomes and also read personal accounts of care and rehab post op to see how others in the same situation had dealt with this.

What I consciously did not do though was watch a video of the procedure. If you are considering this treatment for your horse you may want to seriously consider if you want to watch the following video prior to surgery. It does contain scenes that could be off putting for an owner, but are common place in the life and practice for a vet

This is a video from You Tube of the standing kissing spine operation carried out by Towcester Vets. WARNING – If you decide to watch this it is not for the faint-hearted as it shows the full surgery and at times can be very gory. If you do watch it the video is annotated with notes as they go through each phase and is very informative.

Surgery went well and Dustry remained in the hospital for a further 13 days post-op. Some cases can be released to continue this box rest phase with the staples still in at home but I wanted him to stay there in a controlled and clean environment, with trained medical staff on hand until he had his staples out.

I went to visit him and take over more food and treats, the vet nurses phoned me with daily updates and his surgeon Dr Jessica Kidd even text me pictures of him in his stable to reassure me that he had come through the op ok.

He was walked out twice a day for some in hand exercise and on the final day before coming home he had a short period of turn out in a round pen to stretch his legs. His staples came out 12 days after the op and this is what the wound looked like immediately after they were removed and it was cleaned. dback1dback As you can see from the side on shot the profile of his back has 2 large lumps on it. This is where the supraspinous ligament was sewn back together. These lumps will settle with time and become less visible as he builds back up his wasted back muscles. The incision was then dressed with a sticky dressing to cover the fresh scar and some polsterplast placed across that to give some protection/cushioning if a rug needs to be worn. So 17 days after he was admitted and 13 days post-op we were able to collect him. I warned Mummy Groom that he was not holding much weight and his muscles had visibly wasted away given such a long period on box rest. He never lost his appetite whilst at the hospital, and the care he received was spot on but he is an anxious personality not at ease when stabled for long periods and as such he did drop condition with the stress of it all. Going to collect him really hit home just what a traumatic event this has been for him and how it is going to take time for him to regain confidence in his body and fully recover from the operation. 

It’s horrid to know that you are the one responsible for your horse’s discomfort and that they have had to go through this under your instruction. When I was given Dustry’s kissing spine diagnosis I effectively had 2 choices:

1/ Have him operated on to solve the problem and enable him in the future to continue his ridden career in comfort (at whatever level suitable)

2/ Have him PTS, because I cannot afford to retire a 10 year old horse that could live for another 10+ years as an expensive ‘field ornament’

Given those options available to me I made the right decision in the long term, but it still doesn’t assuage the short term guilt when I see my once boisterous and confident horse currently quiet and sheepish as a result of my decisions. :(

There are a few other options when it comes to kissing spines treatment and not everyone opts for surgery, but Dustry was not a good candidate for any of these alternative treatments which can be less invasive and vary in cost:

  • Corticosteroid Injections
  • Shockwave Therapy
  • Interspinous Ligament Desmotomy

Kissing Spine Operation Aftercare

Thankfully his progress appears to be quick and he is starting to bounce back already. He’s perked up now that he’s back home turned out 24/7 in a little patch of field with access to a field shelter and lots of quiet company on every side of him. I am treating him with kid gloves to help him get his mojo back and avoid any situations that might make him jump/flinch. Less than 3 weeks post-op I don’t think that sudden movements are good for him just yet. I’m sure he’ll find his feet when it comes to high jinks over the next few weeks, but for now it’s softly softly catchy monkey.

Last night I changed his dressing being mindful to run my hands over and near his spine so that he could feel the contact, get used to it and be reassured that it wouldn’t hurt before I began peeling any dressings off. He was very good standing still and relaxed whilst I removed the old bandage, took photos of the wound’s progress and reapplied a new dressing.

I’m going to keep the wound covered for a few more days depending on how well the dressings hold up. By that point all the remaining little scabby areas should have closed up and the wound can then be left open to the air. Here it is after the staples were removed (left) and a few days later (right)

20160729_130507

As you can see from the profile shot below one of the little lumps has gone completely and the other is already much reduced.

dback2

As luck would have it Amigo have brought out the perfect rug for Dustry’s exact situation. It’s a fly rug with a central waterproof panel that keeps the spine, from ears to tail dry. Less fortunate is the price tag attached to this rug and it’s gopping 80s ski wear style design but as the British weather is so unpredictable leaving him in either a lightweight turn out or normal mesh fly rug could risk him getting too hot or worse still rained on and the dressing and incision wet.

So trussed up like he’s about to hit the slopes in Val d’Isere circa 1985 he’s happy bimbling around the field getting to grips with the new feel and function of his back. He’s remaining quiet and only broke into a short trot when initially turned out in the paddock, but he moved the best I’ve ever seen him in those fleeting strides of floaty trot so I’m feeling hopeful that when I bring him back into work next year things will be looking up for us.

I’ll keep you posted on his progress but for now I just want to say a big thank you to my vets Emiliano Espinar from McGonnell and Gillatt for his help with initial diagnosis. Jessica Kidd for her expert diagnostics, surgical skills and for being the only vet I’ve ever met who knows her way round a smart phone! All the nursing staff at Valley Equine for putting up with his high maintenance needs (yes we turned up with his Haygain, nut ball and long list of ‘Dustry dos and don’t so I’m sure they loved me!) and the ever present Mummy Groom who is my rock.

UPDATE 04/08/16

Now in the full size field and moving much better!

0 Comments
Previous Post
wwec1
Next Post
_J1_5969