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Every once in a while, we get a horse that comes into the clinic with “back pain.” Usually, at some point, someone in the horse’s life (owner, farrier, chiropractor) has wondered if the horse may not have “Kissing Spine,” and we get asked to look for it. While not necessarily a new phenomenon, Kissing Spine, or more correctly termed Overriding Dorsal Spinous Processes, is the term we use when horses have interference between one or more spinous processes. This is different from spinal arthritis, which is interference within where the joints of the vertebrae. Let’s talk about anatomy. Below, we see an image of the spinal column of the horse. The spinal column consists of five different types of vertebrae. The cervical spine, circled in green, consists of the first seven vertebrae. The thoracic spine, circled in red, consists of 18 vertebrae, and the lumbar spine, circled in orange, has six vertebrae. The last two parts, the sacral and the caudal vertebrae, is the last 20 vertebrae of the spinal column and tail. The parts that are most affected by Kissing Spine are the thoracic and the lumbar vertebrae, circled in red and orange. Most commonly, T-15 is affected, which is right under the rider’s seat. |
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The following picture is a front to back view of a thoracic vertebra. The spinous process, labeled (a), is what is affected in Kissing Spine. Spinal arthritis occurs at (e), the articular process. |
Kissing spine occurs when one or more of the spinous processes are too close together. Some may even be touching. This causes the bone to start reacting, and the only thing bone knows how to do is make more bone. Bony proliferation begins to occur between the two spinous processes that are too close together. This can also be affected by poor saddle fit and poor muscle development along the spine.
A common misconception with Kissing Spine is that it is the cause of most back pain. This is not true. 5% of back pain in horses is actually from the back. 95% of back pain in horses stems from other problem areas such as hocks, stifles, and feet. In fact, most horses with Kissing Spine don’t actually show any clinical signs. That’s why it’s very important when trying to diagnose a back pain problem, to take into account a full lameness exam. Once this has been performed, there are four types of diagnostics we can do to look for Kissing Spine. The easiest one is x-ray, where you can actually see the bone that has been laid down in reaction to the spinous processes touching. You can also use bone scans, ultrasound, and thermography to diagnose Kissing Spine.
Once diagnosed, there are a few different treatment options for this problem. The first way to address Kissing Spine is to ensure you have a properly fitted saddle. Once this has been performed, horses can begin physical therapy. Exercises to stretch the back and engage the core muscles can help spread the spinous processes apart. Anti-inflammatories may also be used to help facilitate increased comfort and less bony reaction. If this isn’t enough to alleviate pain, injections of steroids in between the vertebrae may give some level of comfort. Mesotherapy, which is the injection of anti-inflammatories into the tissue around the spine can also be helpful in treating Kissing Spine. If all else fails, surgery can be used to either remove the affected parts of the bone, or to cut the ligament in between the processes to relieve tension and allow expansion.
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The important thing to remember about Kissing Spine is that not all horses with back pain have it, and not all horses diagnosed with Kissing Spine have back pain. If your horse is showing problems with performance, or is experiencing behavior problems at certain points of their day, be sure to call your veterinarian for a full lameness workup. At this time, Kissing Spine may be addressed and potentially treated to keep your horse as healthy and happy as possible. |
Great article.