A pain in the back!

[GatesRiverFarm]

NOTE: I KNOW there are old threads on this topic, but thought I’d start a new one to get some more specific & perhaps more UTD advice!

Background (and I’m going to put into a bulleted timeline to hopefully make it easier to read since it’s long…)

• Bought my mare about 2 years ago - she is an absolutely lovely 13 year old warmblood show hunter
• Decided this year to begin training her in lower level dressage (stepped away from jumping)
• Initially did great in lessons but both my trainer and I found it extremely difficult to get her on the bit/moving round
• After roughly a month of training she began balking and refusing to go forward after 1-2 laps of trotting
• Did this for both my trainer and I both…she seemed to be in pain and this is not her “nature” at all to act like that
• We’d get off and put her on the lunge line and she’d work absolutely fine
• We had tried a new dressage saddle on her so thought that may be the problem as she was VERY back sore
• She also was extremely sensitive to having her stifles and belly touched
• Gave her Robaxin & Ulcergard
• Out of an abundance of concern and caution, called vet who did full lameness exam
• Vet suggested back X-rays and found some “minor” (but not overlapping) impingement in her spine
• Vet refused to call the condition kissing spines, but did say she is at the “early” point where all horses begin with KS
• Vet did laser therapy treatment that same day to provide some immediate pain relief
• Vet recommended Robaxin & 2 weeks of rest, then recheck (we also did Bemer & theraplate treatments 2x daily)
• We began performing daily carrot stretches with her
• Vet performed recheck at 1 week and noted 60% improvement in back soreness
• Vet performed recheck at 2 weeks and noted complete improvement in back soreness & movement
• Vet injected hocks & gave Osphos & Adequan, & recommended easing back into riding
• Shortly after, I rode her 1 time for about 10-15 mins. after the 2 week rest period and she was fantastic (walk trot only)
• I also had her evaluated by an equine physiotherapist who created customized exercise program for her, but during the PT evaluation under saddle she began moving fine, but then did the “balking” behavior again refusing to go forward
• PT did however note that based on her evaluation she still honestly felt the prognosis to be good
• Vet recommended more Robaxin & no riding for 10 more days based on balking during PT eval
• I have continued to do carrot stretches with her, tail pulls, belly lifts, butt tucks. Trainer is working her in Pessoa rig 3x/week and I have been hand-walking and lunging her with the Equiband system 3x/week
• We have follow-up with PT on Friday & 40 day recheck with vet the week after that
• Vet indicated possible next steps if she is still not comfortable would be the 3-pronged treatment approach to KS, to include mesotherapy, shockwave and steroid injections.

I guess at this point I just have a few questions…

• Am I missing anything?
• What have your experiences been with KS presentation, treatment, prognosis, etc?
• Has anyone had their horse get to the point of needing the bone or lig snip surgery and how did that go?

Thank you all so much for any advice or thoughts you can offer…I have been reading extensively to help my mare as best I can as I love her SO very much, but sometimes nothing is as good as just asking those who have “been there”.

WORST case, I have a big beautiful pasture at my farm with her name on it where she can spend the rest of her days. Thanks again…

[SBrentnall]

My horse had moderate kissing spines and we opted for the Intraspinous Ligament Desmotomy. It’s a keyhole surgery with minimal downtime. The rest is just treating the symptoms, not the root cause.

Result was amazing! He came back so strong, and developed a butt I hadn’t seen on him in years. Moving much better over his back and muck more forwards.

Of course, he then acted like an idiot in turnout, tore a medial collateral ligament and had to be retired. But his back is still great!

[cbg]

Your vet could block her back and then see if you get the balking behavior. If not that would be a decent indicator of what’s hurting. I tried injecting everything, multiple rounds of shockwave and chiro/acupuncture/massage (robaxin made my guy dopey so I wouldn’t use it on him after the initial try), and while those seemed to help, they didn’t last. So he had spinous process surgery done in April - cost for the surgery and couple of days immediately following was under $2,000 (standing surgery performed at my vet’s clinic). I did leave him with my vet for the 3 month recovery (2 weeks handgrazing, 2 weeks marching handwalks, 1 month turnout, one month lunging in the Pessoa rig) just because it was easier given my travel schedule and the cost of doing so wasn’t much more than my regular board. At the end of the 3 months he came home and went back to
full work. After seeing how my horse did, a friend had the same surgery done on her horse with excellent results as well.

[GatesRiverFarm]

Thank you both for chiming in with your experiences. I have read many a post about people who have had great success with surgical options, and while it is “scary” to think about, the thing I guess that “bothers” me the most about doing the meso/shockwave/steroid approach is that again, it is still just a temporary solution.

I’ve already spent well over $2000+ on diagnosing and treating this issue with her thus far, and while I’m basically willing to go to the ends of the earth to make sure she is happy and comfortable (and hopefully, HOPEFULLY one day again able to be comfortably ridden), I still want to ensure that the money I’m spending to treat her is well-placed.

Again thanks for the input!

[Highflyer]

Given the mildness of the xrays, have you looked at all for other causes? Obviously horses can’t read xrays and some with mild xrays are very reactive (and vice versa) but I would want to do a thorough repro exam before going to surgery, just in case there is something else going on and the KS is coincidental.

[GatesRiverFarm]

@Highflyer

Given the mildness of the xrays, have you looked at all for other causes? Obviously horses can’t read xrays and some with mild xrays are very reactive (and vice versa) but I would want to do a thorough repro exam before going to surgery, just in case there is something else going on and the KS is coincidental.

Well, historically, she has always had “weak” stifles and some mild tarsal sheath issues in her hocks. What the vet and I discussed was that its kind of the chicken or the egg type of scenario…is the weakness in the stifles & hocks making her back sore, or vice-versa?

I definitely would want to explore ALL options for sure before going to surgery, for sure. The reason that I guess we ruled the hocks out as being the causative problem would be that we injected them, waited awhile before getting back on her, and while her gaits felt smoother and better, she still did the “balking” behavior during her PT evaluation, which was AFTER they had been injected.

I wonder too historically if this is something that has been brewing for awhile (whatever the source of pain is), because years ago when I got her, very occasionally she would do these odd little hop steps at the trot - almost like she was about to pick up the canter - but would then keep trotting. Trainer always said this was due to her being weak in her stifles and that it was “hard” for her to push from behind, but I noticed during her PT eval that she did the odd little hop step right before balking and then refusing to move forward. So whatever is bothering her has definitely been brewing for some time.

Can I ask when you say repro exam…you mean reproductive as if she’s having some types of issues there that may be causing the pain?

Thanks for replying

[Highflyer]

Yes, my trainer had a mare with “back problems” that turned out to be some kind of ovarian cysts. Spaying her improved it a lot.

[ghst13]

@GatesRiverFarm

Thank you both for chiming in with your experiences. I have read many a post about people who have had great success with surgical options, and while it is “scary” to think about, the thing I guess that “bothers” me the most about doing the meso/shockwave/steroid approach is that again, it is still just a temporary solution.

I’ve already spent well over $2000+ on diagnosing and treating this issue with her thus far, and while I’m basically willing to go to the ends of the earth to make sure she is happy and comfortable (and hopefully, HOPEFULLY one day again able to be comfortably ridden), I still want to ensure that the money I’m spending to treat her is well-placed.

Again thanks for the input!

I elected to do surgery after trying injections and other therapies because it made more sense from a cost perspective. Injections ran about $800-900 each time and were only lasting 4-5 months. Spending about $2500-3000 on the bone shave surgery was about the same as a year’s worth of injections. Surgery also meant I didn’t have to start second guessing things every 3-5 months wondering if the pain had returned. I’ve been thrilled with the results.

I would try blocking the back as suggested above. If you see a difference that’s a really strong sign although my vet would tell you that not seeing a change doesn’t mean KS isn’t still a problem. Some horses end up so sore elsewhere from compensating that blocking the back won’t give a clear indication.

[GatesRiverFarm]

@Highflyer

Yes, my trainer had a mare with “back problems” that turned out to be some kind of ovarian cysts. Spaying her improved it a lot.

Oh wow that is interesting and something I would’ve never thought of. Very good to keep in mind…thank you!

[GatesRiverFarm]

@ghst13

I elected to do surgery after trying injections and other therapies because it made more sense from a cost perspective. Injections ran about $800-900 each time and were only lasting 4-5 months. Spending about $2500-3000 on the bone shave surgery was about the same as a year’s worth of injections. Surgery also meant I didn’t have to start second guessing things every 3-5 months wondering if the pain had returned. I’ve been thrilled with the results.

I would try blocking the back as suggested above. If you see a difference that’s a really strong sign although my vet would tell you that not seeing a change doesn’t mean KS isn’t still a problem. Some horses end up so sore elsewhere from compensating that blocking the back won’t give a clear indication.

THANK YOU! I am so glad and encouraged to hear of another success story. These past couple of months have been horrible in terms of how I’ve been worried about her and just not having a very clear path forward, and like you said the “not knowing” if/when/how we are going to get her feeling better. That is also great to know that the surgery is affordable. (I would’ve thought $10k!) The seemingly endless stream of injections so far…just injecting everything over and over again…seems unsustainable from a long-term efficacy AND cost standpoint.

[GatesRiverFarm]

…I’m wondering too in terms of the surgery…haven’t spoken with my vet about this yet of course but I’m sure I"ll have to at some point…how is it determined if the horse is a good candidate for the surgery, and also, how is it decided if the bone shaving OR lig snip is better for a particular horse?

[Tee]

Once my guy was diagnosed (bone scan, x-rays, took five years to find as he wasn’t typical in his symptoms), we did a nerve block to determine once and for all that was the issue. He was injected, which lasted around 8 months, I think. Next injection lasted less than 6. I did a third injection to keep him going over that summer and had planned surgery (shaving) in the fall. The last injection did absolutely nothing for him, so we moved the surgery up.

My main concern with the surgery was how long he would be in pain. The vet assured me it’d only be a couple of days. To be honest, I didn’t believe him. Aries had surgery on Tuesday, came home on Wednesday (on SMZs and bute), and by Friday I had a chain to hand walk him. And he’s normally a pretty quiet guy.

Surgery was a huge success, and like was mentioned above, it’s SO nice to not watch every freaking step and second and third guess if they are hurting or not. He put on a ton of muscle and is working better than he ever has.

[ghst13]

@GatesRiverFarm

…I’m wondering too in terms of the surgery…haven’t spoken with my vet about this yet of course but I’m sure I"ll have to at some point…how is it determined if the horse is a good candidate for the surgery, and also, how is it decided if the bone shaving OR lig snip is better for a particular horse?

I’m not a vet but from my experience and research the things that disqualify a horse may be age, other medical conditions or cases where the spine has fused in places. It doesn’t sound like that would be a problem for your horse. I’m sure there may be other disqualifying factors.

I have seen a wide variety of opinions from vets on whether they consider some mild cases to be worth the surgical risk and rehab. My vet emphasized that every horse reacts to pain differently, so while one horse may have horrible x-rays and show no pain symptoms, another may have mild x-rays and react badly. My horse’s x-rays weren’t that bad in the scheme of things but showed significant pain response. It’s down to what the individual horse needs

My vet only does bone shave now because he found there was a higher incidence of reoccurrence in lig snip cases (the ligaments reattach and cause problems again). Since bone shaving can be done standing as well, the cost and risk aren’t much different and I think the difference in rehab is only a month or two. I can’t say definitively, but it’s possible horses with overlapping processes might only be able to do bone shave because lig snip wouldn’t provide enough space between the processes.

[DunByMistake]

So I am definitely not an expert. I did have a gelding with mild kissing spines behind the saddle who had to be put down for other reasons.

But from a lot of the experiences I’ve read on forums and Facebook group, kissing spines seems to often be a secondary problem. However, it is easier to find than some other things. There seems to be a high number of posts where people discover that hind PSD is actually the primary problem and is then affecting the horse’s hock and backs. Since your horse has had some hock and stifle issues already, I personally would look into doing some diagnostics on hind suspensories before I went down the surgical intervention route.

Obviously every horse is different but I read a study that found pain responses in horses with kissing spine when 4 or more spinal processes were involved. And they were overlapping. Given the ‘mild’ diagnosis by your vet, I would probably do a little more investigative work.

[Rusty15]

My horse was diagnosed with KS 6 years ago, a couple months after I bought him. It took a long time to figure out what worked and what didn’t for him, but he is now going better than ever and there are no signs of him slowing down. My very determined he was not a good candidate for surgery and while I’ll always have that “what if” in the back of my head, overall I’m glad we didn’t go the surgery route.

It sounds like you’re being very proactive and covering a lot of bases! That is awesome. Here are some additional tips/points that, based on my experience, may help.

1. Back on track sheet! Keeping my boys back warm is critical. If it is under 60 degrees out, he is wearing his BOT turnout sheet. I layer it under his other winter blankets as well. The key thing is you can’t just slap the sheet on for an hour before you ride. It works best when worn for several hours a day. And it CAN be used pretty much 24/7.

2. Long-term anti inflammatories. I have had good results with Cur-OST Pure performance and am looking into inflammasaver because it is less expensive. IMO these products won’t work miracles on their own, but definitely help and contribute to completing the KS care puzzle.

3. Make sure there are no other secondary issues. For example, my horse has always had bad feet but I didn’t realize just how much they affected his back. Despite looking healthy, he was never truly comfortable barefoot or even with regular front shoes. My current farrier put shoes on all 4 feet with wedges in the front, and not only were his feet finally comfortable, but his back improved massively too!

4. Be wary of the Pessoa. It can teach the horse to travel in a false frame and actually exacerbate back issues. I have found lunging with loose side reins or a chambon, with or without some ace bandages tied to go behind the bum to be much better. Also using a lunging cavesson so the lunge line attaches over the bridge of their nose helps with self carriage. Lots of long and low work, poles, and lateral work for a few months to a year before getting back on should help a lot.

[GatesRiverFarm]

Thank you all so much for chiming in with your thought and advice. I can’t tell you enough how greatly it is appreciated as we try to fumble through getting my girl feeling better. A few notes & updates:

I had another PT session with her, and her PT was very impressed with how much her flexibility and strength has improved. We have been working diligently on carrot stretches, belly lifts, butt tucks, tail pulls, etc. for a good few weeks now and have seen major improvements. She previously was not able to easily do a belly lift or butt tuck, but now she can, which tells us there is some strengthening in her back, which is super.

We have continued to work her on the lunge line, carefully alternating between the Pessoa and equi-core, along with her PT as noted above. She has had some fantastic sessions…going super nice and low…looks comfortable.

Her veterinarian will be here for her follow-up appointment in 2 weeks, so I’m hopeful for that. If she does not show improvement, then we will talk about doing the meso/steroid injections/shockwave approach.

On another note…one thing that I know folks have mentioned is corrective shoeing. She has had the same farrier for a very long time - he is super - but notes that she is VERY “thin soled” and so he cant put pads on her. Wondering if there is a way around this…