Kissing Spine 2018- Lig Snip Results?

[Joysie]

Background: 6 yr old OTTB, purchased after vetting from aftercare organization.Lameness work-up for intermittent behavioral issues when work increased suggests SI issues and confirms the presence of “4 “kissing spines” or impingment lesions with sclerotic bone and osteolysis in the caudal thoracic region”. Recommended to consider injecting SI, left front coffin joint, and ligament snip for the spine.

I know this topic has been discussed and I’ve read every thread. I’m looking for people’s experience more than two years out from the lig snip surgery. I have joined the FB group but honestly, while everyone reports their horse is “happier”, it is an exhausting parade of cascading physical issues and injections and so on.The vet told us that the way the horse has been worked on the lunge line is probably one of the reasons he has been ok up until now. His owner has a limited budget and has just spent more on a horse that is not always pleasant (maybe for good physical reasons) than she paid to purchase him. She wants to do right by the horse but can’t get the vet to prognosticate. I know I’m not providing a ton of information but I’d love to hear if anyone with a similar profile (I know they all vary) has had a successful outcome. I understand the surgery may be falling out of favor?

Thanks!

[Joysie]

Please…anyone?

[LuvRedHeads]

Hi Joysie,

I considered responding earlier, but didn’t, because I didn’t have a successful outcome. But as you haven’t gotten any responses, I will share my experience.

Horse #1. Diagnosed with KS, Impingement of T15-T16. Did the ISDL surgery at very reputable equine hospital that does 100s of these surgeries. Horse healed marvelously, perfect rehab, followed rehab protocol to a T. Started him back under saddle, 6 weeks later, lame in RF. Progressive osteo-arthritis in the coffin joint. Retired him to a trail/companion home.

I also had a second horse diagnosed with KS that had a similar profile to the one you described. I did not opt to do the ISDL surgery. Outcome was not positive in this case, either.

I’d be happy to share any info I gathered. KS can be very unique to each individual animal in terms of outcome of success.

[halt]

It’s been my experience that KS is not so cut and dry - it can cause systemic body issues and some horses with 5 impinging processes have no problems while some with one are crippled. It really is case by case.

I will say that I do see an overwhelming amount of horses that have hind suspensory injuries or failures after the ligament snip process. So there is that. YMMV.

Whether or not that is because the suspensory & other structures were already slightly damaged by the horse chronically compensating in other areas, and protecting himself due to KS (which came first, chicken or egg?) and then the sudden change of posture causes failure, or maybe over-exertion – whether or not the suspensories might have been already slightly aggravated prior to lig-snip and then the sudden newfound freedom in movement is the last straw over their back (no pun intended)… it has not been clear to me. Certainly there is a good correlation between lig-snip and lack of soundness after so I think your concerns are warranted.

The other thing is that the rehab for the lig-snip requires a fantastical amount of lunge work. I am not certain that lunge work is all that great for a horse with KS, so, have never been surprised to report that people who have followed the rehab protocol to a T now have a horse with suspensory issues on their hand. The lig-snip generally outlines an 8 week program that revolves around lunging in side-reins or a pessoa gig. I think 8 weeks of 20-30m circles, in a pessoa-type workout is a surefire way to make a horse’s suspensories sore.

So - what is it? Is it all because of the compensation the horse’s entire life, trickling down to the suspensories? Is it because the horse has newfound freedom over its back, and overexterts itself or we push them too hard? Is it because the rehab protocol encourages small circles and lunging?

I have not seen, personally, fantastic outcomes 3+ years down the road. I have a horse with similar issues and will not be pursuing the lig-snip surgery for the exact fears you’ve outlined.

Other people have noted, both on COTH and off, that perhaps KS is a body-wide issue and whatever causes the KS is involved in causing issues in other parts of the body - similar to how EPSA/DSLD causes overall connective tissue failure.

My personal opinion, having lived in and experienced it, is that once you’ve diagnosed KS you are not going to get better. The KS tends to be the tip of the ice-berg and a whole host of physical issues usually follow.

This horse is six. It’s very sad that a six year old needs all of this - coffin injections, SI injections, and the KS on top… I feel so sorry for him.

[caryledee]

I’ve reported my results on other threads so this may be old information. Not favorable results with ISLD surgery. In my case we found the horse also had cervical arthritis. He is retired. Lig snip was done in 2015. Your vet probably is not able to prognosticate because each case is so different.

If I had it to do again I would do a bone scan before making any decisions. It is not cheap but it would save money in the long run if multiple issues are found. I agree with the others that after KS is treated many times other issues are found. There are some people on the Facebook group that have had positive results and have gone back to competing, FWIW.

On the positive side, my vet does maintain several KS horses at the upper levels. She does not recommend surgery but therapies such as shockwave, injections, and mesotherapy. It is not impossible but not something that may be feasible for someone on a strict budget. Can the horse be returned to the aftercare organization?

[LuvRedHeads]

Coming back to add… I, like @caryledee, was also wondering if the owner has the option to return the horse to the aftercare organization?

In my case, it sounds like my horse #2 had a similar presentation to the one you described in your OP. 6 year old OTTB, lameness work-up for intermittent behavioral issues, 4 impinging spinal processes. This horse was under saddle post-track for <6 months, not successfully going w/t/c. We tried back injections, shoeing changes, new saddle, weeks of lunging, estrone to build up the stifles and hind end. Nothing was proving successful. I could have pursued shockwave, mesotherapy or the ISDL surgery with subtotal ostectomy, but decided at the advice of my vet to stop treatment, as the horse wasn’t responding positively to any therapies. He was only comfortable under saddle on large amounts of Robaxin.

I ended up giving the horse back to his breeder, to live out his years as a pasture ornament. As a one-horse ammy owner with no land, I did not have the means or the setup to accommodate what he would need to be successful under saddle - if ever he would be.

On the other hand, I boarded with a woman who had an older TB, 11 or 12, IIRC. Diagnosed with 2 impinging spinal processes. She did the back injection, did the weeks of lunging to build his back up, and as far as I know, was completely successful with no need to even repeat the back injection. So, it’s really all over the map, as far as long term success.

[Tee]

My guy is 11 this year, had issues on and off basically his entire life until we were finally able to diagnose KS (he had zero typical symptoms of KS and finally found with a bone scan and then x-rays). He had 3 processes impinging. We tried the lunging and back building exercises, and did injections on him three times - the initial one lasted 6 months, the 2nd lasted 8 months, and the 3rd didn’t do anything.

After much discussion with his vet regarding the lig snip or bone shaving, we opted to go with the shaving and eliminate the problem entirely. I will say it wasn’t that expensive, and then 2 1/2 months off work. He’s been back to work now for 4 months and while it’s a slow, slow process building him up, it was totally worth it. He’s moving better than he ever has and I don’t have that every day worry if this is going to be a good or a bad day for him.

I know this doesn’t answer your question, but maybe worth considering as an option? Somewhere I have pics of his before and after if you’d like to see them.

[CindyCRNA]

I’m no help with surgery results as we conservatively treated a T-13, T-14 KS that had bone remodeling on a 15 year old TB with mesotherapy, injections and shockwave. He competes to this day as a low level eventer and has only been touched up once in 2+ years.

[vxf111]

How much was the bone removal/shaving surgery, for those who did that?

[Tee]

All told, Aries’ surgery came in around $3300 (surgery, drugs, painkillers, etc), plus another $300 for a followup before he was cleared to go back to work.

[IPEsq]

One vet practice in my area tends to recommend the bone shaving over lig snip. This horse has some other possible pain issues, though, so I wouldn’t jump to that right off the bat. SI pain and front foot pain can cause similar behavioral problems. I think I would start there. If there is some space between the affected spinous processes and the other treatments aren’t helping enough, inject there as well and possibly shockwave. Then see what you’ve got.

[Joysie]

Thank you all for your responses! I got discouraged and stopped looking for a few days then returned to find all your comments.

Several of you asked about return to the aftercare organization. Unfortunately, this is the second horse she got through them that has significant issues not discovered until put back into work. She has a 7 year old mare retired after extensive suspensory and hock work. Want to bet the mare also has KS? They will only take horses back that can be rehomed for at least trail work. The mare is with her as a companion getting taller every year and also beginning to appear uncomfortable in the pasture at times.

The gelding is a different character, maybe due to his issues. He was retired due to pre-race meltdowns attributed to a less than ideal temperament for the track (now read=pain) He can be hot and stupid on the ground and the same plus balky under saddle. We were thinking his balkiness is strictly pain. When he is willing (comfortable?) he is lovely and brave. He has been dangerous in his bouts of spinning, backing etc.He’s frenetic in the field and his turnout has to be carefully arranged because he’s in constant motion and can be a real aggravation to his pasture mates. A vet who knew him from the track came to the barn one day and recognized him. He said he’d broken a grooms leg. Soo he does not really present like a good companion horse and she doesn’t have space to add him to the mare and an old pony. Nor would they appreciate it.

He is a very fancy grey boy with nice movement and the very little jumping he’s done has been moon-height. So she feels like she needs to control next steps for him as someone will be tempted to put him to work and get hurt or cause him more pain.Very sad. I am learning that anyone who buys an OTTB may want to start with a back X-ray.

We had talked about the bone scan and maybe that really is the best next step. The vet is not recommending the shaving and his more conservative recommendation is injections all around. We had talked about IPEsq’s recommendation to try just the coffin and SI injections, too, as a diagnostic to see if the ks really is the issue. THANK YOU all so much for your input, happy or not. I’ll share it immediately.

[LuvRedHeads]

@Joysie Thanks for the update! Hoping for the best for this owner and horse. Curious - does the horse respond to Robaxin at all? If I had decided to continue treatment for my guy (Horse #2), Mesotherapy or Shockwave was probably where I was headed next.

If you can, keep us posted. Hoping for success for all involved.

[Joysie]

@LuvRedHeads No, she took him straight for the work up after the first time he went up and looked like he was going to flip so she’s not done any intermediate steps. Hospital vet did not recommend medication - just injections and snip.

[Tjkobol]

I’m sorry to hear about so many negative outcomes with the lig nip Sx! I, thankfully, have had a positive experience with this surgery.

My mare has had back issues for years. When she first started having issues we did a full workup including x-rays and u/s. Did not come up with much… but we ended up doing injections in the sacral area… I can’t remember exactly where, I’d have to double check her records… We did this every 1.5 years or so and she did really well. Then about a year and a half ago her back was progressively getting extremely painful. Did a full workup again, diagnosed with kissing spine. Went at it with lots of injections, which showed almost zero relief, so I opted to do the lig snip Sx. I considered the other Sx, where they take some of the bone, but my Dr did not advise it. In my case, I’m glad I went with the Sx that I did.

Wasn’t able to start rehab right away like I was supposed to… I was supposed to handwalk her for 2 weeks following the surgery, and start long-lining her (obviously walk at first) after that. We got two weeks behind cause she was so sensitive to the staples in her back that she was dangerous to handle. Once those were removed 2 weeks after the Sx, we were able to start our rehab… she was totally fine. Followed rehab protocol very closely, had check ups w the Dr regularly.

We are now 13 months post Sx, and she’s doing spectacular. She comes out of her stall a little cold backed, I ALWAYS lunge or long-line her before i get on to warm up her back before I sit all my weight on her. After her warm up, her back feels great, no pain.

Only issue I’ve really had is that ever since the Sx, her stifles have been on the weaker side, something we haven’t really dealt with before… so we do a lot of work specifically to strengthen them, and I don’t typically have any problems. Every once in a while if I worked her really hard the day before, she’ll be a little off on one side the next day, but she actually usually works out of it in the warm up.

We were riding 1st-2nd level before the Sx, and we are back to that now.

[BoyleHeightsKid]

@Joysie

@LuvRedHeads No, she took him straight for the work up after the first time he went up and looked like he was going to flip so she’s not done any intermediate steps. Hospital vet did not recommend medication - just injections and snip.

It sounds like she’s done more for him than the aftercare program! I would not want to send him back there anyway! I know this sounds harsh but I would euth before I did that!

[halt]

@Tjkobol

I’m sorry to hear about so many negative outcomes with the lig nip Sx! I, thankfully, have had a positive experience with this surgery.

My mare has had back issues for years. When she first started having issues we did a full workup including x-rays and u/s. Did not come up with much… but we ended up doing injections in the sacral area… I can’t remember exactly where, I’d have to double check her records… We did this every 1.5 years or so and she did really well. Then about a year and a half ago her back was progressively getting extremely painful. Did a full workup again, diagnosed with kissing spine. Went at it with lots of injections, which showed almost zero relief, so I opted to do the lig snip Sx. I considered the other Sx, where they take some of the bone, but my Dr did not advise it. In my case, I’m glad I went with the Sx that I did.

Wasn’t able to start rehab right away like I was supposed to… I was supposed to handwalk her for 2 weeks following the surgery, and start long-lining her (obviously walk at first) after that. We got two weeks behind cause she was so sensitive to the staples in her back that she was dangerous to handle. Once those were removed 2 weeks after the Sx, we were able to start our rehab… she was totally fine. Followed rehab protocol very closely, had check ups w the Dr regularly.

We are now 13 months post Sx, and she’s doing spectacular. She comes out of her stall a little cold backed, I ALWAYS lunge or long-line her before i get on to warm up her back before I sit all my weight on her. After her warm up, her back feels great, no pain.

Only issue I’ve really had is that ever since the Sx, her stifles have been on the weaker side, something we haven’t really dealt with before… so we do a lot of work specifically to strengthen them, and I don’t typically have any problems. Every once in a while if I worked her really hard the day before, she’ll be a little off on one side the next day, but she actually usually works out of it in the warm up.

We were riding 1st-2nd level before the Sx, and we are back to that now.

While this seems like a positive update (congrats) it does echo my concerns I’ve seen with Lig-Snip surgery – it seems once we fix or address the KS by lig snip, it sometimes causes mechanical failure of other limbs.

Out of curiosity, have you had any x-rays or ultrasounds taken of the stifles? How about the suspensories?

I am not saying that your update isn’t positive, but I would not call it a success if the horse now has another injury or weakness as a result of the lig-snip - if it is even from the lig snip. It’s hard to tell if it is something that is a result of the operation, or if it’s something that is systemic, or if it is something that was there but hidden by compensation, and now that the compensation or back pain is gone (and the associated unsoundness with it) it becomes more obvious?

I’d love feedback and check-ins.

[Tjkobol]

@halt

While this seems like a positive update (congrats) it does echo my concerns I’ve seen with Lig-Snip surgery – it seems once we fix or address the KS by lig snip, it sometimes causes mechanical failure of other limbs.

Out of curiosity, have you had any x-rays or ultrasounds taken of the stifles? How about the suspensories?

I am not saying that your update isn’t positive, but I would not call it a success if the horse now has another injury or weakness as a result of the lig-snip - if it is even from the lig snip. It’s hard to tell if it is something that is a result of the operation, or if it’s something that is systemic, or if it is something that was there but hidden by compensation, and now that the compensation or back pain is gone (and the associated unsoundness with it) it becomes more obvious?

I’d love feedback and check-ins.

I have not had any diagnostics done regarding stifles. It has been almost a non-issue that I haven’t pursued it further. (also, money). I actually haven’t had any issues at all within the past month or so, I think because she is getting worked a little more and is stronger.

I definitely understand your concern though. It could have been a coincidence with the timing, but I do honestly feel that this issue came up after the surgery due to being hidden by compensation.

[bt1]

I think the success of any kissing spine horse is mostly determined by their “pain” (some horse’s xrays look horrible but seem to do fine in real life and vice versa) and the exercise they are given. P.S. the Pessoa work does not have to be done on circle…I take my guy alllllll around the ring most of the time.

[EHOTex]

Hello, Joysie and others.
Would be interesting to know what would be your ideas on how to prevent such condition (KS) from happening?