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International survey of equine orthopaedic specialists reveals diverse treatment strategies for horses with overriding spinous processes


Background: Overriding spinous processes, also known as 'kissing spines', are one of the most common causes of back pain in horses. The aim of this study was to investigate which options for diagnosis and treatment are preferred by equine orthopaedic specialists and assess which techniques are used for local injection. Methods: An online survey was distributed among members of the European/American College of Veterinary Surgeons, the European/American College of Veterinary Sports Medicine and Rehabilitation, the International Society of Equine Locomotor Pathology and nationally recognised advanced equine orthopaedic practitioners.

Results: The survey was completed by 353 respondents. The injection techniques most commonly used involve placing two needles abaxial to the interspinous space (42%) under ultrasonographic guidance (32%) or one needle in the midline (35%) between two spinous processes. The most popular combination for overriding dorsal spinous process therapy was local injection (26.7%) combined with controlled exercise (25.5%). Manual therapy was considered by 42% of European and 25% of American specialists (p = 0.01). Surgical intervention as a first-line treatment was recommended mainly by specialists working in the United States, the UK or Ireland (p = 0.001). Overall, most equine orthopaedic veterinarians (71%; n = 201) preferred conservative management and recommended surgery only for horses that did not respond to conservative therapy.

Limitations: Respondents' personal bias may have skewed the findings.

Conclusions: Despite a growing body of evidence, the therapeutic approach to 'kissing spines' in horses is influenced by professional specialisation and regional preferences. Variations in injection techniques and differing criteria for surgical intervention warrant further investigation.

Keywords: equine; kissing spines; overriding spinous processes; vertebral column.


Author: Dorothea Treß, Christoph Lischer, Roswitha Merle, Anna Ehrle

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