# Steroid injections for kissing spines - any good?



## Booboos (30 November 2012)

(also in NL but have not had any replies)

Has anyone had positive results with steroid injections for kissing spines? Or is an operation the only way to go?

Rusky has been having some problems lately which the local vet had diagnosed as muscle related, however they were only getting worse after her physio sessions so I carted him off to a more experienced vet further away (good vets are few and far between here). He seemed more thorough and knowledgeable and had a clinic full of equipment. X-rays showed deterioration in a number of vertebrae, but worse at T14, 15, 16. The vet was very optimistic that one or two courses of injections (Saralgyl and Tildren) will allow him to return to normal work. He needs 3 weeks of lunging at the moment and then back ridden with a lot of long and low (which to be fair I already do a lot of).


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## WellyBaggins (30 November 2012)

I went straight for the surgery because he is insured and I wasn't sure if the £5k would cover both treatments, it was successful.  I have discussed with my physio extensively and he has had positive results with the steroid injections, my new vet uses the injections first to see if the KS is actually causing any problems, if the steroids are successful then the surgery usually follows.  Not sure if that is any help


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## BeckyC (30 November 2012)

I had the injections first before going for the operation and they did work, however only for about 4 months so it was going to be unmangeable in the long run so I just went for the operation in the end.


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## Dizzco (30 November 2012)

I went straight in for the operation after exhausting every other diagnostic tool to ensure we knew for defninite the kissing spines were the only cause of discomfort - we did (at the very last stage) nerve block the areas around the affected spinal processes and I rode him twice afterwards, once about half an hour after blocking and again a few hours later. This was enough to make a difference in how he felt to me and I have videos of before & after and there are some (albeit slight) obvious visual differences too. Both me and vet were happy following this to go ahead with the op.

It was very successful for us (touch wood) and he is in ridden work now which is so far going very well. We're taking it steady but Im hoping he'll be out competing again next year 

I did consider the injections but for me his problems were becoming quite severe and I wanted a cure rather than a short-term fix. In my mind I decided that he is just a lovely, lovely horse in general and even if the op was not successful in that he'd be not able to cope with ridden work again, he could just live his days out with me as a pet but I'd have peace of mind he was comfortable.


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## TarrSteps (30 November 2012)

It depends a bit on how you define "positive results".  Steroids will reduce inflammation and Tildren will - hopefully - affect the progression of the changes, but neither will effect a cure in a chronic arthritic condition.  That said, I've had good luck in the past with getting horses more comfortable so they can work in a way that will help them long term and, in some cases, settling everything down with medication can allow the horse to return to full function for a considerable amount of time.  I certainly know lots of horses working comfortably (with all sorts of degenerative/chronic conditions) with judicious medication and good management.

Surgery, if it's indicated and works as predicted, obviously produces the potential for a "cure" in that it removes the problem.  The catch is it doesn't work for every horse and the rehab can be quite drawn out.  My understanding is the details of the findings have a large bearing on the indication and predicted outcome of surgery.  If your vet is suggesting an either/or approach then I would be inclined to have a proper discussion of the particular risks and rewards in your case.  I am conservative by nature and would be inclined to try the least invasive option first, then progress if necessary, but I'd want to know what the risks of that path might be, as in am I likely to progress the damage to the point where surgery was then contraindicated.


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## Booboos (30 November 2012)

Thank you everyone, it is extremely helpful to hear of your experiences.

I have two problems: firstly vets (and doctors) here are extremely paternalistic. They don't tell you anything but go ahead and do stuff. I had to physically insert myself between the two vets yesterday to get them to tell me what they were seeing in the x-rays and what they were about to do about it. They give you a discharge letter at the end and that is about all your involvement in decision making. As a result it's very difficult to make an informed decision. Secondly, vets (and docs unfortunately) are rather inward looking and not aware of international research. I asked about an operation and mentioned that it is done in the UK and the answer was that the British are wusses who exaggerate everything. Now it may be that R's case is best dealt with steroids, but surely it's not because of the attitudes of the British to KS! So I am not 100% certain that they are considering all possibilities.

Can I ask how long were your horses box rested after the op? That would be my main concern with R because he is a relatively lively horse who lives out 24/7 and I am not certain box rest would be in his interests.


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## Booboos (30 November 2012)

TarrSteps did you have a specific management routine in mind that might help KS? R lives out 24/7, he is ridden 2-3 times a week with a long warm up session (20 mins in long and low) and then picked up more, and he is lunged once more a week in an EquiAmi.

Currently I am to do 3 weeks on the lunge and then get back on with a lot of long and low work. Should I be doing something else?


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## BeckyC (30 November 2012)

After the op, my horse stayed at the vets for 5 days, he then had 4 weeks box rest with 20mins walking in hand for the last 2 weeks, then its 4 weeks of turnout in a small bit of field, then 4 weeks of turnout in normal field, then 4 weeks of lunging and then you can get back on with obviously light riding to start with.  the main risks with the operation are infection as due to where the wound site is, it cannot drain well.  also you should make sure its definitely the KS causing the issue before going through the op.  With the injections, my horse had to have 1 week of box rest with 30 mins walking in hand, then it was a week or 2 of field rest then a week of riding in walk, a week of adding trot, then a week of adding in canter and polework and then crack on.  Hope this helps!


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## Tammytoo (30 November 2012)

If you look in the Veterinary Forum there is a thread on KS being treated by Cotts Equine Surgery with Interspinous Ligament Desmotomy.  Instead of removing the spinal processes, they sever the tendons between.  Apparently the recovery rate is much quicker and is about a quarter of the price of KS Surgery at around £1,000-£1,200   Might be worth having a read.


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## Bubbles (30 November 2012)

As you know the steroids will only help short term, but would be a good indication that surgery might work in the future. My first ks horse had steroids and the change was tremendous. Sadly surgery wasn't an option due to other issues. Second ks horse has just been operated on. His bone scan results showed huge uptake/bone turnover where as the xrays weren't terribly useful. Difficult decision, especially as plenty of horses with the right regime can manage without surgery.


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## Booboos (30 November 2012)

Thanks BeckyC! The time off work doesn't bother me at all, that's life with horses, but the box rest I've had bad experiences with horses with similar temperament as R and I need to weight up the risks and benefits.

I'll have a look at Veterinary thanks Tammytoo, I seem to have missed that thread. I found Cotts last night while googling, they seem to have a very interesting approach. As luck would have it they are very close to where we used to live in the UK but of course quite a trek from France!


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## WellyBaggins (30 November 2012)

Mine was in the box for two weeks, we had to abort after that as it was not safe to hand graze him, he was then allowed out in a small area as long as he was sensible, which he wasn't  so I turned him out out, until he started his rehab and was in a routine, then he was ok being in in the day and out at night


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## kezimac (30 November 2012)

Tammytoo said:



			If you look in the Veterinary Forum there is a thread on KS being treated by Cotts Equine Surgery with Interspinous Ligament Desmotomy.  Instead of removing the spinal processes, they sever the tendons between.  Apparently the recovery rate is much quicker and is about a quarter of the price of KS Surgery at around £1,000-£1,200   Might be worth having a read.
		
Click to expand...

my horse had this operation on 9 processes on tuesday. It might be worth at least speaking to Richard Coomer as I believe it was developed from research from france!


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## Booboos (1 December 2012)

That's very interesting to know. I will try to chat to the vet in the UK and see if he has any contacts in France, thanks. Good luck with your horse, hope he makes a full recovery.


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## nbred (18 February 2013)

Hi, what did you decide to do with your horse? mine was operated on 4 months ago (cotts equine procedure) so would be interested to know.thanks x


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## Booboos (18 February 2013)

I hope things went well with your horse's operation! Can you tell a difference or is it too soon?

I went for the injections for now as my vet was adamant they had a good chance of working long term, so it was worth a shot. He had 3 weeks on the lunge with the equiami, but still wasn't quite right. He was seen again and this time he was lame on the hard on a 10m circle on the right fore. We narrowed it down to a foot problem and he's now got special shoes. One month on and the difference is very noticeable, he is very keen to work, very supple through his back and better than ever.

I don't know if it will last, but for now we seem to be getting somewhere. One day at a time I suppose.


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## MrsMozart (18 February 2013)

A good update BB  Long may it continue lass.


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## jenniferharland (27 April 2013)

My horse had the steroid injections but were only effective for 2 weeks after the 2 weeks box rest he had. Went back to the vets and was told he needed an operation. The vet released tension in the interspinous ligament with key hole surgery and the horse had to be on box rest for 2 months. After this I was told to lunge in a pessoa, but my horse is very naughty and kicks out at me when I lunge him (without the pessoa) so rang the vets and they said to hack him out. I have not rang the vet back as my horse went into colic and didn't drink for a week so is currently not in work but I would prefer to build his muscles with the pessoa before I began schooling him with me on his back!


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## Booboos (27 April 2013)

Thank you for sharing your story jenniferharland, I hope your boy makes a full recovery and stay safe as you are brining him back to work. Rusky has lost an enormous amount of muscle and is ataxic with his back legs, none of which is directly related to the KS so we are trying to diagnose the cause of these problems before thinking further about the KS.


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