Dr. Christy Cable, DVM, DACVS, announced this week that the novel Kissing Spine surgery she performed seven weeks ago on back-sore Thoroughbred Heartly Smart, previously diagnosed with the disease, appears to have completely eradicated the mare’s pain, and potentially reshaped some of the trouble-spots in the spine.
“Overall, I am very happy with her progress,” Dr. Cable says. “Her back is 100 percent pain-free right now.”
Cable adds, “At this point, I would say that I am cautiously optimistic that Heartly Smart’s back pain is going to be manageable going forward,” and that she will be able to carry the weight of a rider once more.
On Feb. 18, after a battery of treatments was tried in attempts to alleviate the mare’s back pain, Dr. Cable intervened.(Please see related story).
She decided to try a minimally invasive surgery first pioneered in the United Kingdom by Dr. Richard Coomer, DVM, on Heartly Smart. During a two-and-a-half hour procedure, done on the mildly sedated, still-standing mare, Dr. Cable followed the instructions of Dr. Coomer’s methods:
- Radiographs were taken and four areas of kissing spine were identified
- Four areas on Heartly Smart’s spine, where areas appear to touch or “kiss” were also photographed with an ultrasound to precisely pinpoint their location
- After the mare was prepped and given a sedation regimen, similar to what is prescribed for a horse undergoing a dental procedure, incisions were made at the trouble spots, and an interspinous ligament desmotomy, or cutting of the ligaments, was performed.
After weeks of recuperation and physical therapy at the facilities of Thoroughbred charity ReRun, Inc., which is partnering with Dr. Cable on the project, Heartly Smart was evaluated yesterday.
And the news was good.
“When I first tried to examine her, prior to the surgery, she would try to kick me when I attempted to get her to flex and lift her spine,” Dr. Cable says. “The more I tried this, the harder she tried to kick, and she even tried to bite me.
“Yesterday, during my follow-up examination, I was able to perform the same maneuvers, and it was absolutely no problem: she just stood there.”
Radiographs taken yesterday also reveal that two of the four trouble spots where surgery was performed, show changes. Where the spine overlapped or touched at the sites located closer toward her front, there is now more room or space, she explains. In two other surgical sites, located further away from the front, there is not any radiographic evidence that the sites have undergone structural changes. Dr. Cable however, suspects that by cutting the ligaments in those areas, pain was alleviated.
While the surgery is very promising, and evidence revealed by the radiographs is also encouraging, Cable cautions against giving too much weight to radiographs, in general, when attempting to diagnose back pain in a horse.
She explains: “Kissing Spine has always presented a conundrum to veterinarians because even though radiographs may show a horse has the condition, that horse may or may not experience symptoms,” she says. “It has been confusing for veterinarians, because even though the radiograph may be abnormal, it doesn’t mean the horse has a clinical problem that needs treatment.”
Surgical treatment, she stresses, is for animals that are clearly in pain, and for whom all other non-surgical options have been tried and ruled out as effective.
“I’ve received phone calls from all over the country from people whose horses have a radiographic diagnosis of Kissing Spine, but they’re not having pain,” she says. “These are not the horses who are candidates for the treatment.”
Before any surgical option is scheduled, the first step is always to address any back pain through other non-surgical means, including proper saddle fittings, physical therapy, injections, and other therapies, she says. Only after all else has failed does this new and promising procedure become an option, she says.
Heartly Smart will continue to undergo weeks of physical therapy to strengthen her topline. She is being cared for and exercised by Susan Swart, president of ReRun, Inc., New York chapter.
Once Dr. Cable feels the mare is capable of carrying weight again, she will be ridden under saddle.
If the mare continues to be pain free, the novel surgery pioneered by the UK veterinarian could be a breakthrough for riding horses that have been sidelined due to recurrent pain, Dr. Cable says.
“The surgery that Dr. Coomer designed offers an option for horses who had no other options. It’s a minimally invasive and straight-forward procedure” that offers a lot of hope.
She adds, “I wasn’t’ the brilliant mind who discovered it, it was Dr. Coomer. He described his methods in great detail, and I read it and thought it was brilliant.”
Off Track Thoroughbreds.com congratulates Dr. Christy Cable and Heartly Smart for their exciting work!