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Blue Ridge Equine Clinic Newsletter


In This Issue
New Treatment for Back Pain and "Kissing" Spines
Cautions Regarding the Use of Ceftiofur
2013 MRI Schedule 
March 14
April 11
May 9
June 13

New Treatment for Back Pain and "Kissing" Spines

Paul Stephens

You may have already been asked by a client about a brief blurb in The Horse magazine touting a new technique for treating back pain associated with kissing spines. The Chronicle of the Horse also reported on it. I have had several people make cold calls wanting to sign up for the surgery just based on this promotion by the lay press. Although the hardcopy of the paper has just been published (Veterinary Surgery 41: 2012, 890-897. Coomer et al), it has actually been available online since July. I would encourage anyone looking at horses with back pain to read this paper. Abstracts and detailed summaries are readily accessible via Google search ("Novel surgical treatment for kissing spines"). Full reprints can be obtained through the AAEP's deal with the Texas A&M library. The surgery involves the transection of the interspinous ligament (NOT the dorsal ligament) and is performed standing with sedation and local anesthesia. Each site requires a 1cm incision and the interspinous space is confirmed with US after initial localization via radiographs. Thirty-eight horses were treated with corticosteroid injection only (range of 1-7 sites); 37 received surgery only (range of 3-8 sites). Thirty-four of the injected horses improved initially but 19 had recurrence of back pain. Thirty-five of the surgery horses responded; none had recurrence. Median follow up was approximately 1 year. There were no complications encountered during or after the procedure.

This study can be criticized in that the selection of cases was not based on results of local anesthesia or scintigraphy. In another back paper from Dyson's group (EVJ 44: 2012, 178-184.) the relationship between radiographs, scintigraphy and clinical signs in horses with kissing spines was examined and they made a strong argument that local anesthesia is essential for making a diagnosis. The discussion at the end of the surgery paper acknowledges this potential shortcoming but defends their reliance on clinical signs and radiographic evidence by pointing to the high percentage of horses that improved initially in both medically and surgically treated cases. Those of us who have become knowledgeable about the state of back pain in people through our own personal experiences understand that diagnosis and treatment remains controversial even with the advantage of MRI evaluation. Nevertheless, for horses who present with clinical signs of performance-limiting back pain and the radiographic finding of kissing spines, this new surgical treatment may represent a bona fide advance. Now we need to see others duplicate its success while continuing to refine the criteria for diagnosis. 


Cautions Regarding the Use of Ceftiofur 


Ceftiofur is a popular 3rd generation cephalosporin used as either a daily or long-acting parenteral injection. While the package inserts state that this antibiotic has efficacy against some anaerobic infections, primarily Fusobacterium and some Bacteroides, it is not effective against spore forming anaerobes. Over the years we have received and treated several cases of wound-derived botulism as well as cases of gas gangrene that developed secondary to either IM injection (mainly flunixin) or from deep penetrating wounds (especially with wood foreign bodies) that had initial treatment with ceftiofur. Recently we received a case of severe necrotizing myositis/fasciitis in a pony attacked by dogs. The pony had received appropriate doses of ceftiofur and gentamicin. [Aminoglycosides have no anaerobic activity]. Although cultures were not performed, clinical signs were consistent with clostridial myonecrosis. We suggest that wounds with the potential for deep necrotic tissue should get anaerobic coverage with penicillin or metronidazole. If the animals become febrile, depressed and have local pain, consider immediate referral for debridement and fasciotomy combined with IV penicillin. For the rare cases with signs of botulism, treatment requires immediate administration of the antitoxin. We also recommend that owners not give flunixin IM.

Thank you again for your support,


Abby, Paul and Steve
Blue Ridge Equine Clinic




434 973 7947