Kissing spines, or overriding dorsal spinous processes, is a common source of chronic back pain in sport horses that is increasingly recognized through improved imaging and treated with a range of medical and surgical options.
Kissing spines welfare requires understanding a condition where the relationship between radiographic findings and clinical pain is complex. The high prevalence of radiographic kissing spines in sport horse populations, combined with the variable clinical expression, means that diagnostic interpretation requires integrating imaging with careful clinical assessment of pain and functional impairment. Horses with genuine clinical kissing spines pain experience chronic back discomfort that affects every ridden moment of their working lives. The behavioral signs, including girth sensitivity, bucking, and resistance, are welfare signals that are too often attributed to behavioral problems rather than pain. Treatment choice should be guided by the severity of clinical signs and welfare need, with surgical options reserved for cases that do not respond to conservative management.