Evidence for non-surgical kissing spines management has grown substantially — physiotherapy, corticosteroids, and modified training extend comfortable working lives for many horses.
Non-surgical kissing spines management welfare evidence has strengthened to the point where surgery should not be the default first choice for horses with this diagnosis. Most horses benefit from a structured non-surgical trial combining environmental management (saddle fit correction), pharmacological management (interspinous injections), and rehabilitation (physiotherapy and progressive strengthening). The welfare advantage of non-surgical management when effective is significant: avoiding surgery avoids the procedural welfare costs and the 4-6 month rehabilitation period. For horses that respond inadequately to non-surgical approaches, surgery remains a well-evidenced option with good success rates. The welfare-positive approach matches treatment intensity to disease severity rather than defaulting to the most invasive intervention.