Overriding dorsal spinous processes (kissing spines) cause significant back pain in horses, and nonsurgical management approaches are increasingly effective for many affected animals.
Kissing spines management decisions must balance the welfare cost of the condition against the welfare cost of treatment. Horses with kissing spines often present with behavioral problems that are mislabeled as training or temperament issues, meaning pain is not recognized and unaddressed for extended periods. When properly diagnosed, nonsurgical management combining corticosteroid treatment, appropriate analgesia, targeted physiotherapy, and saddle fit correction resolves signs adequately in many horses. Surgery is effective when conservative management fails but requires extended convalescence. The most important welfare intervention is accurate diagnosis through appropriate imaging so that pain is recognized and addressed rather than attributed to behavioral problems.