Overriding dorsal spinous processes in horses causes significant back pain, and surgical interventions are increasingly being refined to improve welfare outcomes and return-to-function rates.
Kissing spines surgery illustrates the complexity of equine welfare decisions where radiographic findings must be integrated with clinical signs and individual horse response. The high prevalence of radiographic overriding dorsal spinous processes in the general horse population, combined with variable clinical expression, means that imaging alone cannot guide treatment decisions — pain assessment is essential. When surgical intervention is indicated for genuinely painful cases, outcomes are generally good, with the majority of horses returning to previous or improved work levels. The welfare case for surgery in appropriately selected horses is strong: chronic back pain significantly reduces quality of life, and effective treatment removes a persistent pain burden. Post-surgical rehabilitation quality is as important as the surgery itself for optimal welfare outcomes.