Interspinous ligament desmotomy for equine kissing spines produces good long-term outcomes for selected cases, with welfare depending critically on post-surgical rehabilitation quality.
Surgical management of kissing spines involves significant procedural welfare cost — anesthesia, surgical recovery, and the weeks of discomfort during healing — that is justified only when the expected long-term welfare benefit is substantial and evidence-based case selection criteria are met. The welfare calculus requires honest assessment of prognosis: horses with severe multi-level disease or who have failed conservative management have lower surgical success rates and may experience the welfare costs of surgery without proportionate benefit. Welfare-centered surgical decision-making involves this honest prognosis discussion and requires genuine commitment to the rehabilitation that determines whether surgical welfare investment produces durable outcomes.