Many horses with radiographic kissing spines respond well to conservative management rather than surgery, with targeted physiotherapy and ridden rehabilitation.
Conservative management of kissing spines preserves options, avoids surgical risks, and in many cases provides excellent welfare outcomes that allow horses to remain comfortable in work. The key is accurate diagnosis of whether radiographic changes are causing clinical pain — not all horses with visible kissing spines require intervention. Corticosteroid injections into affected interspinous spaces provide significant pain relief, while physiotherapy programs that develop epaxial musculature reduce dynamic contact between processes during movement. A comprehensive approach including saddle fit optimization, rider position assessment, targeted exercises, and regular re-evaluation achieves good welfare outcomes for many horses without surgical intervention.