Surgical treatment of impinging dorsal spinous processes through interspinous ligament desmotomy provides meaningful pain relief in many horses, with welfare outcomes influenced by rehabilitation quality.
Kissing spines surgery provides genuine welfare improvement for many horses through reduction of the mechanical pain source. The realistic expectation of 70-80% improvement rather than universal cure is important for welfare decision-making by owners facing financial and emotional commitments. Rehabilitation quality after surgery significantly influences outcomes, making the post-surgical period a critical welfare responsibility. Horses that do not improve after surgery deserve further investigation for concurrent pathology rather than being managed as treatment failures without further diagnostic effort.