Many horses with overriding dorsal spinous processes can be managed without surgery through targeted rehabilitation, physiotherapy, and appropriate management changes.
Not all horses with kissing spines on radiography require surgery - the relationship between radiographic findings and clinical pain is complex. Many horses with moderate interspinous contact respond well to conservative management combining local treatment (injections, mesotherapy), physiotherapy, and rehabilitation exercise that builds supportive back musculature. This conservative approach avoids surgical risk and recovery welfare costs. The welfare-centered approach is to establish whether the horse is genuinely in pain (using the RHpE and response to local anaesthetic), then pursue the least invasive effective management rather than defaulting to surgery based on radiographic appearance alone.