Horse Kissing Spines: Diagnosis, Treatment and Welfare

Overriding dorsal spinous processes (kissing spines) is a significant source of back pain in horses, particularly those in ridden work. Welfare-focused management requires accurate diagnosis and honest assessment of the horse's experience.

Key Facts

Kissing spines occur when adjacent dorsal spinous processes of the thoracic or lumbar vertebrae contact or overlap, causing pain
Up to 39% of horses in some studies show radiographic evidence of kissing spines, though not all cases are clinically significant
Signs include back pain on palpation, reluctance to work, behaviour changes under saddle, and movement abnormalities
Diagnosis requires radiography with clinical correlation; radiographic changes alone do not confirm pain
Treatment options include corticosteroid injection, interspinous ligament injections, mesotherapy, and surgical intervention (interspinous ligament desmotomy)
Saddle fit assessment is essential: ill-fitting saddles that concentrate pressure on the dorsal spine contribute to both pain and spinal changes

Welfare Considerations

Kissing spines welfare is complicated by the prevalence of radiographic changes that may or may not represent clinical pain. The challenge is distinguishing horses with genuine back pain that limits their welfare from those with incidental radiographic findings and no functional limitation. Diagnostic nerve blocks help determine the clinical significance of radiographic lesions. Horses with genuine kissing spines pain show negative affective states under saddle and on handling that reduce quality of life significantly. Treatment decisions should be driven by welfare assessment rather than solely by radiographic appearance. Critically, saddle fit must be assessed in all kissing spines cases: no treatment is sustainable if the causative mechanical factor remains. Return to work after treatment should be gradual and guided by the horse's behavioural response.

What You Can Do

Seek veterinary investigation for any horse showing back pain signs or reluctance under saddle
Ensure saddle fit is professionally assessed annually and whenever a horse changes body condition
Never work a horse through clear signs of back pain without veterinary assessment
Support research into kissing spines prevention through appropriate saddle fit and exercise management
Discuss treatment options transparently with your vet, including realistic prognosis assessment
Consider retirement from demanding work as a positive welfare outcome if pain cannot be adequately managed