Kissing spine is one of the most commonly discussed and perhaps most misunderstood causes of back pain in horses.
Some horses buck. Some become girthy, refuse transitions or object violently to being ridden. Others continue working, competing and apparently doing everything asked of them despite significant changes being visible on X-ray.
That has led to a familiar phrase:
“Ride the horse, not the X-ray.”
But there is a serious problem with using that phrase to justify continued ridden work.
A horse’s failure to demonstrate pain is not proof that pain doesn’t exist.
Horses cannot tell us how much something hurts. Pain expression varies between individuals, and horses can actively reduce observable discomfort behaviours when humans are present.
In one study of hospitalised orthopaedic patients, observable discomfort behaviours fell by an average of 77.4% when a caretaker approached. In 30% of horses, those behaviours stopped altogether until the person left.[1]
So when a horse has significant pathological changes in its spine but continues to comply under saddle, there are two very different conclusions we could draw:
“The horse isn’t showing us that it hurts.”
or:
“The horse isn’t hurting.”
Science currently allows us to say the first.
It does not necessarily allow us to say the second.
That distinction should matter enormously when deciding whether we continue sitting on that horse’s back.
What Is Kissing Spine?
The condition commonly called kissing spine involves abnormally close, impinging or overriding dorsal spinous processes.
The dorsal spinous processes are the bony projections extending upwards from the vertebral column. In a healthy spine there is space between each of the spinous processes.
With kissing spine, those spaces become narrowed. As the condition progresses, the processes may touch, impinge or overlap.
Changes visible on imaging can include:
- narrowing between adjacent processes;
- bone-to-bone contact;
- sclerosis or increased bone density;
- radiolucent areas (look brighter/whiter on x-ray) and osteolysis;
- reactive bone formation;
- remodelling of the processes; and
- overriding or overlapping processes.
The area beneath the saddle particularly the middle and caudal thoracic spine is commonly affected.
It’s important to note that there is a difference between closely spaced spinous processes and established pathological bony change.
A narrow space is not automatically equivalent to advanced kissing spine.
However, when repeated contact between the bones has produced sclerosis, osteolysis, remodelling or other visible changes to the bone itself, we are no longer simply looking at two bones that happen to sit relatively close together. We are looking at boney tissue that has responded to abnormal mechanical forces.
How Does Kissing Spine Present?
There is no single classic presentation.
Physical signs may include:
- back sensitivity or pain on palpation;
- muscle spasm;
- poor topline development;
- asymmetrical musculature;
- hollowing through the back;
- difficulty lifting the thorax and back;
- restricted spinal movement;
- altered hindlimb movement;
- difficulty engaging the abdominal musculature;
- reduced performance;
- stiffness;
- recurrent unexplained lameness; and
- secondary sacroiliac or limb problems.
Behaviour may be equally important.
Behavioural signs can include:
- girthiness;
- resentment of grooming;
- moving away during saddling;
- refusing to stand at the mounting block;
- ears pinned during mounting;
- tail swishing;
- reluctance to go forward;
- rushing;
- bucking;
- rearing;
- kicking out;
- resistance to contact;
- difficulty maintaining canter;
- problems with transitions;
- cross-cantering;
- refusing fences;
- rushing fences; and
- a previously willing horse becoming anxious, defensive or resistant.
None of these signs individually equates to kissing spine. They can occur with numerous painful conditions.
But neither should they automatically be labelled behavioural, naughty, lazy or training problems until pain has been properly investigated.
What About Horses That Show No Signs?
Radiographic changes associated with kissing spine have been identified in horses described as having no recognised clinical signs of back pain.
This is sometimes interpreted as evidence that kissing spine does not necessarily hurt. That is NOT what those findings demonstrate.
They demonstrate that radiographic abnormalities can exist without investigators identifying clinical signs that they attribute to back pain.
Those are not the same thing.
Pain is a subjective experience. A horse cannot self-report it.
We therefore infer pain from things we can observe:
- behaviour;
- posture;
- facial expression;
- palpation responses;
- lameness;
- physiological measurements;
- performance changes; and
- responses to analgesia.
Every one of those methods has limitations.
Research into equine discomfort has demonstrated that horses may dramatically suppress observable discomfort behaviour when a person approaches. Brief direct observation can therefore underestimate the discomfort a horse displays when left undisturbed.[1,2]
That makes the description “asymptomatic” potentially misleading.
A more accurate description is often:
“No recognised clinical signs of pain were identified.”
We know what we observed.
We cannot necessarily know what the horse experienced.
Horses Don’t Have to Scream Before We Listen
Horses evolved as prey animals. Showing weakness, injury or impaired movement carries a biological cost. Recognising equine pain can consequently be difficult.
This does not mean every horse deliberately hides every pain response. Nevertheless, expecting an animal to provide an unmistakable outward demonstration before we accept that something hurts is an unreliable model that could lead to serious welfare issues.
Individual responses to pain can vary. One horse may buck explosively. Another may pin its ears. Some may subtly alter their posture. Others may simply become less willing. Many may even continue doing everything asked of it.
Compliance is not proof of comfort.
A horse jumping a course is not proof that its back doesn’t hurt.
A horse performing a dressage test is not proof that its back doesn’t hurt.
A horse standing quietly to be saddled is not proof that its back doesn’t hurt.
A horse continuing to work despite significant pathology does not automatically give us permission to keep asking.
When Severe Disease Hides in Plain Sight: Even Keel
One of the cases behind Dressage Atlas’s position is the Thoroughbred Even Keel, known at home as Wiggle.
Even Keel raced in Hong Kong for three seasons. He was retired after injuring his right fore superficial digital flexor tendon and underwent rehabilitation before being exported to New Zealand.
His export veterinary report described him as:
“Sound for full work without exclusion.”
Once in New Zealand, however, he displayed a collection of apparently unrelated behaviours:
- tongue poking;
- head flicking and nose wiggling;
- nappiness;
- saddle aversion;
- tail swishing;
- difficulty bending to the right; and
- resistance during saddling.
Each behaviour was given a plausible alternative explanation.
The tongue behaviour was attributed to his history of being tongue-tied. His head movements were blamed on allergies or dental discomfort. Saddle aversion was attributed to ulcers. His difficulty bending and nappiness were described as common ex-racehorse behaviour.
What struck us most is that he remained rideable.
He allowed people to saddle him. He carried a rider. He was generally obedient under saddle.
Even during his final lameness examination, he did not palpate obviously painful through the back. Because he flexed significantly lame through both hocks, the hocks initially appeared to be the most likely problem.
Radiographs told a profoundly different story.
Even Keel was diagnosed with Grade 4 kissing spine affecting approximately 80% of his spine.
The damage was so extensive that no reasonable treatment could restore him to comfortable function, and he was humanely euthanised.
This is one individual case, not a controlled scientific study. It demonstrates the diagnostic problem discussed throughout this article.
He had passed veterinary assessment.
He did not display an unmistakable response to back palpation.
He continued to permit ridden work.
His behaviours could individually be explained away.
Yet he had catastrophic spinal pathology.
Clinical examination alone had not identified it.
Radiography alone could not have described every aspect of his experience but without radiography, the structural disease would have remained hidden.
This is why the choice should never be framed as:
“Do we examine the horse or examine the X-ray?”
We need both.
Clinical examination tells us how the horse is functioning.
Diagnostic imaging tells us what cannot be seen from the outside.
Neither should be used to dismiss the other.
Does Radiographic Severity Matter?
Yes; although imaging must still be interpreted as part of the whole horse.
A major study involving 582 horses investigated relationships between clinical back pain, radiographic abnormalities and nuclear scintigraphy of the thoracolumbar spine.
The researchers found significant associations between higher radiographic grades and thoracolumbar pain. Scintigraphic abnormalities were also associated with clinical pain.[3]
The fact that radiographic changes and observable pain do not correlate perfectly does not mean radiographic pathology is meaningless.
It means our ability to recognise pain and identify its exact source is imperfect.
When imaging demonstrates actual contact accompanied by sclerosis, osteolysis, remodelling or overlapping processes, the abnormality deserves more consideration than whether the horse happens to buck when mounted.
Kissing Spine in Thoroughbred Racehorses
Kissing-spine-type changes appear to be particularly common in Thoroughbred racehorses.
In a post-mortem study of 36 Thoroughbreds that died or were euthanised at Californian racetracks, Haussler and colleagues found impingement of the dorsal spinous processes in 92% of specimens.
Degenerative changes affecting the thoracolumbar articular processes occurred in 97%, while every specimen showed degeneration of the lumbar intertransverse joints and sacroiliac articulations. Some changes were both severe and widespread.[4]
A smaller radiographic study of 30 Chilean Thoroughbreds also found radiographic changes consistent with kissing spine throughout the population examined.
Stallions and mares averaged four affected dorsal spinous processes, while geldings averaged 3.5. The most significant changes occurred around T14–T16; the region situated beneath the rider and saddle.[5]
These studies demonstrate that spinal impingement and wider degenerative spinal pathology can be extraordinarily prevalent in some racing populations.
This matters when racehorses are retired into second careers.
A horse may leave racing because of a tendon injury, poor performance or another immediately apparent problem while substantial spinal pathology remains undiscovered.
If that horse is assumed to be suitable for ridden retraining without appropriate investigation, its reluctance, stiffness or defensive behaviour may be blamed on its temperament, racing history or inadequate retraining.
The horse may be labelled:
- nappy;
- girthy;
- cold-backed;
- difficult to bend;
- resistant to the saddle;
- anxious;
- unwilling to go forward; or
- simply a “typical ex-racehorse”.
None of those labels explain why the behaviour exists.
High prevalence does not make pathology harmless. It makes careful investigation more important.
What Causes Kissing Spine?
There is unlikely to be one single cause.
Potential contributing factors include:
- individual anatomy and conformation;
- developmental factors;
- genetic susceptibility;
- abnormal spinal loading;
- poor muscular development;
- inadequate trunk stability;
- chronic hollow or extended posture;
- inappropriate training;
- poorly fitting saddles;
- trauma;
- hindlimb lameness;
- sacroiliac dysfunction;
- forelimb problems; and
- compensatory movement resulting from pain elsewhere.
The relationship can work in both directions. Pain elsewhere can change the way the horse moves its back. Back pain can change how the horse loads its limbs.
This creates the potential for a cycle:
pain → altered movement → muscular dysfunction → abnormal loading → further pain
This is one reason simply treating the visible spinal lesion without investigating the rest of the horse can fail.
Genetics May Also Matter
Training and management may influence spinal loading, but kissing spine should not automatically be treated as something a rider has created.
A 2022 genome-wide association study examined 155 Stock-type and Warmblood horses that had been clinically and radiographically graded from unaffected to severe kissing spine.
Researchers identified a genetic marker associated with increasing kissing-spine grade and a candidate region on equine chromosome 25.[6]
The findings were preliminary. They cannot yet predict the outcome for an individual horse, and the study did not examine Thoroughbreds.
They did, however, support the likelihood that some horses carry greater inherited susceptibility.
Development is therefore most likely to be multifactorial.
Genetics may influence the anatomical foundation. Growth, conformation, nutrition, muscular development, training, injury and spinal loading may then influence how, or whether, that susceptibility develops into significant disease.
Correct work may reduce avoidable loading and improve spinal support. It cannot guarantee that a genetically susceptible horse will never develop kissing spine.
Dr Audrey DeClue and Kissing Spine
Veterinarian Dr Audrey DeClue has devoted considerable attention to kissing spine through The Horse First podcast and her work with sport horses.
Her approach is particularly interesting because she examines kissing spine beyond the narrow question of modern ridden horses.
In her 2023 episode Kissing Spine in Sport Horses, DeClue discusses comparable spinal pathology across an extraordinary range of species and time periods; including dogs, cats, humans, otters, horses and even dinosaurs.[7]
That has an important implication.
Kissing spine cannot simply be dismissed as a disease created by modern saddles, modern dressage or modern riding.
There is considerably more going on.
In Part Two, DeClue specifically examines whether kissing-spine lesions are painful and asks the provocative question:
“Do you ride the horse or the radiograph?”[8]
Her work is particularly relevant to the welfare problem surrounding horses with significant imaging findings but few outward signs.
Because absence of obvious resistance does not answer the fundamental question:
Does bone-on-bone pathology hurt the horse even when the horse continues to cooperate?
Diagnosing Kissing Spine
Diagnosis should never consist solely of taking one X-ray and declaring the horse’s back responsible for every problem it has.
A thorough veterinary investigation may include:
- detailed history;
- physical examination;
- palpation;
- dynamic assessment;
- lameness examination;
- ridden assessment where appropriate;
- diagnostic analgesia;
- radiography;
- ultrasound;
- nuclear scintigraphy; and
- investigation of concurrent limb, pelvic or sacroiliac pathology.
Radiographs
Radiography allows veterinarians to examine the spacing and structure of the dorsal spinous processes.
It can identify narrowing, impingement, overlapping, sclerosis, osteolysis and remodelling.
Posture and neck position can influence the apparent spacing between processes, so images must be obtained and interpreted correctly.
Radiographs show structure. They do not directly measure the horse’s subjective experience of pain.
That does not make structural pathology irrelevant.
Nuclear scintigraphy
A bone scan can identify increased radiopharmaceutical uptake, providing information about active bone turnover.
This can be useful when several abnormalities are visible and the veterinarian is attempting to determine which areas are biologically active.
Diagnostic analgesia
Local anaesthetic may be used to determine whether blocking an area changes the horse’s movement, behaviour or performance.
But even this is not a perfect test.
The complex anatomy of the equine thoracolumbar spine can make it difficult to isolate one structure completely.
Diagnosis therefore requires judgement rather than one magic test.
An X-ray should not replace clinical examination.
Clinical examination should not be used as an excuse to avoid imaging when substantial spinal disease may be present.
Treatment
Treatment depends on the severity of the pathology, the individual horse and whether other painful conditions are present.
Options include:
- rehabilitation;
- veterinary pain management;
- mesotherapy;
- local medication;
- interspinous ligament desmotomy; and
- surgical removal or reshaping of affected bone.
But there is an important distinction:
Reducing pain temporarily is not necessarily the same thing as resolving the disease process that caused it.
Correct Work and Rehabilitation
Appropriate rehabilitation is an essential part of virtually every kissing-spine treatment programme.
The goal is not simply to make the horse fitter.
It is to improve how the horse supports and moves its spine.
Rehabilitation may include:
- controlled walking;
- appropriate mobilisation exercises;
- groundwork;
- in-hand exercises;
- progressive pole work;
- controlled hill work;
- exercises developing trunk stability;
- strengthening of the abdominal musculature; and
- progressive rebuilding of the topline.
Where ridden work is considered appropriate by the horse’s veterinary team, it should only be introduced once the horse is comfortable and physically capable of supporting it.
Simply lunging endless circles is not rehabilitation.
Neither is forcing the horse’s head down in an attempt to make its back appear rounded.
Correct rehabilitation changes function, not merely outline.
Advantages
Rehabilitation can address muscular weakness and dysfunctional movement without surgery. It can also address contributing biomechanical problems throughout the body.
Limitations
Exercise cannot magically remove established pathological bone.
Rehabilitation requires time, consistency and close attention to the quality of movement.
Most importantly:
A painful horse cannot simply be exercised out of pain.
Multifidus: The Spine’s Deep Stabiliser
One of the most valuable findings in the racehorse research concerns the multifidus muscle.
Multifidus runs deeply alongside the vertebral column and provides segmental stability to the spine.
It acts less like a large movement-producing muscle and more like the bracing within a building: stabilising individual sections so the whole structure can function effectively.
In a study of 22 Hong Kong Thoroughbred racehorses presented for euthanasia for reasons other than back pain, every horse had measurable left-to-right multifidus asymmetry at more than two spinal levels.
Seventeen of the 22 horses had severe Grade 3 spinal pathology. Sixteen of those 17 showed multifidus or sacrocaudalis dorsalis atrophy on the same side as the more severe lesion. Increasing pathological severity was significantly associated with increasing muscle asymmetry.[9]
The study did not establish that all 22 horses had kissing spine.
The pathology included abnormalities affecting several spinal structures. Only one horse had overriding dorsal spinous processes recorded as its primary finding.
What the study demonstrated was a significant relationship between severe spinal pathology and localised atrophy of the muscles responsible for stabilising that region.
This creates another potential cycle:
spinal pathology → pain or altered muscle recruitment → multifidus atrophy → reduced spinal stability → further dysfunctional loading
Simply resolving pain—or surgically creating more space between the spinous processes—does not necessarily restore normal multifidus function.
That function must be rebuilt.
Can Multifidus Be Strengthened?
Yes.
A separate study followed eight unridden horses performing dynamic mobilisation exercises for three months.
The programme consisted of:
- three cervical flexion exercises;
- one cervical extension exercise; and
- three lateral-bending exercises performed to both sides.
Each exercise was repeated five times per session, five days per week.
After three months, multifidus cross-sectional area had increased significantly on both sides at all six measured spinal levels between T10 and L5.
Left-to-right asymmetry also decreased.[10]
These exercises are commonly called carrot stretches, although they should be controlled mobilisation exercises rather than the horse simply twisting its neck as far as possible to obtain food.
They may include:
- chin towards the chest;
- chin between the forelegs;
- chin towards the front fetlocks;
- controlled extension forwards and upwards; and
- lateral bending towards the girth, hip or hock.
The important point is not that carrot stretches cure kissing spine.
They do not remove established bone, reverse sclerosis or eliminate bone-on-bone contact.
Their value lies in recruiting and strengthening part of the muscular system responsible for supporting and stabilising the spine.
That makes them potentially valuable within preparation, prevention and rehabilitation—but never a justification for exercising a horse through unresolved pain.
Mesotherapy and Medical Treatment
Mesotherapy involves multiple small injections into the skin or superficial tissues across the affected region.
It is intended to influence pain signalling and reduce muscular pain or spasm.
Other veterinary treatments can include anti-inflammatory medication, local corticosteroid treatment, shockwave therapy and other pain-management strategies.
Advantages
Pain relief can allow a horse to move more normally and begin effective rehabilitation.
This matters because asking a painful horse to strengthen itself while the painful movement pattern remains active may simply reinforce compensation.
Limitations
Analgesia does not remove bone-on-bone contact.
It can reduce the experience or expression of pain without necessarily removing the underlying mechanical cause.
That distinction becomes especially important if pain relief is used primarily to allow a horse to continue being ridden.
Medical treatment should be part of a considered rehabilitation plan—not a means of silencing the horse sufficiently to keep it performing.
Interspinous Ligament Desmotomy: The “Ligament Snip”
Interspinous ligament desmotomy, or ISLD, involves surgically cutting the interspinous ligament between affected dorsal spinous processes.
It can be performed in the standing, sedated horse through relatively small incisions.
A controlled study involving 68 horses compared ISLD with corticosteroid treatment. Initial resolution of recognised back-pain signs occurred in both groups, but recurrence occurred in 19 medically treated horses and none of the surgical cases during the reported follow-up. Radiographs also demonstrated increased interspinous spacing following ISLD.[11]
Later research produced more nuanced results.
In one long-term study, 51 of 56 horses returned to some level of performance after ISLD, but only 27 returned to an equivalent or higher level than before surgery. Recurrent back pain accounted for some horses returning at a lower level.[12]
Advantages
ISLD is minimally invasive compared with traditional bone resection, can often be performed standing and has produced useful results in appropriately selected horses.
Limitations
It is still surgery.
Complications can occur, and cutting a ligament does not automatically correct the reason the horse developed dysfunctional spinal loading.
It also does not remove established bony pathology.
Postoperative rehabilitation remains essential.
Surgery creates an opportunity for the horse to move differently.
Rehabilitation teaches the horse what to do with that opportunity.
Bone Shave or Ostectomy
Where significant bony impingement exists, another surgical option is ostectomy.
Part of an affected dorsal spinous process is removed or reshaped so adjacent processes can no longer impinge in the same way.
This directly changes the anatomy rather than simply suppressing pain.
A case series of 23 horses undergoing subtotal ostectomy reported 19 returning to full athletic function within the first year.[13]
A larger study involving 102 horses treated using a minimally invasive technique reported complete resolution of recognised clinical signs and return to intended work in 80% of surviving horses available for long-term follow-up.
Horses without another orthopaedic problem had substantially better outcomes than horses with concurrent pathology.[14]
An older study involving 215 surgically treated horses reported 72% returning to full work, with another 9% returning to some athletic work.[15]
Advantages
Unlike pain-management approaches, ostectomy physically removes the area of bony impingement.
For advanced cases, this may be more logical than repeatedly suppressing pain from structures that continue to contact one another.
Limitations
It is more invasive than ISLD.
Recovery and rehabilitation are significant, and surgery does not guarantee restoration of normal movement or comfort. In fact, the body will eventually lay down more bone to stabilise the spine where the bone has been removed and over time, the horse may end up in a worse state than it started.
A horse that has spent years protecting its back has developed muscular and neurological compensation around that pain.
Removing part of a bone does not instantly teach the horse how to use its body normally again.
Nor does a published “return to work” statistic tell us everything we would want to know about each horse’s long-term comfort.
When Is Kissing Spine Too Far Gone?
There is no single X-ray at which every veterinarian can point and say:
“This horse can never be comfortable again.”
The number of affected processes matters.
The severity of remodelling matters.
Other spinal pathology matters.
Concurrent lameness matters.
Response to treatment matters.
And above all:
The horse’s quality of life matters.
There is an important distinction between being unsuitable for ridden work and being unable to enjoy a comfortable life.
A horse may no longer be an ethical candidate for carrying a rider while remaining perfectly capable of living happily as a paddock horse.
Where pain persists despite appropriate treatment, rehabilitation and management, however, the question eventually stops being:
“Can we get this horse back into work?”
and becomes:
“Can we keep this horse genuinely comfortable?”
That is a welfare decision, not a sporting one.
Can Kissing Spine Be Prevented?
We do not understand the causes well enough to promise prevention.
Genetic and developmental factors mean kissing spine cannot always be blamed on one rider, one saddle or one method of training.
But that does not mean management and training are irrelevant.
We can reduce avoidable stresses by:
- ensuring appropriate saddle fit;
- investigating lameness early;
- developing the young horse progressively;
- developing abdominal and postural strength;
- strengthening and recruiting multifidus;
- building the topline gradually;
- avoiding prolonged hollow, braced movement;
- providing sufficient recovery;
- avoiding training through pain;
- maintaining appropriate hoof balance;
- recognising behavioural changes early; and
- treating the horse’s body as an interconnected system.
Correct dressage should progressively improve the horse’s ability to support a rider.
It should not simply manufacture a particular neck position.
The hindquarters, pelvis, abdominal wall, thorax, back and neck all influence one another.
Healthy training should improve that system rather than merely produce the outward shape of a dressage horse.
The Dressage Atlas Position
This is where Dressage Atlas deliberately takes a conservative position.
There is disagreement within veterinary medicine about the significance of radiographic kissing-spine findings, particularly in horses without recognised clinical signs.
We acknowledge that uncertainty.
But uncertainty cuts both ways.
If science cannot establish that every horse with significant radiographic pathology is experiencing pain, neither can it establish that the quiet, compliant horse with the same pathology is pain-free simply because it continues to perform.
We therefore do not consider compliance sufficient evidence of comfort.
There is an important difference between slight narrowing without secondary change and established disease.
But where imaging demonstrates bone-on-bone contact accompanied by sclerosis, osteolysis, remodelling, overriding or other significant pathological change, Dressage Atlas does not believe the absence of dramatic behaviour should be used to justify continued ridden work.
This position is deliberately more conservative than some current approaches to kissing spine.
That is intentional.
Horses have different pain thresholds.
They express pain differently.
Some shout.
Some whisper.
And some continue doing exactly what we ask of them.
Just because the horse can does not necessarily mean the horse should.
When the uncertainty is whether sitting on a horse’s diseased spine hurts, we believe the horse deserves the benefit of that uncertainty.
References and Further Reading
- Torcivia C, McDonnell S. In-Person Caretaker Visits Disrupt Ongoing Discomfort Behavior in Hospitalized Equine Orthopedic Surgical Patients. Animals. 2020;10(2):210. https://doi.org/10.3390/ani10020210
- Torcivia C, McDonnell S. Equine Discomfort Ethogram. Animals. 2021;11(2):580. https://doi.org/10.3390/ani11020580
- Zimmerman M, Dyson S, Murray R. Close, impinging and overriding spinous processes in the thoracolumbar spine: the relationship between radiological and scintigraphic findings and clinical signs. Equine Veterinary Journal. 2012;44(2):178–184. https://doi.org/10.1111/j.2042-3306.2011.00373.x
- Haussler KK, Stover SM, Willits NH. Pathologic changes in the lumbosacral vertebrae and pelvis in Thoroughbred racehorses. American Journal of Veterinary Research. 1999;60(2):143–153. https://doi.org/10.2460/ajvr.1999.60.02.143
- Infante D, Croxatto A, Corrêa F. Radiologic findings consistent with kissing spines syndrome in Chilean Thoroughbred horses. Sustainability, Agri, Food and Environmental Research. 2016;4(4):14–17.
- Patterson Rosa L, Whitaker B, Allen K, et al. Genomic loci associated with performance-limiting equine overriding spinous processes (kissing spines). Research in Veterinary Science. 2022;150:65–71. https://doi.org/10.1016/j.rvsc.2022.06.015
- DeClue A. Kissing Spine in Sport Horses. The Horse First: A Veterinary Sport Horse Podcast. Episode 55, May 2023.
- DeClue A. Kissing Spine in Sport Horses, Part Two: Do You Ride the Horse or the Radiograph? The Horse First: A Veterinary Sport Horse Podcast. Episode 56, September 2023.
- Stubbs NC, Riggs CM, Hodges PW, Jeffcott LB, Hodgson DR, Clayton HM, McGowan CM. Osseous spinal pathology and epaxial muscle ultrasonography in Thoroughbred racehorses. Equine Veterinary Journal. 2010;42(Suppl 38):654–661. https://doi.org/10.1111/j.2042-3306.2010.00258.x
- Stubbs NC, Kaiser LJ, Hauptman J, Clayton HM. Dynamic mobilisation exercises increase cross-sectional area of musculus multifidus. Equine Veterinary Journal. 2011;43(5):522–529. https://doi.org/10.1111/j.2042-3306.2010.00322.x
- Coomer RPC, McKane SA, Smith N, Vandeweerd JME. A controlled study evaluating a novel surgical treatment for kissing spines in standing sedated horses. Veterinary Surgery. 2012;41(7):890–897. https://doi.org/10.1111/j.1532-950X.2012.01013.x
- Prisk AJ, García-López JM. Long-term prognosis for return to athletic function after interspinous ligament desmotomy for treatment of impinging and overriding dorsal spinous processes in horses: 71 cases (2012–2017). Veterinary Surgery. 2019.
- Brink P. Subtotal ostectomy of impinging dorsal spinous processes in 23 standing horses. Veterinary Surgery. 2014;43(1):95–98. https://doi.org/10.1111/j.1532-950X.2013.12078.x
- Minimally invasive cranial ostectomy for the treatment of impinging dorsal spinous processes in 102 standing horses. Veterinary Surgery. 2021. https://doi.org/10.1111/vsu.13736
- Walmsley JP, Pettersson H, Winberg F, McEvoy F. Impingement of the dorsal spinous processes in 215 horses: case selection, surgical technique and results. Equine Veterinary Journal. 2002;34(1):23–28.
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