Unlimited access >

Kissing spine....please share your stories and any advice

So my mare has just been diagnosed with kissing spine, three spots on Xray, one where the bone literally lies on top of the other (I think T 15?) I’m getting all kinds of advice, from putting her down, to steriod injections, etc…Please share your positive (or even negative) stories. She is a young mare, smart, but bucks like a rodeo bronc under saddle, obviously pain related.

I’m so sorry to hear about your diagnosis, but hopefully this provides a starting ground to get her better. I’ve been dealing with a KS spine diagnosis now for ~ 9 months, although it sounds like my horse’s case is a bit more mild than yours. However, here are a few things I’ve learned after speaking with multiple vets about this; maybe some of it could be insightful for you.

  • There is a Horses with KS facebook group, and one called NoBackNoHorse - I recommend both.
  • KS is diagnosed a lot, but is not always clinically relevant. More importantly, the severity as assessed by radiographs does not always correlate with clinical symptoms (aka, pain) - some horses have awful xrays and no pain, others have mild xrays and lots of pain. You have to use the xrays as a tool, and really read the horse in front of you.
  • KS rarely exists in a vacuum. Lots of horses also have neck arthritis, negative plantar angle (NPA in the back hooves, or neg palmer angle in the front), and/or proximal suspensory desmitis (PSD, or high suspensory inflammation/irritation).
  • There are two surgeries: lig snip (less invasive) and bone shave (more invasive). Mind you these are both highly invasive spinal surgeries, so should both be considered a last resort. Depending on who you ask, the success rate of the surgeries (i.e., does the surgery fix the problem, and the horse return to full work?) hovers somewhere between 40%-60%. To me, that does not inspire confidence, and I would be very careful to eliminate any other possible source of pain before jumping into either.
  • Things to try before surgery: steroid injections, biphosphonates (like OsPhos), shockwave, mesotherapy. There are more ideas in the facebook groups.
  • Regardless of what therapy you choose, you will need to do physical therapy/rehab to stretch your horse’s topline and strengthen your horse’s core. There are great ideas and books recommended in the facebook groups. Sometimes this approach, combined with maybe steroid injections and/or shockwave and/or mesotherapy is enough to get your horse back on track. There is a lot to be said for “breaking the pain cycle” combined with rehab/PT to teach your horse how to move correctly.
  • In the Horses with KS group, you’ll see a lot of folks talk about surgery not working, and causing other problems resulting the horses being retired or put to sleep due to intractable pain, and many others who say the surgery brought their horse back to life and were a god send. So the surgeries can work, for some horses, in some circumstances. But be aware they are not always a cure-all (see bullet above with other common ailments). I would consider surgery a last resort.

A personal anecdote (which is a common story, from what I’ve seen in my research over the last year):

My KS horse has cervical arthritis (mild), NPA, and now (9 months after the KS diagnosis), it turns out she’s had PSD the whole time. For the back, we have done steroid injections, OsPhos, and shockwave, and each helped a little (along with physical therapy/rehab). I have been working to address the other issues over the last nine months, but after constantly regressing every time I start to bring her back to work despite all the treatments (and despite now the feet looking much, much better), I had another vet out and we started from scratch. Here, we found the PSD. The first vet saw my horse’s back was sore, radiographed the KS, and triumphantly proclaimed we found the root issue. Well, looking back at symptoms, I can honestly say the behavior under saddle has been happening for over a year at this point, long before the back was sore, so I think the PSD (in part with the NPA) was the root issue, which in turn caused the back to be sore. We will see once we resolve the PSD whether the KS is actually a thing we need to concern ourselves with (my money says it’s not, and we went down the wrong rabbit hole).

KS is the kind of thing that is easy to see on radiographs, thus it’s easy to assume that’s where the pain is coming from. But it turns out the back is connected to both the front and hind end, so pain from either of these areas can radiate and spread, especially if a horse is using other/different/incorrect body parts to compensate for pain.

Best of luck on your journey.


So in my experience of having exactly one horse with (mild) KS, my travels I’ve learned that KS is not the death sentence it used to be. Tbh I think if we xrayed every ridden horse out there, a ton of them would have some degree of KS. There are a LOT of options, and there can also be a lot of causes of KS that aren’t actually in the back. @Feathered_Feet explained it much better than I can, basically any kind of issue at either end can cause KS to appear or worsen. The spine is the bridge that connects the front and the back, so if one end goes wonky, the bridge in the middle can also go awry.

My horse has 2-3 points of impingement in his tspine. No serious overlap, but there’s definitely remodeling and contact on xray. We did steroid injections at those points, his SI (was also palpating very sore there), and Osphos. It made minimal difference. His symptoms were being tense/anxious under saddle, crow hopping behind at the canter to switch leads on and off, and riding “up” instead of riding “down.” His symptoms always went away in the warm weather and when on night time turnout. His KS area never palpated sore, but some don’t and he was certainly acting like his KS was a problem otherwise.

He has a history of NPA, and his hinds have been an issue for a few years. We would get the angles under control, but then things would fall apart, then we’d get them back under control. It was a battle. He was in steel with wedge rim pads, and then eventually wedge full pads with a clear jelly fill, and while that corrected his angles, it didn’t support his frogs/soles and it crushed his heels, so it sent him into caudal failure. We put him in 3D frog support pads at his last shoeing (hinds), and it’s changed his life. All of his symptoms have gone away, even his anxiety on the ground. This is anxiety he’s had since I bought him nine years ago, and I’m not kidding when I say it went away overnight.

So if it were me, I’d start conservative with the back (don’t jump right to surgery) and check out other areas like feet. It’s easier to fix the root of an issue than to chase symptoms without knowing what’s causing them. I did that for years and it’s frustrating and expensive. All of his problems, which I’ve easily spent a downpayment on a house trying to fix, were resolved with some $20 pads.


I tried going the conservative route with my mare. I did shockwave, mesotherapy, injections, acupuncture, feed through muscle relaxants, etc. Unfortunately I spent a LOT of money and none of it worked. As a last ditch effort, I sent her for the lig snip surgery. The recovery was a breeze for us and now we are on to rehab work. I still have no idea if she will be rideable at the end of this, and if she’s not, that’s okay. But I knew that personally I had to try that final option before making the decision to retire her.


If you do a search there are many old threads. I posted the longer version of my story on one or more of them. I have a horse I’ve had since he was 3 with 30 days on him. Did a PPE that didn’t including back films (this was a decade ago and they were less common and less available back then). As an aged horse he started to show backsoreness and we discussed KS. He had the ligament snipping surgery. He came back better than he ever had been before. It’s now been 3-4 years and he’s sounder than ever. He does a slightly less taxing job (2’6 hunter rather than 3’0 hunter) because before he was leased and now I ride him and I’m a chicken-- there is no back-specific reason why he couldn’t have gone back to his old job, though he’s also older and for various reasons probably would have at some point started slowing down/stepping down for other reasons. Not to jinx things but you have never seen a sounder horse than this horse and he went and went and went with TERRIBLE back pain, never saying “no” until he literally couldn’t. He’s very stoic and probably suffered a long time, so long that he caused some soft tissue injuries in his front feet trying to “save himself” from using his back. And now that it’s fixed he is sound sound sound again.


Old threads where I posted…

Oh and I still can’t stop grabbing with my inside rein going to the right. Which goes to show you how much easier it is to fix a horse than to fix an idiot rider :wink:

What @Feathered_Feet said. Research has shown as many as 40% of horses have KS and are asymptomatic their entire lives. It’s currently a popular diagnosis and I think many times it is unrelated or a side effect rather than a root cause.

One of the linked threads @vxf111 is one I started about a horse I was considering purchasing with KS found on PPE. I bought the horse and 18 months later he’s been in full work and is successfully competing with no issues.

1 Like

Thank you for the replies…I id try to search old threads, but for some reason not much was coming up.
I did get some good suggestions from my vet, or at least starting points to start working with the issue. I’m pretty sure it is back pain, as she is generally a pretty good girl, and smart. I don’t want to throw in the towel just yet.
Was really looking for other people’s experiences and hopefully successes!!
Thanks to you all so much for taking the time to reply!

Our 7 year old OTTB started acting really badly over the winter during his flat lessons, very unlike him. We have had him since he was 4, did a PPE but no back x-rays. He started being a little off behind without a def diagnoisis late 2021, some counter cantering, that sort of thing, always a little weak behind. We did a couple of back xrays about March, suspected KS was the issue, and decided to do the Bone Scan to get real answers (we are very close to NBC). Thankfully the only thing that “lit up” was KS, about 2 spots, not severe, but there. We also had his dressage saddle looked at and it was a mess underneath, so got that fixed. We did the injections to his back as well as meso. Started him back slowly and changed the saddle pad too which he really really likes. We used the pessoa on him to help build core strength and his flat lessons were returning to normal if not better! put him on the super sport too to help build back his top line. We noticed though, that he looked to have some atrophy above his tail, it sloped off and wasn’t building back up. And, the counter canter was back, but didn’t always happen, but enough that we knew he still wasn’t right.
Decided to check for EPM, and his titer came up as 500, so low but on the high exposure range. We also did an ultrasound of his hind legs and it showed thickening of both hind suspensorys. We are treating him for the EPM, thinking he picked that up during winter/spring, and will be treating the hind too shortly. We have been walking him for a couple of weeks now. He’s responding really well to the EPM med and his top line has built back up. So a combination of KS, EPM, and weird thickening of suspensorys. We have yet to compete this year after an incredible season last year. HORSES!
Wishing you the best with your horse!

Etalon Diagnostics (etalondx.com) has information on Kissing Spines on their website. They also have a link to their research study. There was a gelding at the barn who had surgery for Kissing Spines at Tufts veterinary center in Massachusetts. At the moment he is getting back to exercising.

I changed to Etalon for color/pattern testing for my sabino Paint gelding after using UC Davis. UCD’s color and pattern tests are not as extensive and they are more expensive. Etalon does a lot of research and has descriptions for everything. They have identified 32 variants for Dominant white, for example. They also discovered Flamboyant white in an Arabian stallion. They have health and temperant tests included in the minipanel. I’ve had my horse for 21 years and finally confirmed he is n/n for HYPP (Impressive apperas once). He is G/G for Curiousty. I was skeptical until we moved to a new barn and several people noticied it. The health panel covers a few dozen tests. I also did the ancestry panel. They are getting underway on an ancestry study of Mustangs.

You can learn a lot. My now-retired vet asked me do a short summary on color and pattern for his large animal management course in a vet tech program. He told them that the reason horse owners spend so much time on color and pattern is they don’t know what color their horse is.


went through this last year with my mare. it was devastating, so sorry to hear you’re going through this

My vet recommended injections and if that wasn’t helpful then surgery. I instead decided to retire my mare. I had spent thousands already getting a diagnosis and with other rehab methods that did nothing. To me, spending thousands of dollars and time with rehab for a “maybe” wasn’t worth it. It will be a problem and work in progress forever, even if you get surgery. The facebook group was helpful for reality check and seeing others’ experience. best of luck!

1 Like

Your vet didn’t mention/call this suspensory desmitis? Because that’s what this sounds like. And is definitely commonly found among horses with KS. If this were my horse, I’d get another vet out to do a lameness exam, blocking, and (if positive) ultrasound. Because this sounds like proximal suspensory desmitis and might be at the root of your horses “kissing spine” pain. If nothing else, I would keep PSD in the back of your mind if you don’t see improvement with the current plan.

(I hope your current plan works, but just in case…)


I know one young horse who had lig snip surgery and has come back well from that. They chased a variety of other issues for a while first including metabolic, low E and Se, and sore feet. His X-rays weren’t that bad. Perhaps caused by his other body issues, but we don’t know because he didn’t have images with his PPE.

For significant overriding of bone, injections are not possible other than you can try to diffuse steroid in the area I suppose or do meso. You’d probably be looking at bone shave surgery for that spot at least.

It does sound like for this horse, it’s a significant problem. If you do the surgery, you will need to pay attention to all the postural and proprioceptive things (including hoof angles) as part of the rehab plan. But I wouldn’t discount the significance of this image. And avoiding using the back properly can lead to all the other problems as secondary problems, just like they could, if primary, contribute to back problems.