🩻 Beyond “Clear”: What Equine Spine X-Rays Really Tell Us

If you’ve ever had spinal X-rays taken of your horse and been told “they’re clear”—but your horse is still showing back pain, behavioral issues under saddle, or inconsistent performance—this post is for you.

As an equine therapist who reviews spinal radiographs on a near-daily basis, I want to talk about a pattern I see all too often:

A horse presents with back-related dysfunction, the vet takes lateral spine radiographs, and the report comes back: “No kissing spines, spine is normal.”
Even worse - “the rads are normal, it’s just behavioral”
But when I ask to see the actual X-rays? I see plenty of not-so-normal going on.

Let’s unpack why that matters—because recognizing these early changes can make the biggest difference in long-term soundness and function.

🧐 First Off, What Are We Actually Looking At?

When we X-ray a horse’s back, we’re primarily seeing the dorsal spinous processes—those tall, fin-like projections off the vertebrae that stack up like a row of shark fins. That’s what we’re able to assess best on standard lateral radiographs.

These spinous processes are where we diagnose “kissing spines” (more formally, overriding dorsal spinous process disease). It’s a condition where the processes get too close together, start touching, or even fuse, creating pain and restriction in spinal movement.

But here’s the critical part: fusing isn’t the beginning of the problem—it’s the end stage of a long process.

These spinous processes are fusing, this is advanced Kissing Spines at every visible spinal segment

❗ What Shows Up Before Kissing Spines?

There are subtle but significant changes that can appear on radiographs well before spinous processes are actually touching or fusing. These may include:

Reduced interspinous spacing – the spaces are narrower than normal
Irregular bone edges – scalloping, flattening, or remodeling
Reactive bone changes – indicating inflammation or pressure
Changes in alignment or orientation – suggesting instability or compensation

These are red flags. But because they don’t meet the threshold of full-blown kissing spines, they’re often dismissed as “normal.”
They’re not.

If you or your care team catch these early changes, this is actually good news—because there’s plenty of time to intervene, adjust the horse’s program, and prevent progression.

Looking at the very tall SPs of the withers, we are less likely to see kissing. What I more often see is this calcification of the interspinous ligament. Calcification of ligaments is the body’s response to excessive and abnormal strain.

Far right - Kissing and beginning to fuse
Left circle is a little tricky to see, but looks to be diminished spacing with some remodeling starting on the SP to the right

Can you spot the segment that’s beginning to fuse?

“Darker white” highlighted areas are areas of increased bone density aka the SPs are laying down new bone to attempt to fuse these locations. These SPs are impinging during motion, likely during riding. Diminished spacing between SPs without much remodeling is also noteworthy, it’s good to find it at this stage! But it’s not nothing… it’s your early warning sign.

Diminished spacing - an early warning sign when paired with clinical symptoms like pain, reduced range of motion, behavioral changes, etc.

🔍 A Clear X-Ray ≠ A Clear Back

Let’s be blunt:

Just because the spinous processes aren’t touching, that doesn’t mean the back is fine.
Just because the X-rays say “normal,” doesn’t mean there isn’t functional dysfunction.
And just because it’s not yet “kissing spines,” doesn’t mean the horse is in the clear.

Also important: lateral spine X-rays only show us one part of the spine. The intervertebral joints, facet joints, and soft tissues? Those are either invisible or very poorly visualized on plain radiographs.

So if we’re seeing visible changes in the spinous processes—the only part we can see clearly—it’s a safe bet that the parts we can’t see are also struggling.

Here’s your reminder of how jacked up the vertebral body and its associated joints can get, and you’d never see it on X-ray. This horse has impinging SPs that have not actually fused.

🧩 X-Rays Are Just One Piece of the Puzzle

This is why no good rehab or diagnostic plan is based on X-rays alone. They are a tool—an important one—but not the only one. Function matters more than form.

I’ve worked with horses who have terrifying radiographs but are able to return to high-level performance with the right rehab, care team, and management.
I’ve also seen horses with barely-there changes on film who can’t seem to improve—because other pieces aren’t in place: pain management, saddle fit, posture, hoof balance, consistent therapy, or owner capacity.

Bottom line: we don’t ride the X-ray.
But the X-ray still matters—especially when we understand what we’re really looking at.

✅ What to Do If Your Horse Has “Not-Quite-Kissing-Spines” Changes

If your vet or therapist points out changes that fall short of full fusion or overriding, don’t panic—but don’t ignore it either. Here’s what to do:

Review the radiographs yourself with a qualified professional—ask questions.
Get a functional assessment – How is the horse moving? Any behavioral indicators?
Build a proactive rehab plan – Strengthen posture, mobilize the spine, support comfort.
Involve a team – Vet, therapist, farrier, saddle fitter, trainer, owner—all on the same page.

This is the window of opportunity. Don’t wait until it’s “bad enough” to get serious. By then, your options narrow, and your horse’s long-term comfort may already be compromised.

💡 In Summary

X-rays that don’t show kissing spines aren’t always “normal”
Early signs of spinal stress are real and deserve attention
Full-blown kissing spines is often preventable with early intervention
Functional evaluation matters just as much (if not more) than imaging
A horse’s comfort and capability depend on the whole picture, not one set of films

Let’s raise the bar on how we interpret and act on spinal radiographs. Because your horse deserves more than “it’s not kissing spines, so it must be fine.”

📩 Want help decoding your horse’s spine X-rays or building a rehab plan?
Reach out to our team for a consult—we’ll help you see the whole picture, and what to do next.

🧰 More of a DIY kinda person? Check out my Kissing Spines Masterclass online program.

Barbara ParksMarch 17, 2025Comment