Why I Am Generally Not an Advocate for Kissing Spine Surgery:
A practitioner’s perspective from both the equine world and human medicine
There are certain topics in the horse world that carry a lot of emotional weight. Kissing spine surgery is one of them.
I want to be very clear about my intention with this article. This is not written to shame owners, veterinarians, or professionals who have pursued or recommended surgery. Every situation is complex. Every horse is an individual. Every owner is trying to make the best decision they can with the information, resources, and guidance available to them at the time.
This is simply my perspective after years of hands-on work with horses in pain, alongside my parallel experience working in a human medical office where I see what back surgery looks like on the other side of the consent form.
And I am generally not an advocate for kissing spine surgery.
Not because I don’t believe kissing spine exists.
Not because I think bone changes are irrelevant.
Not because surgery never has a place.
But because I believe kissing spine is rarely a primary problem. It is most often a downstream result of long-standing compensation, loading patterns, and unresolved dysfunction elsewhere in the body.
And because I have watched, over and over, how invasive spinal surgery fundamentally changes living beings in ways that imaging reports do not capture.
What kissing spine surgery actually entails
Kissing spine surgery is not minor.
Muscle is cut.
Fascia is disrupted.
Bone is altered or removed.
Nerves are inevitably affected.
The thoracolumbar spine is a major highway of movement, proprioception, postural control, and nervous system communication. When we operate in this region, we are not just creating space between bones. We are intervening in one of the most complex, load-bearing, sensation-rich areas of the body.
Recovery is long. Rehab is intensive. Outcomes are variable.
Some horses return to work.
Some improve partially.
Some never truly look comfortable again.
Some trade one pain pattern for another.
Radiographs may look better. But a horse is not a radiograph.
What I see in human medicine every day
Working in a doctor’s office has profoundly shaped how I view orthopedic surgery, especially spinal surgery.
I regularly see people who have had back surgery years ago. Many of them tell remarkably similar stories.
“I was never the same after.”
“I wish I had tried everything else first.”
“I wouldn’t recommend it to anyone.”
“It helped one thing but created three new problems.”
Some people do feel relief. I will never deny that.
But a very large percentage of patients describe persistent pain, altered sensation, reduced capacity, scar tissue complications, and a long list of secondary issues that developed after surgery.
What stands out most to me is this.
When someone who has already had back surgery consistently warns others not to get it, we should listen.
Humans can talk. They can describe nerve pain, burning, pulling, numbness, instability, and loss of function.
Horses cannot.
So when we choose spinal surgery for a horse, we are making that decision without the ability to truly know how it feels in their body.
That matters.
Kissing spine is usually part of a much bigger picture
In my clinical experience, kissing spine is rarely an isolated pathology.
It almost always exists alongside a combination of:
Limb asymmetries
Hoof imbalance or long-term trimming and shoeing issues
Dental and TMJ imbalance
Hyoid and tongue restriction
Saddle fit or tack pressure problems
Poor thoracic sling function
Weak or inhibited abdominal engagement
Neck and poll restriction
Nervous system dysregulation
Training and workload that exceeds the horse’s current capacity
When a horse cannot move efficiently through the limbs, ribcage, and core, the spine becomes the place that absorbs excessive load.
Over time, bone adapts to stress.
That adaptation is what we often label as kissing spine.
But removing or reshaping bone does not automatically change why the spine was overloaded in the first place.
If the forces remain the same, the body will simply find a new place to break down.
Surgery treats structure, not strategy
Surgery changes anatomy.
It does not automatically change:
How the horse uses its body
How forces travel through the musculoskeletal system
How the nervous system organizes movement
How tack interacts with the back
How the horse has learned to brace for years
Those patterns live in the nervous system and in motor memory.
Without addressing them, we risk surgically altering tissue while leaving the underlying strategy untouched.
That is one of the biggest reasons I struggle with surgery as a first-line option.
The cost that is rarely discussed
There is a physical cost.
There is a financial cost.
There is a time cost.
There is an emotional cost.
But there is also a biological cost.
Scar tissue is not the same as original tissue.
Healing tissue is not identical to untouched tissue.
Nerves do not always regenerate cleanly.
Even when surgery is technically successful, the body is permanently changed.
This does not mean surgery never has a place.
It means we should be extremely thoughtful before choosing an irreversible intervention.
What I prefer to see first
Before considering surgery, I believe most horses deserve an intensive, well-structured, conservative care plan that may include:
Consistent, skilled bodywork
Rehabilitation-focused conditioning
Progressive strengthening of the thoracic sling and core
Saddle and tack evaluation
Dental and TMJ assessment
Hoof balance optimization
Nervous system regulation work
Honest evaluation of training expectations
Not one session.
Not two sessions.
A real program.
Many horses show meaningful improvement when the full picture is addressed.
Some become comfortable enough to return to work.
Some become comfortable pasture horses.
Some surprise everyone.
Those outcomes matter.
Radiographs do not equal suffering
Plenty of horses have radiographic kissing spine and show no pain.
Plenty of horses show pain with minimal radiographic change.
Images show structure.
They do not show experience.
Treating images instead of individuals leads to overtreatment.
Rare cases do exist
Yes, there are cases where conservative management truly fails.
Yes, there are cases where surgery may be considered after everything else has been attempted thoughtfully and thoroughly.
Those cases tend to be the minority.
They should be approached with:
Clear expectations.
Long-term rehab planning.
A full support team.
The question I always come back to
Instead of asking:
“How fast can we surgically remove the symptom?”
I ask:
“What is this horse compensating for?”
“What has this body been trying to manage for years?”
“What systems are failing to share load appropriately?”
Those questions lead to more sustainable answers.
A closing thought
I’ve sat across from too many people who quietly say, “I wish I had never done it.”
I’ve put my hands on too many horses who were told they were fixed, but their bodies told a very different story.
I’ve also had the privilege of watching horses change in really meaningful ways when they’re given time, thoughtful care, and a team that’s willing to look beyond a single diagnosis.
That’s why I feel the way I do.
Not because I’m anti-vet.
Not because I think surgery is evil.
Not because I believe I have all the answers.
But because I believe horses deserve every reasonable chance to heal and adapt before we choose something permanent.
If you’re standing at that crossroads right now, feeling overwhelmed, scared, or unsure, you’re not alone. And you’re not failing your horse by asking more questions.
Slow paths still move forward.
Layered care still counts.
Trying conservative options first is not “doing nothing.”
It’s doing something very intentional.
Your horse deserves a team willing to listen, observe, reassess, and adjust.
And you deserve support while you navigate it.
