Kissing spines, or overriding dorsal spinous processes, occur when the bony projections along a horse’s spine become too close together or overlap, potentially causing back pain and limiting spinal movement. Some horses with kissing spines might show poor performance, reluctance to work, bucking, or sensitivity to saddling, while others have radiographic evidence of kissing spines without any clinical signs, making diagnosis more complex than images alone. Veterinarians diagnose the condition using a combination of the horse’s history, physical examination, and imaging to confirm the source of pain. Treatment typically combines rehabilitation and targeted exercise with medical and/or surgical management, depending on the severity of the horse’s clinical signs.