New research insights on equine spinal conditions help veterinarians extend horses soundness and longevityMany problems can develop in the horses neck and spine, leading to a wide variety of clinical signs, and different diagnostic and management challenges make issues trickier. | iStockStretching from skull to tail, the horses vertebral column contains 51 to 57 vertebrae that shape movement, balance, and performance. Each of the spines cervical, thoracic, lumbar, sacral, and coccygeal regions can develop its own specifi c disease processes involving bones, ligaments, muscles, cartilage, and/or nerves, creating a wide array of clinical signs that can make diagnoses challenging, says Sue Dyson, MA, VetMB, PhD, DEO, former head of clinical orthopedics at the Animal Health Trust Centre for Equine Studies, in Newmarket, England.Weve got this huge spectrum of problems, and different areas that can get damaged, which result in a wide variety of clinical signs related to eachobviously with different diagnostic and management challenges, she says.Fortunately, researchers continue to uncover better ways to diagnose, treat, and prevent such problems, says Kevin Haussler, DVM, DC, PhD, Dipl. ACVSMR, associate professor at Lincoln Memorial University, in Harrogate, Tennessee. There has been a lot of progress in spinal-related issues lately, so its an exciting time, he says.Neck and Spine Problems: An OverviewSpinal issues in horses include bony changessuch as remodeling (changes in size and shape), arthritis, misalignment, and fracturesand soft tissue injuries affecting muscles and ligaments, Dyson says. Nerve compression can also occur, causing lameness, weakness, stumbling, or difficulty bearing weight.Conditions arise from damage to the spinal cord, and the signs vary depending on the location of that damage. In the cervical region, for example, horses might develop intervertebral disc disease or damage the nuchal ligamentwhich anchors at the back of the skull, then runs down the neck and attaches along the bones of the neck and into the withersand its bursae, which are fluid-filled cushions that sit between the ligament and the bones it rubs against. The withers serve as a key transition point between the neck and back and can suffer fractures from trauma.Further back, in the thoracic and lumbar regions, two or more spinous processes can touch or override one another, forming impinging dorsal spinous processes (IDSPs), while arthritis might affect the articular process joints. Additionally, spondylosisnew bone on the underside of the bonescan occur in the vertebral bodies. The lumbosacral area experiences major spinal flexion, mediated by large muscles under the spine, putting it at heightened injury risk. The junction between the spine and the ilial wings, called the sacroiliac joints, presents another completely different set of problems, Dyson says.As for tails, our sources say they can incur fractures, soft tissue injuries, and neurologic problems. But their pathologies (disease or damage) remain largely understudied.The Latest in ImagingRadiographs (X rays) still serve as a great starting point for viewing spinal bones in 2D, Dyson says. But in the past decade computed tomography (CT) has advanced to provide 3D images of the entire neck and upper thoracic spine.Haussler says CT scanners with larger gantries now allow anesthetized horses to undergo 3D imaging of the lumbosacral region. In his early necropsy work on Thoroughbreds, he showed that osteophytes can pinch nerves around the lumbosacral junction, leading to chronic hind-limb lameness.At Ocala Equine Hospital, in Florida, Natasha Werpy, DVM, Dipl. ACVR, and her colleagues have been developing dynamic CT, capturing images of the neck in motionflexed, extended, turning, and everything between.One of my ongoing concerns is that we take radiographs of standing horses without seeing if those joints can actually move, Haussler says. Theres just so much going on from a spinal pain and dysfunction perspective that you cant appreciate otherwise.New endoscopic tools allow veterinarians to see the intervertebral foramenthanks to innovations led by Jan-Hein Swagemakers, DVM, at Tierklinik Lsche, in Germany.Ultrasound is also improving, Haussler says. Techniques developed by Cooper Williams, VMD, Dipl. ACVSMR, in Maryland, and Philippe Benoit, DVM, in Cardiff-by-the-Sea, California, and France, reveal previously unseen soft tissue changes in the poll and upper neck.Theres a lot going on in this arealots of movement, the nuchal ligament, strong tendons attaching there, in a region that sometimes gets really flexed during training, putting lots of stress on soft tissues, Haussler says. Once you start looking in earnest, you find all kinds of soft tissue, neurologic, and bony changes.Bone scansnuclear scintigraphycan highlight active lesions, but the 3D versionposition emission tomography (PET)is still limited by scanners too small for the equine spine, Dyson says. Even so, interpreting results can be tricky, she explains. Studies show scintigraphy often flags more activity in the lower neck than the upper, but that doesnt necessarily equate with pain, she says. There is greater motion and more modeling changes in that area.Enhancing the Gold Standard: The Clinical ExamIndeed, for all its value, diagnostic imaging can still reveal issues that dont bother the horse, Dyson says. If you were to X ray 100 healthy horses, probably 80 of them would have close spinous processes, she explains. So its really important to correlate imaging with clinical signs.Hence, the clinical exam remains her gold standard. Not enough people do a thorough systematic examination with every horse, so they are not sufficiently aware of what is normal and what is abnormal, she says.She begins by observing muscle development, looking for anything abnormal or asymmetrical. She also palpates both sides, checks range of motion, assesses movement in hand and under saddle, and examines the limbs to rule out problems in the legs.Haussler recommends applying tail traction to check for neurologic problems, and gently pulling the tail backward to assess and treat back pain, based on recent Finnish research. The tail can tell us a lot, and it gives us a window into the nervous system, he says.In recent years practitioners have focused more closely on horses behavioral reactions to physical examsespecially the body language and facial expressions of pain. Its like the horse is screaming at us about where the problem lies, Haussler says. We need to listen.The Holistic ApproachAnother new trend consists of looking at the whole horse, rather than zeroing in on specific problem areas, our sources say.The axial skeleton both influences and responds to problems elsewhere in the body, Haussler explains. Its like when people have a sprained ankle, he says. They carry themselves differently, and they can get back pain. Around 75% of horses with back problems also show lameness, and about 25% of lame horses have back issues, he says.Plus, as prey animals, horses compensate to mask pain, Dyson says. They react to lameness by reducing the range of motion of the back when theyre in motionand that then leads to loss of muscle and muscle tone, she explains. While that might appear to be a primary back issue, the main problem might actually be lameness.Impinging dorsal spinous processes can be a particular red herring, she adds. A horse with kissing spines, as theyre colloquially called, on X ray might have poor hind-limb propulsion for a totally different reason, such as bilateral proximal suspensory desmopathy (a painful ligament injury at the top of both hind cannon bones), without any clinical relevance for the kissing spines. I need to be having an open mind about the underlying problemor problems, she says.Hausslers group is also exploring how neck pain relates to wider issues across the body. Neck pain or stiffness can influence everything from how a horse uses her back to how she places her feet, potentially triggering lameness, gait irregularities, or even behavioral resistance under saddle, he says.Treatment AdvancesEquine surgeons have been making vertebral repairs for decades, but new techniques deliver better results with less invasive fixation, greater precision, and fewer complications, Haussler says.Researchers at Colorado State University (CSU), in Fort Collins, and Grosbois Equine Veterinary Clinic, in France, are refining surgical approaches for Wobbler syndrome, using custom 3D-printed spacers and bone plates that reduce spinal cord pressure more effectively than earlier basket implants. In 2023 Swagemakers applied his foramen arthroscopy to perform foraminotomiesremoving excess bone from the spinal canalin horses with mild forelimb lameness, with full recovery, and has successfully conducted many more of the procedures. And in 2025, surgeons at the University of Bern, in Switzerland, used computer assistance, CT guidance, and lag screws to repair a neck fracture in a fallen dressage gelding, and he returned to full performance within a year.In cases of IDSP with confirmed clinical significance, surgeons traditionally removed sections of the impinging spinous processes with horses under general anesthesia. More recently, surgeons often operate on standing sedated horses. Theyve also adopted interspinous ligament desmotomycutting spinal ligamentsas a faster, less invasive option. But if the spinous processes are too close together or overlapping, this is not feasible, Dyson warns.In addition to surgery, or instead of it, many veterinarians still rely on non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroid injections, and sometimes extracorporeal shock wave therapy (ESWT) or mesotherapy. This is combined with appropriate rehabilitation exercises to restore appropriate muscle development, strength, and coordination, Dyson says.Research with experimentally induced neck pain models, led by Melinda Story, DVM, PhD, an assistant professor at CSU, have helped refine how and when to use such tools in horses.Meanwhile clinicians are trying bisphosphonates, which are typically used for navicular disease, as a potential treatment in select cases of spinal osteoarthritis and bone pain, Haussler says.For chronic neuropathic pain or central sensitizationwhere the nervous system incorrectly processes painscientists have seen success with gabapentin and cannabidiol (CBD), Haussler says. Acupuncture also appears to regulate pain perception and relax muscles in horses.Getting Down to the GenesSome spinal diseases have hereditary components, and geneticists are working to identify the genes responsible, Haussler says. Carrie Finno, DVM, PhD, Dipl. ACVIM, associate professor at the University of California, Davis, for example, is studying the possible heritability of caudal cervical vertebral anomalies, or equine complex vertebral malformation (ECVM), which is also called C6-C7 malformation.Haussler explains that veterinarians have long recognized ECVM, yet its prevalence might be increasing, possibly due to selective breeding for expressive dressage movement. Yes, these horses can move freely, he says, but from a spinal health perspective, maybe were crossing over a fi ne threshold into making them have significant neurologic compromise.Another condition with potential genetic roots is IDSP (again, kissing spines) in Thoroughbreds, Dyson says. Some breeding programs have reported clusters of related horses with the condition, although not all show clinical signs. The presence or absence of clinical signs may be related to the way in which horses are worked, reflected by muscle development patterns, she explains.Haussler emphasizes that no ones blaming breeders. People dont select these unwanted characteristics on purpose, he says. Were always looking for horses that run faster, jump higher, and generally perform better. Unfortunately, other genes or traits sometimes get dragged along, with unwanted consequences.Breeders already use DNA testing to reduce several genetic diseases unrelated to the spine, and thats the aim here, too. If we can identify the genes related to these diseases, we can begin selective breeding programs, Haussler says.New Training, Discipline, and Equipment InsightsAs research evolves, scientists are paying closer attention to how the horses environment shapes spinal health, Haussler says. Teams in the U.K., U.S., and Netherlands, for example, are investigating how rider posture, rein tension, and the horses head and neck position affect the spine. Rider influences can make a big difference in whether a horse is able to cope with spinal-related issues or not, he says.High head carriage puts extra stress on neck joints, reduces back flexibility, and leads to poor muscle development. | Adobe stock photoHyperflexion remains a popular research topic, Dyson says. Researchers have shown that prolonged rollkurwhich she defines as excessive hyperflexion of the poll with the horses nose at the chest increases pressure at the poll, especially in the atlantoaxial joint and nuchal bursae. This raises concerns about long-term strain on neck ligaments and joints, but clinical problems are relatively unusual, she says. Short periods of riding low, deep, and round (LDR)not rollkurhavent been linked to back or neck problems.High head carriage, on the other handseen with some novice riders aboard and in horses with other pain-related problemsputs extra stress on neck joints, reduces back flexibility, and leads to poor muscle development. This is potentially deleterious, with huge biomechanical consequences, Dyson says. Going with the head in the air is bad.She also notes that equestrian discipline also plays a role. Contrary to common belief, show jumpers can experience more neck problems than dressage horses, as suggested by researchers on recent studies. They extend their necks when landing, Dyson explains. Youve got massive forces being generated. Dressage horses, by contrast, carry their heads lower, which opens up the articular process joints more, so theres less pressure.Another key factor involves saddle fit. Pressure concentrates just behind the withers, where the riders weight and girth tension combine, Haussler says.In exams Dyson says she always checks for muscle wasting behind the withers. An ill-fitting saddle is obviously going to cause problems for the horse, she says.Daily management and horsemanship matter, too. Our sources emphasize the importance of letting horses stretch and lower their necks.They can have the best genes, but horses can still be a mess because of management and other things that are going on, Haussler says.Take-Home MessageThe horses spine can develop problems ranging from mild soft tissue strain to serious neurologic disease. Diagnosing and managing these issues requires a whole-horse approach, careful clinical evaluation, and increasing reliance on advanced imaging and surgical techniques. Continued research into and increased awareness about the equine spines complexity equip practitioners to improve our horses comfort, performance, and longevity.This article is from the Research Roundup 2025 issue ofThe Horse: Your Guide to Equine Health Care. We at The Horse work to provide you with the latest and most reliable news and information on equine health, care, management, and welfare through our magazine and TheHorse.com. Your subscription helps The Horse continue to offer this vital resource to horse owners of all breeds, disciplines, and experience levels. To access current issues included in your subscription, please sign in to theAppleorGoogleapps ORclick herefor the desktop version.