06/23/2026
Yes! 👏
Nothing drives me more insane than hearing thoracic spinal radiographs described as "mild" when the horse says otherwise.
Every month, I review images showing spinous processes that are touching, overriding, fusing, or demonstrating multi-level compression. Yet far too often, the conversation stops there.
The spinous processes are not the joint.
Read that again.
The spinous processes are not the joint.
They are simply the part of the vertebrae we can readily see on standard radiographs.
Below them lies the anatomy that matters most to function and pain generation: facet joints, intervertebral discs, spinal nerves, the spinal cord, ligaments, muscles, tendons, ribs, and blood vessels.
None of this can be seen on a standard radiograph of only the spinous processes.
Most importantly, spinal nerves exit at every single vertebral level below the spinous processes.
Every. Single. Level.
So when I hear, "It's only mild," while standing in front of a horse with behavioural changes, altered posture, performance limitations, and clear dysfunction on assessment, I have to ask:
Mild according to whom?
Because the horse often disagrees.
Imaging findings and clinical signs do not always correlate. Horses with significant radiographic changes can appear comfortable, while others with seemingly "mild" findings can be profoundly affected.
This is why imaging should never be interpreted in isolation.
We have many other metrics to evaluate a horse:
* anatomy & physiology (i.e. understanding normal anatomy versus pathology)
* movement assessment (gait evaluation)
* passive joint evaluation
* palpation (muscles, tendons, fascia)
* case history
* behaviour (this one is often the most clear)
And most importantly, we have the horse.
A radiograph is one piece of the puzzle.
What we see on the image may only be the tip of the iceberg.