The inclusion of thoracolumbar radiographs in a pre-purchase examination (PPE) is a topic of current and intense debate, subsequent to a statement from the Federation of European Equine Veterinary Associations (FEEVA) advocating the exclusion of spinous process radiography from the PPE. This review will consider the reasons behind the addition of such radiographs into PPEs, the limitations of radiography in ambulatory practice and therefore the diagnostic limitations to the practitioner, the diagnostic benefit of a complete radiographic examination, and discussion of common and less-frequent thoracolumbar pathologies. We will focus on laterolateral radiographs of the spinous processes as these are most commonly acquired during the PPE. The lack of consistent and repeatable grading systems highlights the subjective nature and variability in assessing this region radiographically. Coupled with the sparse evidence of correlation between clinical symptoms and radiographic abnormalities of the thoracolumbar spine leads us to conclude that taking radiographs of the back during PPEs should not be performed unless the clinical examination indicates otherwise.