Baastrup disease
Updates to Article Attributes
Baastrup syndrome (also referred to as kissing spines) results from adjacent spinous processes in the lumbar spine rubbing against each other and resulting in hypertrophy and sclerosis with focal midline pain and tenderness relieved by flexion and aggravated by extension.
Epidemiology
It tends to be more common in the elderly 1.
Clinical presentation
Focal midline pain and tenderness relieved by flexion and aggravated by extension.
Pathology
This process can result in degenerative hypertrophy, inflammatory change (as seen in case 1) and even a pseudoarthrosis with bursa formation. This interspinous bursa may extend between the ligamenta flava in the midline forming an epidural cyst and further contributing to the already existing canal stenosis 2.
This condition is usually seen in patients with excessive lordosis of the lumbar spine.
Associations
- older age
- anterolisthesis
- central canal stenosis 7
Radiographic features
Plain radiograph and CT
- often shows close approximation and contact of adjacent spinous processes (kissing spines)
- there is resultant enlargement, flattening and reactive sclerosis of apposing interspinous surfaces
MRI
May demonstrate interspinous bursal fluid and posterocentral epidural cyst(s). MRI can be very helpful in determining whether there is resulting posterior compression of the thecal sac.
FDG-PET/CT
May demonstrate FDG-avidity when associated with an inflammatory response such as bursitis 5,6. The best diagnostic clue for avoiding misinterpretation may be scrutinising sagittal multiplanar reconstructions (MPR) and involvement being limited to spinous processes, which is rare in malignancy 6.
Treatment and prognosis
Both conservative and surgical options are available for treatment. Local steroid injection into the interspinous processes will/ ligament region could often ease the back pain 8. Surgical options include interspinous process decompression devices (e.g. Wallis system, X STOP), and steroid/local anaesthetic injection into the bursa.
History and etymology
It is named after Christian Ingerslev Baastrup, Danish radiologist (1855-1950) 3.
-<p><strong>Baastrup syndrome</strong> (also referred to as <strong>kissing spines</strong>) results from adjacent spinous processes in the lumbar spine rubbing against each other and resulting in hypertrophy and sclerosis with focal midline pain and tenderness relieved by flexion and aggravated by extension. </p><h4>Epidemiology</h4><p>It tends to be more common in the elderly<sup> 1</sup>.</p><h4>Clinical presentation</h4><p>Focal midline pain and tenderness relieved by flexion and aggravated by extension.</p><h4>Pathology</h4><p>This process can result in degenerative hypertrophy, inflammatory change (as seen in case 1) and even a pseudoarthrosis with bursa formation. This interspinous bursa may extend between the <a title="Ligamentum flavum" href="/articles/ligamentum-flavum">ligamenta flava</a> in the midline forming an epidural cyst and further contributing to the already existing canal stenosis <sup>2</sup>.</p><p>This condition is usually seen in patients with excessive lordosis of the lumbar spine.</p><h6>Associations</h6><ul>- +<p><strong>Baastrup syndrome</strong> (also referred to as <strong>kissing spines</strong>) results from adjacent spinous processes in the lumbar spine rubbing against each other and resulting in hypertrophy and sclerosis with focal midline pain and tenderness relieved by flexion and aggravated by extension. </p><h4>Epidemiology</h4><p>It tends to be more common in the elderly<sup> 1</sup>.</p><h4>Clinical presentation</h4><p>Focal midline pain and tenderness relieved by flexion and aggravated by extension.</p><h4>Pathology</h4><p>This process can result in degenerative hypertrophy, inflammatory change (as seen in case 1) and even a pseudoarthrosis with bursa formation. This interspinous bursa may extend between the <a href="/articles/ligamentum-flavum">ligamenta flava</a> in the midline forming an epidural cyst and further contributing to the already existing canal stenosis <sup>2</sup>.</p><p>This condition is usually seen in patients with excessive lordosis of the lumbar spine.</p><h6>Associations</h6><ul>
-</ul><h5>MRI</h5><p>May demonstrate interspinous bursal fluid and posterocentral epidural cyst(s). MRI can be very helpful in determining whether there is resulting posterior compression of the thecal sac. </p><h5>FDG-PET/CT</h5><p>May demonstrate FDG-avidity when associated with an inflammatory response such as <a title="Bursitis" href="/articles/bursitis">bursitis</a> <sup>5,6</sup>. The best diagnostic clue for avoiding misinterpretation may be scrutinising sagittal multiplanar reconstructions (MPR) and involvement being limited to spinous processes, which is rare in malignancy <sup>6</sup>. </p><h4>Treatment and prognosis</h4><p>Both conservative and surgical options are available for treatment. Local steroid injection into the interspinous processes will often ease the back pain. Surgical options include <a title="Interspinous processes spacer" href="/articles/interspinous-processes-spacer">interspinous process decompression devices</a> (e.g. Wallis system, X STOP), and steroid/local anaesthetic injection into the bursa.</p><h4>History and etymology</h4><p>It is named after <strong>Christian Ingerslev Baastrup</strong>, Danish radiologist (1855-1950) <sup>3</sup>.</p>- +</ul><h5>MRI</h5><p>May demonstrate interspinous bursal fluid and posterocentral epidural cyst(s). MRI can be very helpful in determining whether there is resulting posterior compression of the thecal sac. </p><h5>FDG-PET/CT</h5><p>May demonstrate FDG-avidity when associated with an inflammatory response such as <a href="/articles/bursitis">bursitis</a> <sup>5,6</sup>. The best diagnostic clue for avoiding misinterpretation may be scrutinising sagittal multiplanar reconstructions (MPR) and involvement being limited to spinous processes, which is rare in malignancy <sup>6</sup>. </p><h4>Treatment and prognosis</h4><p>Both conservative and surgical options are available for treatment. Local steroid injection into the interspinous processes / ligament region could often ease the back pain<sup> 8</sup>. Surgical options include <a href="/articles/interspinous-processes-spacer">interspinous process decompression devices</a> (e.g. Wallis system, X STOP), and steroid/local anaesthetic injection into the bursa.</p><h4>History and etymology</h4><p>It is named after <strong>Christian Ingerslev Baastrup</strong>, Danish radiologist (1855-1950) <sup>3</sup>.</p>
References changed:
- 8. Okada K, Ohtori S, Inoue G, et al. Interspinous Ligament Lidocaine and Steroid Injections for the Management of Baastrup's Disease: A Case Series. (2014) Asian spine journal. 8 (3): 260-6. <a href="https://doi.org/10.4184/asj.2014.8.3.260">doi:10.4184/asj.2014.8.3.260</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/24967039">Pubmed</a> <span class="ref_v4"></span>
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