What is the treatment for Baastrups disease?

Treatment for Baastrup's Disease (Kissing Spine Syndrome)

The treatment for Baastrup's disease should begin with conservative measures, including anti-inflammatory medications and physical therapy, progressing to interventional procedures such as steroid injections before considering surgical options for refractory cases. 1, 2, 3

Diagnostic Criteria

Before initiating treatment, confirm the diagnosis with:

• Clinical presentation: Low back pain that worsens with extension and improves with flexion
• Imaging findings: Close approximation of adjacent spinous processes (typically at L4-L5)
• Physical examination: Pain exacerbated by finger pressure at the affected level
• Diagnostic test: Positive response to local anesthetic injection between spinous processes 4

Treatment Algorithm

First-Line Treatment (Conservative Management)

1. Non-pharmacological approaches:

   • Physical therapy focusing on core strengthening
   • Posture correction to reduce excessive lordosis
   • Activity modification to avoid spine extension
   • Heat/cold therapy

2. Pharmacological management:

   • NSAIDs for pain and inflammation
   • Muscle relaxants for associated muscle spasm

Second-Line Treatment (Interventional Procedures)

1. Steroid injections:
   • Subcutaneous or interspinous steroid injections
   • Target: Space between affected spinous processes
   • Frequency: Can be repeated if initial response is positive but temporary 2

Third-Line Treatment (Surgical Options)

For patients with persistent symptoms despite conservative management and injections:

1. Minimally invasive approaches:

   • Full-endoscopic interspinous plasty
     • Resection of marginal osteophytes
     • Removal of inflamed tissue
     • Recovery of physiological gap between spinous processes 4

2. Open surgical options:

   • Excision of the interspinous bursa
   • Partial spinous process resection (osteotomy)
   • Spinal fusion may be considered in cases with associated instability 5

Special Considerations

• Elderly patients: Higher prevalence in patients over 70 years; conservative management should be emphasized
• Associated conditions: When Baastrup's disease coexists with spondylolisthesis or spinal stenosis, treatment should address both conditions 5
• Neurological symptoms: If intraspinal synovial cysts are present causing neurogenic claudication, surgical decompression may be necessary

Treatment Efficacy

• Conservative treatment and steroid injections provide significant relief in many patients
• Full-endoscopic interspinous plasty has shown promising results with VAS score improvements from 7-8 to 1-2 and ODI improvements from >70% to approximately 30% 4
• Surgical interventions should be reserved for cases refractory to conservative management

Monitoring and Follow-up

• Regular assessment of pain levels and functional status
• Follow-up imaging to evaluate structural changes and potential recurrence
• Continued home exercise program to maintain core strength and proper posture

The management of Baastrup's disease requires a stepwise approach, starting with conservative measures and progressing to more invasive options only when necessary to improve quality of life and reduce morbidity.