What is the management of lower lumbar pain using the Bastrup's method (Baastrup's disease)?

From the Guidelines

Management of lower lumbar Baastrup's disease should prioritize conservative treatments, including pain management with NSAIDs, physical therapy, and weight loss, before considering surgical intervention, as recommended by recent guidelines 1. When managing lower lumbar Baastrup's disease, it is essential to consider the patient's overall condition and medical history. Initially, focus on pain management with NSAIDs like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for 1-2 weeks.

• Physical therapy is crucial, emphasizing core strengthening exercises, proper posture training, and lumbar flexion avoidance.
• Weight loss is recommended for overweight patients to reduce spinal load.
• For persistent pain, consider corticosteroid injections between affected spinous processes, such as methylprednisolone (40-80mg) with lidocaine, which may provide relief for several months.
• Activity modification to avoid excessive extension of the lumbar spine is crucial. In cases where conservative management fails after 6-12 months, surgical options include partial spinous process resection or interspinous spacer placement.
• Imaging studies, such as MRI or CT scans, may be necessary to assess the extent of the disease and guide treatment decisions 1.
• It is essential to note that Baastrup's disease occurs when adjacent spinous processes come into contact during extension, causing inflammation and pain, so treatment aims to reduce this contact and associated inflammation while improving spinal stability through muscle strengthening.

From the Research

Lower Lumbar Baastrup Management

• Baastrup's disease is a rare condition of the vertebral column characterized by low back pain arising from the close approximation of adjacent posterior spinous processes and resultant degenerative changes 2, 3, 4.
• The diagnosis of Baastrup's disease rests on clinical examination and detailed imaging studies, including standard and dynamic flexion-extension radiographs, MRI, CT scan, and FDG PET/CT 3, 5.
• Proposed therapies for Baastrup's disease include:
  • Conservative treatment, such as anti-inflammatory drugs and physical therapy 5, 4.
  • Percutaneous infiltrations, such as subcutaneous steroid injections 4.
  • Surgical therapies, such as excision of the bursa or osteotomy 2, 3, 5.
• Baastrup's disease is often underdiagnosed and mistreated due to a lack of knowledge and/or improper diagnostic techniques, leading to frequent mistreatment 2, 4, 6.
• The disease is more common than once believed and is associated with other degenerative disease processes of the spine 6.
• Appreciation of Baastrup's disease and identification on imaging can improve diagnosis and appropriate treatment of associated back pain 6.