What is Bastrup disease of the lumbar spine?

From the Guidelines

Baastrup disease is a degenerative condition of the lumbar spine where adjacent spinous processes come into close contact, causing localized back pain that can be diagnosed through imaging modalities such as MRI, CT scans, or X-rays, and treated with conservative measures or interventional procedures. The condition typically affects the lower lumbar vertebrae, particularly L4-L5, and is characterized by inflammation and the formation of a pseudoarthrosis between the spinous processes, along with the development of bursitis in the interspinous space 1. According to the American College of Radiology, MRI of the lumbar spine has become the initial imaging modality of choice for patients with subacute or chronic low back pain who have failed 6 weeks of conservative therapy, as it accurately depicts lumbar pathology, including disc degeneration, and the thecal sac and neural structures 1. Some key points to consider in the diagnosis and treatment of Baastrup disease include:

• The use of MRI to identify potential actionable pain generators that could be targeted for intervention or surgery 1
• The importance of conservative therapy, including pharmacologic and nonpharmacologic treatments, such as exercise and remaining active, as first-line treatment for chronic low back pain 1
• The potential benefits of interventional procedures, such as steroid injections, in severe cases that do not respond to conservative treatment
• The role of CT myelography and CT lumbar spine without IV contrast in assessing the patency of the spinal canal and osseous margins, respectively 1. Overall, the goal of treatment for Baastrup disease is to alleviate pain and improve quality of life, and a comprehensive approach that incorporates imaging modalities, conservative measures, and interventional procedures as needed is essential for achieving this goal.

From the Research

Definition and Characteristics of Baastrup's Disease

• 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.
• It is also known as "kissing spine syndrome" due to the close contact of adjacent spinous processes 3, 4.
• The disease usually affects the lumbar spine, with L4-L5 being the most commonly affected level 3, 4.

Diagnosis of Baastrup's Disease

• Diagnosis rests on clinical examination and detailed imaging studies, including standard and dynamic flexion-extension radiographs, MRI, CT scan, and FDG PET/CT 3, 5.
• The hallmark of imaging findings is the close approximation and contact of adjacent spinous processes, with subsequent findings including oedema, cystic lesions, sclerosis, flattening, and enlargement of the articulating surfaces, bursitis, and occasionally epidural cysts or midline epidural fibrotic masses 3.

Symptoms and Treatment of Baastrup's Disease

• Symptoms include back pain with midline distribution that worsens during extension, is relieved during flexion, and is exaggerated upon finger pressure at the level of interest 3, 4.
• Proposed therapies include conservative treatment, percutaneous infiltrations, or surgical therapies such as excision of the bursa or osteotomy 2, 3, 5.
• Anti-inflammatory drugs and physical therapy are also commonly used treatment options 5.