Abstract
Baastrup’s disease or "kissing spines syndrome" was first described as a cause of lumbar pain before computerized tomography (CT) and magnetic resonance imaging (MRI) scanning existed. The diagnosis was based on x-ray studies, which showed that the spinous processes, especially in the lower lumbar spine, became approximated to each other and this was a generator of positional back pain. Biomechanically, the interspinous and supraspinous ligaments that are degenerated in Baastrup's disease normally contribute significantly to sagittal alignment. Ligamentous stenosis and anterolisthesis would be the expected pathology with deterioration of these ligaments and were initially described on CT and MRI in patients with symptoms similar to Baastrup's disease as isolated individual case reports. This review will highlight the relationship between the various clinical presentations, biomechanics, and overlap of Baastrup's disease with interspinous bursitis, segmental stenosis, and instability, presenting them as a disease continuum rather than as separate disease processes.
Highlights
BackgroundBaastrup's disease was first described in 1933 as a cause of postural back pain, which was thought to be related to the adjacent 'kissing' of the spinous processes [1]
Sagittal lumbar computerized tomography (CT) shows the close approximation and common hyperostosis seen with the spinous processes of Baastrup's disease
Et al reviewed 10 cases of posterior dorsal intraspinal cysts and noted concurrent degenerative disc disease and variable degrees of stenosis, spondylolisthesis at or below the level of the cyst with marked facet degeneration, and three patients had facet joint effusions [12]. They concluded that Baastrup's disease is associated with interspinous fluid and if the fluid bursa is large enough it could extend into the posterior epidural space causing canal stenosis
Summary
Baastrup's disease was first described in 1933 as a cause of postural back pain, which was thought to be related to the adjacent 'kissing' of the spinous processes [1]. Incorporating the biomechanics together with the radiologic findings, we hypothesized that repetitive shear due to weakening of the interspinous and supraspinous ligaments leads to the development of interspinal adventitious bursas and cysts, and extension of an inflammatory process within the ligamentum flavum This progressive degenerative process contributes to the frequently observed soft tissue canal stenosis reported in many cases, many patients present initially with localized positional lumbar pain and not neurogenic claudication (Figure 2). Et al reviewed 10 cases of posterior dorsal intraspinal cysts and noted concurrent degenerative disc disease and variable degrees of stenosis, spondylolisthesis at or below the level of the cyst with marked facet degeneration, and three patients had facet joint effusions [12] They concluded that Baastrup's disease is associated with interspinous fluid and if the fluid bursa is large enough it could extend into the posterior epidural space causing canal stenosis. If the patient has only localized postural back pain with extension without any radicular findings or claudication, initial use of simple interspinous infiltration or radiofrequency ablation within the interspinous ligament should be the appropriate initial treatment after failing conservative measures
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