Three cases of L4–5 Baastrup’s disease due to L5–S1 spondylolytic spondylolisthesis

Abstract

Baastrup's disease is characterized by degeneration of spinous processes and interspinous soft tissue, which may cause spinal stenosis. Purpose of this article is to report the possible new cause of Baastrup's disease and result of surgical treatments. Authors treated three cases of Baastrup's disease on L4-L5 with L5-S1 spondylolytic listhesis. Conservative treatment did not relieve the pain; therefore, surgical treatments were planned according to each specific disease condition. In one case, anterior lumbar interbody fusion of L5-S1 was performed, and after surgery, the size of epidural cyst on L4-L5 was decreased. L4-L5 bilateral laminectomy was performed to directly decompress posterior epidural cyst in a case with stable L5-S1 spondylolytic listhesis. In last case, facet joints and spinous process were removed by L5-S1 posterior lumbar interbody fusion (PLIF) surgery. After the surgery, patients' back and leg pain was improved and postoperative MRI revealed successful decompression of the spinal canal. Improvement in back and leg symptoms was noted at 12-month follow-up. Baastrup's disease at the L4-L5 level may have developed from the instability caused by L5-S1 spondylolytic spondylolisthesis. Viable treatment options include the fusion of L5-S1 or a laminectomy at the L4-L5 level.