[Radiological manifestations of Baastrup's disease in children]

Baastrup’s Disease in Pediatric Gymnasts

Baastrup’s disease is a rare, often misdiagnosed, and causes back pain in children. It is characterized by degenerative changes of both spinous processes and interspinous soft tissues between two adjacent vertebrae. Repetitive spinal movements in the sagittal plane predispose injury to posterior elements of the spine. Chronic flexion and extension strain the interspinous ligament, causing the neighboring spinous processes to adjoin. Patients typically report midline back pain in the lumbar region, which radiates both cephalad and caudad but not laterally. Pain is aggravated by extension and palpation and is alleviated with flexion. Some children with Baastrup’s do not experience pain but present with swelling along the spinous processes. Diagnosis is dependent on distinctive radiologic findings and exam features. Increased interspinous spaces and bone remodeling may be observed. While the current treatment for pain associated with Baastrup’s is directed towards physical therapy, massage therapy, nonsteroidal anti-inflammatory medications, muscle relaxants, and rest from activity, this is the first report of children undergoing interventional modalities for the treatment of back pain associated with Baastrup’s disease. We present two unique pediatric cases of female gymnasts with Baastrup’s disease who were successfully treated by two different techniques: interspinous ligament injection and medial branch block.

Successful Relief of Back Pain From Baastrup Disease (Kissing Spines) by Interspinous Radiofrequency Lesioning: A Case Report

Baastrup disease is a condition where spinous processes form painful pseudoarticulations. We present a patient with midline axial back pain consistent with Baastrup disease confirmed by computed tomography, which revealed degenerative changes along the opposing surfaces of the spinous processes at L1-2 and L2-3. Local anesthetic and steroid interspinous injections lost their effectiveness over time. She underwent successful interspinous radiofrequency lesioning, which has not been previously described in the literature. At 4 months follow-up, she reported complete pain relief.

Baastrup's disease (kissing spines syndrome): a pictorial review

Abstract

Excessive lordosis is a common finding and may produce mechanical pressure that causes repetitive strains of the interspinous ligament with subsequent degeneration and collapse. Baastrup’s disease (kissing spine syndrome) is a term referring to close approximation of adjacent spinous processes due to degenerative changes of the spine. Baastrup’s disease usually affects the lumbar spine, with L4-L5 being the most commonly affected level. There is higher occurrence at ages over 70 and no gender predilection. 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. Diagnosis rests on clinical examination and imaging studies. The hallmark of imaging findings is the close approximation and contact of adjacent spinous processes, with all the subsequent findings including oedema, cystic lesions, sclerosis, flattening and enlargement of the articulating surfaces, bursitis and occasionally epidural cysts or midline epidural fibrotic masses. Proposed therapies include conservative treatment, percutaneous infiltrations or surgical therapies such as excision of the bursa or osteotomy. The purpose of this study is to illustrate the spectrum of imaging findings in Baastrup’s disease and to emphasise upon including the syndrome in the list of potential causes of low-back pain.

Teaching Points

• Baastrup’s disease refers to close approximation of adjacent spinous processes.

• Diagnosis of Baastrup’s disease is verified with clinical examination and imaging studies.

• Contact of adjacent spinous processes results in oedema, sclerosis, flattening and enlargement.

• Proposed therapies include conservative treatment, percutaneous infiltrations or surgical therapies.