Epidemiology, diagnosis and management of Baastrup's disease: a systematic review

A new classification of lumbar Basstrup's disease based on radiographic and clinical symptoms

OBJECTIVE

To propose a new classification method for lumbar Basstrup's disease based on radiographic and clinical symptoms, and to test its credibility and reproducibility.

METHODS

A retrospective analysis of 116 patients with complete data of lumbar Basstrup's disease in our hospital from January 2019 to January 2022, radiological imaging including X-ray, CT and MRI, were divided into two main types according to the number of segments: type I (single segment) and type II (multiple segments), each type was divided into a total of eight subtypes according to the degree of degeneration: Ia, Ib, Ic, Id, IIa, IIb, IIc, IId; it was further divided into 16 subtypes according to the presence or absence of clinical symptoms (i.e. low back pain or/and lower limb neurological symptoms: no 0, yes 1): Ia0, Ia1, Ib0, Ib1, Ic0, Ic1, Id0, Id1; IIa0, IIa1, IIb0, IIb1, IIc0, IIc1, IId0, IId1.The 116 patients with Basstrup's disease were successively typed twice (1 month interval) by five physicians according to the new classification method, and the reliability and reproducibility of the new classification were assessed using the Kappa consistency test.

RESULTS

Among 116 patients with lumbar Basstrup's disease: there were 60 cases of type I (single segment), accounting for 51.72%, including Ia 19 cases, Ib 16 cases, Ic 10 cases, and Id 15 cases; there were 56 cases of type II (multiple segments), accounting for 48.28%, including IIa 10 cases, IIb 20 cases, IIc 14 cases, and IId 12 cases. Of the 116 patients, 47 cases had no clinical symptoms (Ia0 16 cases, Ib0 3 cases, Ic0 6 cases, Id0 1 case, IIa0 8 cases, IIb0 2 cases, IIc0 10 cases, IId0 1 case), accounting for 40.52%; 69 cases were accompanied by low back pain or/and lower extremity nerve symptoms (Ia1 3 cases, Ib1 13 cases, Ic1 4 cases, Id1 14 cases, IIa1 2 cases, IIb1 18 cases, IIc1 4 cases, IId1 11 cases), accounting for 59.48%.Five physicians completed two rounds of a total of 1160 typings, with inter-assessor typing agreement of 82.47% (80.17-85.34%) and a mean Kappa value of 0.723 (0.771-0.831); intra-assessor typing agreement of 82.76% (77.59-86.21%) and a mean Kappa value of 0.801 (0.742-0.841).

CONCLUSION

The new classification method for lumbar Basstrup's disease based on radiographic and clinical symptoms is simple, practical, with good credibility and reproducibility, and provides some guidance for clinical treatment.

Partial Spinous Process Decompression in Baastrup's Disease: A Case Report and Literature Review

Baastrup's disease represents a frequent, primarily radiological phenomenon on imaging studies of the spine. Nevertheless, it can present as a rare, symptomatically relevant pathology that implies a therapeutic consequence. Yet, there is little evidence and agreement on a consistent treatment strategy in the current literature. Here, we present the case of a 46-year-old man who presented with chronic, persistent midline back pain that was relieved by flexion and aggravated by spinal extension. Extensive imaging studies, including computed tomography, magnetic resonance imaging, and single-photon emission computed tomography confirmed the close approximation of the spinous processes at the levels L4-L5 and L5-S1. Clinically symptomatic isolated Baastrup's disease was confirmed by a local anesthetic infiltration test. As conservative treatment options failed, partial resection of the spinous processes was performed. Conservative treatment, including analgesics and physical therapy, represents the initial treatment approach for Baastrup's disease. When clinical features of Baastrup's disease are present, differential diagnoses have been excluded, and conventional therapy has been exhausted surgical decompression with low surgical risk and good prognosis may be indicated after careful consideration of the indications.