The Baastrup syndrome results from adjacent spinous processes in the lumbar spine rubbing against each other and resulting in focal midline pain and tenderness relieved by flexion and aggravated by extension.
It tends to be more common in the elderly.
This process can result in a degenerative hypertrophy, inflammatory change (as seen in case 1) and even a pseudarthrosis with bursa formation. This interspinous bursa may extend between the ligamentum flavae in the midline forming an epidural cyst and further contributing to the already existing canal stenosis 2.
This condition is usually seen patients with excessive lordosis of the lumbar spine.
Plain film and CT
- often shows close approximation and contact of adjacent spinous processes (kissing spines)
- there is resultant enlargement, flattening and reactive sclerosis of apposing interspinous surfaces.
May demonstrate interspinous bursal fluid and a postero-central epidural cyst(s). MRI can be very helpful in determining whether there is resulting posterior compression of the thecal sac.
Both conservative and surgical options are available for treatment. Local steroid injection into the interspinous processes will often ease the back pain. Surgical options include interspinous process decompression devices (e.g, Wallis system, X STOP), and steroid / local anaesthetic injection into the bursa.
It is named after Christian Ingerslev Baastrup, Danish radiologist (1855 - 1950) 1.
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- 1. Christian Ingerslev Baastrup from whonamedit.com, the dictionary of medical eponyms. Christian Ingerslev Baastrup
- 2. Chen CK, Yeh L, Resnick D et-al. Intraspinal posterior epidural cysts associated with Baastrup's disease: report of 10 patients. AJR Am J Roentgenol. 2004;182 (1): 191-4. AJR Am J Roentgenol (full text) - Pubmed citation
- 3. Rutherford EE, Tarplett LJ, Davies EM et-al. Lumbar spine fusion and stabilization: hardware, techniques, and imaging appearances. Radiographics. 27 (6): 1737-49. doi:10.1148/rg.276065205 - Pubmed citation
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