Baastrup’s Disease: An Often Missed Etiology for Back Pain
Identifieur interne : 000040 ( Pmc/Corpus ); précédent : 000039; suivant : 000041Baastrup’s Disease: An Often Missed Etiology for Back Pain
Auteurs :Source :
- Cureus [ 2168-8184 ] ; ????.
Abstract
Baastrup’s disease is a relatively common disorder of the vertebral column, characterized by low back pain arising from the close approximation of adjacent posterior spinous processes and resultant degenerative changes, most commonly at L4-L5. Though fairly common, Baastrup’s disease is overwhelmingly underdiagnosed and often missed due to a lack of knowledge and/or improper diagnostic techniques, leading to frequent mistreatment. We present a case of a 56-year-old man who presented with chronic, ongoing low back pain of several years duration. His pain was relieved by flexion of the spine, and aggravated by extension. Imaging studies revealed “kissing” posterior spinous processes, consistent with a diagnosis of Baastrup’s Disease. He was treated with subcutaneous steroid injections and showed considerable clinical improvement.
Url:
DOI: 10.7759/cureus.465
PubMed: 26929892
PubMed Central: 4762769
Links to Exploration step
PMC:4762769Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Baastrup’s Disease: An Often Missed Etiology for Back Pain</title></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">26929892</idno><idno type="pmc">4762769</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4762769</idno><idno type="RBID">PMC:4762769</idno><idno type="doi">10.7759/cureus.465</idno><date when="????">????</date><idno type="wicri:Area/Pmc/Corpus">000040</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000040</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Baastrup’s Disease: An Often Missed Etiology for Back Pain</title></analytic><series><title level="j">Cureus</title><idno type="eISSN">2168-8184</idno><imprint><date when="????">????</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Baastrup’s disease is a relatively common disorder of the vertebral column, characterized by low back pain arising from the close approximation of adjacent posterior spinous processes and resultant degenerative changes, most commonly at L4-L5. Though fairly common, Baastrup’s disease is overwhelmingly underdiagnosed and often missed due to a lack of knowledge and/or improper diagnostic techniques, leading to frequent mistreatment. We present a case of a 56-year-old man who presented with chronic, ongoing low back pain of several years duration. His pain was relieved by flexion of the spine, and aggravated by extension. Imaging studies revealed “kissing” posterior spinous processes, consistent with a diagnosis of Baastrup’s Disease. He was treated with subcutaneous steroid injections and showed considerable clinical improvement.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Baastrup, C" uniqKey="Baastrup C">C Baastrup</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Filippiadis, Dk" uniqKey="Filippiadis D">DK Filippiadis</name></author><author><name sortKey="Mazioti, A" uniqKey="Mazioti A">A Mazioti</name></author><author><name sortKey="Argentos, S" uniqKey="Argentos S">S Argentos</name></author><author><name sortKey="Anselmetti, G" uniqKey="Anselmetti G">G Anselmetti</name></author><author><name sortKey="Papakonstantinou, O" uniqKey="Papakonstantinou O">O Papakonstantinou</name></author><author><name sortKey="Kelekis, N" uniqKey="Kelekis N">N Kelekis</name></author><author><name sortKey="Kelekis, A" uniqKey="Kelekis A">A Kelekis</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Clifford, Pd" uniqKey="Clifford P">PD Clifford</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bywaters, Eg" uniqKey="Bywaters E">EG Bywaters</name></author><author><name sortKey="Evans, S" uniqKey="Evans S">S Evans</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kwong, Y" uniqKey="Kwong Y">Y Kwong</name></author><author><name sortKey="Rao, N" uniqKey="Rao N">N Rao</name></author><author><name sortKey="Latief, K" uniqKey="Latief K">K Latief</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Farinha, F" uniqKey="Farinha F">F Farinha</name></author><author><name sortKey="Rainho, C" uniqKey="Rainho C">C Raínho</name></author><author><name sortKey="Cunha, I" uniqKey="Cunha I">I Cunha</name></author><author><name sortKey="Barcelos, A" uniqKey="Barcelos A">A Barcelos</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Singla, A" uniqKey="Singla A">A Singla</name></author><author><name sortKey="Shankar, V" uniqKey="Shankar V">V Shankar</name></author><author><name sortKey="Mittal, S" uniqKey="Mittal S">S Mittal</name></author><author><name sortKey="Agarwal, A" uniqKey="Agarwal A">A Agarwal</name></author><author><name sortKey="Garg, B" uniqKey="Garg B">B Garg</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rajasekaran, S" uniqKey="Rajasekaran S">S Rajasekaran</name></author><author><name sortKey="Pithwa, Yk" uniqKey="Pithwa Y">YK Pithwa</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Depalma, Mj" uniqKey="Depalma M">MJ DePalma</name></author><author><name sortKey="Slipman, Cw" uniqKey="Slipman C">CW Slipman</name></author><author><name sortKey="Siegelman, E" uniqKey="Siegelman E">E Siegelman</name></author><author><name sortKey="Bayruns, Tj" uniqKey="Bayruns T">TJ Bayruns</name></author><author><name sortKey="Bhargava, A" uniqKey="Bhargava A">A Bhargava</name></author><author><name sortKey="Frey, Me" uniqKey="Frey M">ME Frey</name></author><author><name sortKey="Chin, Kr" uniqKey="Chin K">KR Chin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mann, Dc" uniqKey="Mann D">DC Mann</name></author><author><name sortKey="Keene, Js" uniqKey="Keene J">JS Keene</name></author><author><name sortKey="Drummond, Ds" uniqKey="Drummond D">DS Drummond</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Maes, R" uniqKey="Maes R">R Maes</name></author><author><name sortKey="Morrison, Wb" uniqKey="Morrison W">WB Morrison</name></author><author><name sortKey="Parker, L" uniqKey="Parker L">L Parker</name></author><author><name sortKey="Schweitzer, Me" uniqKey="Schweitzer M">ME Schweitzer</name></author><author><name sortKey="Carrino, Ja" uniqKey="Carrino J">JA Carrino</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kacki, S" uniqKey="Kacki S">S Kacki</name></author><author><name sortKey="Villotte, S" uniqKey="Villotte S">S Villotte</name></author><author><name sortKey="Knusel, Cj" uniqKey="Knusel C">CJ Knüsel</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Jang, Ec" uniqKey="Jang E">EC Jang</name></author><author><name sortKey="Song, Ks" uniqKey="Song K">KS Song</name></author><author><name sortKey="Lee, Hj" uniqKey="Lee H">HJ Lee</name></author><author><name sortKey="Kim, Jy" uniqKey="Kim J">JY Kim</name></author><author><name sortKey="Yang, Jj" uniqKey="Yang J">JJ Yang</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chen, Ck" uniqKey="Chen C">CK Chen</name></author><author><name sortKey="Yeh, L" uniqKey="Yeh L">L Yeh</name></author><author><name sortKey="Resnick, D" uniqKey="Resnick D">D Resnick</name></author><author><name sortKey="Lai, Ph" uniqKey="Lai P">PH Lai</name></author><author><name sortKey="Liang, Hl" uniqKey="Liang H">HL Liang</name></author><author><name sortKey="Pan, Hb" uniqKey="Pan H">HB Pan</name></author><author><name sortKey="Yang, Cf" uniqKey="Yang C">CF Yang</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Beks, Jw" uniqKey="Beks J">JW Beks</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lamer, Tj" uniqKey="Lamer T">TJ Lamer</name></author><author><name sortKey="Tiede, Jm" uniqKey="Tiede J">JM Tiede</name></author><author><name sortKey="Fenton, Ds" uniqKey="Fenton D">DS Fenton</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mitra, R" uniqKey="Mitra R">R Mitra</name></author><author><name sortKey="Ghazi, U" uniqKey="Ghazi U">U Ghazi</name></author><author><name sortKey="Kirpalani, D" uniqKey="Kirpalani D">D Kirpalani</name></author><author><name sortKey="Cheng, I" uniqKey="Cheng I">I Cheng</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Okada, K" uniqKey="Okada K">K Okada</name></author><author><name sortKey="Ohtori, S" uniqKey="Ohtori S">S Ohtori</name></author><author><name sortKey="Inoue, G" uniqKey="Inoue G">G Inoue</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Barz, T" uniqKey="Barz T">T Barz</name></author><author><name sortKey="Melloh, M" uniqKey="Melloh M">M Melloh</name></author><author><name sortKey="Lord, Sj" uniqKey="Lord S">SJ Lord</name></author><author><name sortKey="Kasch, R" uniqKey="Kasch R">R Kasch</name></author><author><name sortKey="Merk, Hr" uniqKey="Merk H">HR Merk</name></author><author><name sortKey="Staub, Lp" uniqKey="Staub L">LP Staub</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="case-report"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Cureus</journal-id><journal-id journal-id-type="iso-abbrev">Cureus</journal-id><journal-id journal-id-type="issn">2168-8184</journal-id><journal-title-group><journal-title>Cureus</journal-title></journal-title-group><issn pub-type="epub">2168-8184</issn><publisher><publisher-name>Cureus</publisher-name><publisher-loc>Palo Alto (CA)</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">26929892</article-id><article-id pub-id-type="pmc">4762769</article-id><article-id pub-id-type="doi">10.7759/cureus.465</article-id><article-categories><subj-group subj-group-type="heading"><subject>Orthopedics</subject></subj-group><subj-group><subject>Physical Medicine & Rehabilitation</subject></subj-group><subj-group><subject>Neurosurgery</subject></subj-group></article-categories><title-group><article-title>Baastrup’s Disease: An Often Missed Etiology for Back Pain</article-title></title-group><contrib-group><contrib contrib-type="editor"><name><surname>Muacevic</surname><given-names>Alexander</given-names></name></contrib><contrib contrib-type="editor"><name><surname>Adler</surname><given-names>John R</given-names></name></contrib></contrib-group><contrib-group><contrib contrib-type="author"><name><surname>Philipp</surname><given-names>Lucas R</given-names></name><xref ref-type="aff" rid="aff-28383">1</xref></contrib><contrib contrib-type="author" corresp="yes"><name><surname>Baum</surname><given-names>Griffin R</given-names></name><xref ref-type="aff" rid="aff-28383">1</xref></contrib><contrib contrib-type="author"><name><surname>Grossberg</surname><given-names>Jonathan A</given-names></name><xref ref-type="aff" rid="aff-28383">1</xref></contrib><contrib contrib-type="author"><name><surname>Ahmad</surname><given-names>Faiz U</given-names></name><xref ref-type="aff" rid="aff-28383">1</xref></contrib></contrib-group><aff id="aff-28383"><label>1</label> Department of Neurological Surgery, Emory University School of Medicine</aff><author-notes><corresp id="cor1">Griffin R. Baum <email>gbaum@emory.edu</email></corresp></author-notes><pub-date date-type="pub" publication-format="electronic"><day>22</day><month>1</month><year>2016</year></pub-date><pub-date date-type="collection" publication-format="electronic"><month>1</month><year>2016</year></pub-date><volume>8</volume><issue>1</issue><elocation-id>e465</elocation-id><history><date date-type="received"><day>4</day><month>12</month><year>2015</year></date><date date-type="accepted"><day>22</day><month>1</month><year>2016</year></date></history><permissions><copyright-statement>Copyright © 2016, Philipp et al.</copyright-statement><copyright-year>2016</copyright-year><copyright-holder>Philipp et al.</copyright-holder><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/3.0/"><license-p>This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</license-p></license></permissions><self-uri xlink:href="http://cureus.com/articles/3982-baastrups-disease-an-often-missed-etiology-for-back-pain">This article is available from http://cureus.com/articles/3982-baastrups-disease-an-often-missed-etiology-for-back-pain</self-uri><abstract><p>Baastrup’s disease is a relatively common disorder of the vertebral column, characterized by low back pain arising from the close approximation of adjacent posterior spinous processes and resultant degenerative changes, most commonly at L4-L5. Though fairly common, Baastrup’s disease is overwhelmingly underdiagnosed and often missed due to a lack of knowledge and/or improper diagnostic techniques, leading to frequent mistreatment. We present a case of a 56-year-old man who presented with chronic, ongoing low back pain of several years duration. His pain was relieved by flexion of the spine, and aggravated by extension. Imaging studies revealed “kissing” posterior spinous processes, consistent with a diagnosis of Baastrup’s Disease. He was treated with subcutaneous steroid injections and showed considerable clinical improvement.</p></abstract><kwd-group kwd-group-type="author"><kwd>back pain</kwd><kwd>baastrup's disease</kwd></kwd-group></article-meta><notes><p content-type="disclaimer">The content published in Cureus is the result of clinical experience and/or research by independent individuals or organizations. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein. All content published within Cureus is intended only for educational, research and reference purposes. Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional. Do not disregard or avoid professional medical advice due to content published within Cureus.</p></notes></front><body><sec sec-type="intro"><title>Introduction</title><p>Baastrup’s Disease (Baastrup syndrome) is a relatively common pathology affecting the vertebral column. First formally described by Christian Ingerslev Baastrup in 1933, the disorder is characterized by the close approximation and contact of the spinous processes of adjacent vertebrae in the setting of degenerative spine disease [<xref rid="REF1" ref-type="bibr">1</xref>-<xref rid="REF2" ref-type="bibr">2</xref>]. As a product of the radiological findings of this process, the syndrome is often referred to as the “kissing spine” syndrome. The impingement of these hypertrophied spinous processes may yield a reactive sclerosis, remodeling, and further spinal degeneration [<xref rid="REF3" ref-type="bibr">3</xref>]. Academically, Baastrup’s Disease is a well-documented cause of low back pain, with some studies reporting an incidence as high as 81% in patients older than 80 years, though the actual prevalence is unknown [<xref rid="REF4" ref-type="bibr">4</xref>-<xref rid="REF5" ref-type="bibr">5</xref>]. Although it is by no means a rare disorder, Baastrup syndrome is frequently missed by clinicians due to lack of knowledge or poor imaging technique. As a result, this relatively common pathology is largely underdiagnosed and subsequently mistreated [<xref rid="REF6" ref-type="bibr">6</xref>-<xref rid="REF7" ref-type="bibr">7</xref>].</p><p>Here, we present a case of a 56-year-old man with a chief complaint of low back pain of several years duration. Through this case, we attempt to illustrate the characteristic features of Baastrup’s disease in its clinical presentation and key diagnostic findings. With consideration of the information presented herein, it is our hope to further educate the medical and academic community regarding this highly prevalent, commonly misdiagnosed, and erroneously treated condition. </p></sec><sec><title>Case presentation</title><p>The patient is a 56-year-old man who presented with chronic, ongoing, low back pain of several years duration. The pain was predominately axial in nature, with intermittent radiation in a craniocaudal fashion along the paraspinal regions. His pain was markedly worsened with extension of the back and improved with flexion. Pain limited his ability to extend his lumbar spine. It did not radiate to the legs, and there was no associated weakness, numbness, or bladder/bowel complaints.</p><p>His past medical history included psoriasis and hypertension, and his past surgical history included a cholecystectomy and sacroiliac iliac joint injections for arthritis.</p><p>The differential diagnosis included lumbar spondylosis, degenerative disc disease, herniated nucleus pulposus, and spinal stenosis. History and physical exam, however, provided sufficient information to effectively rule out several of these diagnoses.</p><p>On physical exam, he was neurologically intact, with no focal neurologic defects. Our patient had no leg pain or weakness, no radiation along peripheral nerve distributions, and no sensory deficits or paresthesias. There was mild to moderate tenderness in the midline in the lower back, with limited ability to extend at the spine. Baastrup’s disease became the most likely diagnosis when considering the relief of pain with flexion, and exacerbation with extension of the spine.</p><p>Ultimately, imaging studies confirmed our clinical suspicion. CT scan revealed mild, lumbar spondylosis with prominent and hypertrophic spinous processes that were touching each other with adjacent sclerosis (Figure <xref ref-type="fig" rid="FIG1">1</xref>).</p><p><fig fig-type="figure" id="FIG1" orientation="portrait" position="float"><label>Figure 1</label><caption><title>Radiographic findings on plain film and CT</title><p>Mild lumbar spondylosis with prominent, hypertrophic spinous processes, contacting one another between L3 and L5 with adjacent sclerosis.</p></caption><graphic xlink:href="cureus-0008-000000000465-i01"></graphic></fig></p><p>MRI corroborated these findings, with sclerotic and hypertrophic “kissing” spinous processes from L2 to L5, with mild L5-S1 facet hypertrophy (Figure <xref ref-type="fig" rid="FIG2">2</xref>). There was no significant spinal canal or neural foraminal stenosis. The patient was treated with steroid injections under fluoroscopic guidance with marked symptomatic relief.</p><p><fig fig-type="figure" id="FIG2" orientation="portrait" position="float"><label>Figure 2</label><caption><title>Radiographic findings on MRI</title><p>T1 (A) and T2 (B) weighted imaging showing sclerotic and hypertrophic “kissing” spinous processes from L2 to L5, with mild L5-S1 facet hypertrophy</p></caption><graphic xlink:href="cureus-0008-000000000465-i02"></graphic></fig></p></sec><sec sec-type="discussion"><title>Discussion</title><p>Baastrup’s disease—“kissing spine disease”—is a relatively common disorder of the vertebral column, characterized by low back pain arising from the close approximation of adjacent, posterior spinous processes and resultant degenerative changes.</p><p>The disease most often affects the lumbar spine between L4-L5, and in the majority of cases only involves a single level [<xref rid="REF5" ref-type="bibr">5</xref>]. Chronic contact between spinous processes may induce osseous hypertrophy and eburnation at this pathological joint. Repetitive shear force at the opposing surfaces can yield further architectural distortion and sclerosis, and contribute to the formation of interspinal adventitial bursae and cysts. Extension of this inflammation through the ligamentum flavum may also contribute to central canal stenosis [<xref rid="REF3" ref-type="bibr">3</xref>,<xref rid="REF8" ref-type="bibr">8</xref>].</p><p>Though it has been documented as arising idiopathically and independent of other pathology [<xref rid="REF2" ref-type="bibr">2</xref>,<xref rid="REF9" ref-type="bibr">9</xref>], the changes seen in Baastrup’s syndrome are typically associated with other degenerative elements including degenerative disc disease with loss of disc height, spondylolisthesis, and spondylosis [<xref rid="REF5" ref-type="bibr">5</xref>]. As intuition may suggest, these changes are most frequently seen in elderly patients, owing to the repetitive strain and mechanical pressure produced by excessive lordosis; persistent strain on the interspinous ligament may consequentially yield further degeneration and collapse [<xref rid="REF2" ref-type="bibr">2</xref>,<xref rid="REF4" ref-type="bibr">4</xref>-<xref rid="REF5" ref-type="bibr">5</xref>]. Additionally, as a product of repetitive spinal flexion and extension, Baastrup’s syndrome has been seen clinically in 6.3% of college athletes, most notably gymnasts [<xref rid="REF10" ref-type="bibr">10</xref>]. For this reason, it is important to consider Baastrup’s syndrome in vulnerable populations who lie outside of the anticipated age demographic for degenerative spine disease.</p><p>Other documented etiologies include poor posture and traumatic injury. Any condition which contributes to excessive lordosis may also produce Baastrup’s syndrome including kyphoscoliosis, tuberculous spondylitis, stiff thoracolumbar transition, obesity, and bilateral forms of congenital hip dislocation [<xref rid="REF2" ref-type="bibr">2</xref>,<xref rid="REF5" ref-type="bibr">5</xref>,<xref rid="REF11" ref-type="bibr">11</xref>].</p><p>The initial clinical presentation of the disorder is most often characterized by low back pain, and although rarely, the cervical spine may be involved [<xref rid="REF2" ref-type="bibr">2</xref>,<xref rid="REF12" ref-type="bibr">12</xref>]. The pain is described as midline, in the lumbar region, and with radiation along the spine but not laterally. Symptoms are relieved with spinal flexion and aggravated by extension, and the pain can be elicited clinically by palpation of the affected interspinous space. In the setting of secondary central canal disease, leg pain and weakness have been described with standing or walking in a fashion consistent with neurogenic claudication [<xref rid="REF2" ref-type="bibr">2</xref>,<xref rid="REF8" ref-type="bibr">8</xref>,<xref rid="REF13" ref-type="bibr">13</xref>]. Clinical maneuvers which passively or actively extend the lumbar spine are useful in reproducing symptoms.</p><p>Diagnosis is dependent upon characteristic findings on imaging studies. The ‘kissing’ of closely approximated spinous processes can often be seen on lateral plain film X-rays, sometimes with visible sclerosis of the articulating surfaces [<xref rid="REF3" ref-type="bibr">3</xref>]. Computed Tomography is suitable for visualizing these bony changes and may also show generalized degenerative changes in greater detail; however, neither CT nor plain films are suitable for demonstrating pathological changes in the soft tissues of the spine. Frequently, Baastrup’s disease is missed due to lack of knowledge and overexposure of the spinous processes [<xref rid="REF7" ref-type="bibr">7</xref>].</p><p>MRI is the most sensitive imaging modality for detecting Baastrup’s disease and may do so much earlier in the disease course. It has been noted that interspinous bursitis may precede the more pronounced osseous changes of the spinous processes, which MRI is the best suited for detecting [<xref rid="REF3" ref-type="bibr">3</xref>]. The bursae appear as bright, high-intensity areas on T2-weighted MRI, between posterior spinous processes. Additionally, MRI may show reactive sclerosis and hypertrophy of the spinous processes--which may have flattened and enlarged articulating surfaces, may show associated edema at the level of the interspinous ligament, and provides insight into the degree to which the posterior thecal sac is compressed [<xref rid="REF11" ref-type="bibr">11</xref>,<xref rid="REF14" ref-type="bibr">14</xref>].</p><p>Treatment of Baastrup’s syndrome is an ongoing topic of debate. Traditionally, surgical techniques have been employed including excision of the bursae and osteotomy to shorten the offending spinous processes [<xref rid="REF2" ref-type="bibr">2</xref>]. Other studies suggest that these osteotomy-only techniques are ineffective in relieving symptoms [<xref rid="REF15" ref-type="bibr">15</xref>]. The use of interlaminar stabilization devices has not been investigated in patients with Baastrup's disease, but could be paired with an osteotomy procedure. Alternatively, percutaneous injections of long-acting corticosteroids and sometimes local anesthetics have been used to treat inflammation and pain [<xref rid="REF16" ref-type="bibr">16</xref>-<xref rid="REF18" ref-type="bibr">18</xref>]. Results have shown significant improvement in pain scores at over one year following treatment [<xref rid="REF18" ref-type="bibr">18</xref>]. Physical therapy also plays an important role in the long-term management of Baastrup’s syndrome and focuses on reducing interspinous strain and lordosis.</p><p>Baastrup’s disease is underdiagnosed and often missed, resulting in incorrect treatment. Some studies have suggested that Baastrup’s disease may not be mutually exclusive from other causes of degenerative spine disease, and multiple pathologies may coexist simultaneously [<xref rid="REF7" ref-type="bibr">7</xref>,<xref rid="REF11" ref-type="bibr">11</xref>]. Furthermore, degeneration of one anatomical component of the spine may induce degeneration of other spinal elements [<xref rid="REF19" ref-type="bibr">19</xref>]. Although the most common primary pathologies responsible for low back pain are intervertebral discs and facet joints, it is important to consider spinal elements lying outside of the vertebral bodies when generating a differential diagnosis for axial back pain.</p></sec><sec sec-type="conclusions"><title>Conclusions</title><p>Careful clinical evaluation of patients and critical analysis of imaging studies are necessary for the correct diagnosis and subsequent treatment of all causes of low back pain. Baastrup’s disease is characterized by “kissing” posterior spinous processes of the spine, resulting in pain with spinal extension, morphological changes of the vertebrae, and further spinal degeneration as best seen on MRI. Though this condition is presumed to be a relatively common etiology for low back pain, it is overwhelmingly underdiagnosed and often missed due to a lack of knowledge and/or improper diagnostic techniques. As such, these individuals are frequently mistreated and may undergo unnecessary procedures which are ineffective in addressing the underlying etiology of their pain. Clinically, the pain resulting from Baastrup’s disease is relieved by flexion of the spine and aggravated by extension of the spine or palpation. Treatment remains a subject of debate, though percutaneous corticosteroid injections have been shown to be beneficial for symptom relief. </p></sec></body><back><fn-group content-type="competing-interests"><fn fn-type="conflict"><p>The authors have declared that no competing interests exist.</p></fn></fn-group><fn-group content-type="other"><title>Human Ethics</title><fn fn-type="other"><p>Emory University Institutional Review Board issued approval IRB00071441</p></fn></fn-group><ref-list><title>References</title><ref id="REF1"><label>1</label><element-citation publication-type="journal"><article-title>On the Spinous Processes of the Lumbar Vertebrae and the Soft Tissues Between them, and on Pathological Changes in that Region</article-title><source>Acta Radiologica</source><person-group><name><surname>Baastrup</surname><given-names>C</given-names></name></person-group><fpage>52</fpage><lpage>55</lpage><volume>14</volume><year>1933</year></element-citation></ref><ref id="REF2"><label>2</label><element-citation publication-type="journal"><article-title>Baastrup’s disease (kissing spines syndrome): a pictorial review</article-title><source>Insights Imaging</source><person-group><name><surname>Filippiadis</surname><given-names>DK</given-names></name><name><surname>Mazioti</surname><given-names>A</given-names></name><name><surname>Argentos</surname><given-names>S</given-names></name><name><surname>Anselmetti</surname><given-names>G</given-names></name><name><surname>Papakonstantinou</surname><given-names>O</given-names></name><name><surname>Kelekis</surname><given-names>N</given-names></name><name><surname>Kelekis</surname><given-names>A</given-names></name></person-group><fpage>123</fpage><lpage>128</lpage><volume>6</volume><year>2015</year><pub-id pub-id-type="pmid">25582088</pub-id></element-citation></ref><ref id="REF3"><label>3</label><element-citation publication-type="book"><article-title>Baastrup disease</article-title><source>Am J Orthop</source><person-group><name><surname>Clifford</surname><given-names>PD</given-names></name></person-group><fpage>560</fpage><lpage>561</lpage><publisher-loc>New Jersey</publisher-loc><publisher-name>Belle Meade</publisher-name><volume>36</volume><year>2007</year><pub-id pub-id-type="pmid">18033570</pub-id></element-citation></ref><ref id="REF4"><label>4</label><element-citation publication-type="journal"><article-title>The lumbar interspinous bursae and Baastrup’s syndrome. An autopsy study</article-title><source>Rheumatol Int</source><person-group><name><surname>Bywaters</surname><given-names>EG</given-names></name><name><surname>Evans</surname><given-names>S</given-names></name></person-group><fpage>87</fpage><lpage>96</lpage><volume>2</volume><year>1982</year><pub-id pub-id-type="pmid">7178764</pub-id></element-citation></ref><ref id="REF5"><label>5</label><element-citation publication-type="journal"><article-title>MDCT findings in Baastrup disease: disease or normal feature of the aging spine?</article-title><source>AJR Am J Roentgenol</source><person-group><name><surname>Kwong</surname><given-names>Y</given-names></name><name><surname>Rao</surname><given-names>N</given-names></name><name><surname>Latief</surname><given-names>K</given-names></name></person-group><fpage>1156</fpage><lpage>1159</lpage><volume>196</volume><year>2011</year><pub-id pub-id-type="pmid">21512085</pub-id></element-citation></ref><ref id="REF6"><label>6</label><element-citation publication-type="journal"><article-title>Baastrup’s Disease: a poorly recognised cause of back pain</article-title><source>Acta Reumatol Port</source><person-group><name><surname>Farinha</surname><given-names>F</given-names></name><name><surname>Raínho</surname><given-names>C</given-names></name><name><surname>Cunha</surname><given-names>I</given-names></name><name><surname>Barcelos</surname><given-names>A</given-names></name></person-group><fpage>302</fpage><lpage>303</lpage><volume>40</volume><year>2015</year><pub-id pub-id-type="pmid">25782695</pub-id></element-citation></ref><ref id="REF7"><label>7</label><element-citation publication-type="journal"><article-title>Baastrup’s disease: The kissing spine</article-title><source>World J Clin Cases</source><person-group><name><surname>Singla</surname><given-names>A</given-names></name><name><surname>Shankar</surname><given-names>V</given-names></name><name><surname>Mittal</surname><given-names>S</given-names></name><name><surname>Agarwal</surname><given-names>A</given-names></name><name><surname>Garg</surname><given-names>B</given-names></name></person-group><fpage>45</fpage><lpage>47</lpage><volume>2</volume><year>2014</year><pub-id pub-id-type="pmid">24579072</pub-id></element-citation></ref><ref id="REF8"><label>8</label><element-citation publication-type="journal"><article-title>Baastrup’s disease as a cause of neurogenic claudication: a case report</article-title><source>Spine</source><person-group><name><surname>Rajasekaran</surname><given-names>S</given-names></name><name><surname>Pithwa</surname><given-names>YK</given-names></name></person-group><fpage>273</fpage><lpage>275</lpage><volume>28</volume><year>2003</year></element-citation></ref><ref id="REF9"><label>9</label><element-citation publication-type="journal"><article-title>Interspinous bursitis in an athlete</article-title><source>J Bone Joint Surg Br</source><person-group><name><surname>DePalma</surname><given-names>MJ</given-names></name><name><surname>Slipman</surname><given-names>CW</given-names></name><name><surname>Siegelman</surname><given-names>E</given-names></name><name><surname>Bayruns</surname><given-names>TJ</given-names></name><name><surname>Bhargava</surname><given-names>A</given-names></name><name><surname>Frey</surname><given-names>ME</given-names></name><name><surname>Chin</surname><given-names>KR</given-names></name></person-group><fpage>1062</fpage><lpage>1064</lpage><volume>86</volume><year>2004</year><pub-id pub-id-type="pmid">15446539</pub-id></element-citation></ref><ref id="REF10"><label>10</label><element-citation publication-type="journal"><article-title>Unusual causes of back pain in athletes</article-title><source>J Spinal Disord</source><person-group><name><surname>Mann</surname><given-names>DC</given-names></name><name><surname>Keene</surname><given-names>JS</given-names></name><name><surname>Drummond</surname><given-names>DS</given-names></name></person-group><fpage>337</fpage><lpage>343</lpage><volume>4</volume><year>1991</year><pub-id pub-id-type="pmid">1839364</pub-id></element-citation></ref><ref id="REF11"><label>11</label><element-citation publication-type="journal"><article-title>Lumbar interspinous bursitis (Baastrup disease) in a symptomatic population: prevalence on magnetic resonance imaging</article-title><source>Spine</source><person-group><name><surname>Maes</surname><given-names>R</given-names></name><name><surname>Morrison</surname><given-names>WB</given-names></name><name><surname>Parker</surname><given-names>L</given-names></name><name><surname>Schweitzer</surname><given-names>ME</given-names></name><name><surname>Carrino</surname><given-names>JA</given-names></name></person-group><fpage>211</fpage><lpage>215</lpage><volume>33</volume><year>2008</year></element-citation></ref><ref id="REF12"><label>12</label><element-citation publication-type="journal"><article-title>Baastrup’s sign (kissing spines): A neglected condition in paleopathology</article-title><source>International J Paleopathol</source><person-group><name><surname>Kacki</surname><given-names>S</given-names></name><name><surname>Villotte</surname><given-names>S</given-names></name><name><surname>Knüsel</surname><given-names>CJ</given-names></name></person-group><fpage>104</fpage><lpage>110</lpage><volume>1</volume><year>2011</year></element-citation></ref><ref id="REF13"><label>13</label><element-citation publication-type="journal"><article-title>Posterior epidural fibrotic mass associated with Baastrup’s disease</article-title><source>Eur Spine J</source><person-group><name><surname>Jang</surname><given-names>EC</given-names></name><name><surname>Song</surname><given-names>KS</given-names></name><name><surname>Lee</surname><given-names>HJ</given-names></name><name><surname>Kim</surname><given-names>JY</given-names></name><name><surname>Yang</surname><given-names>JJ</given-names></name></person-group><fpage>165</fpage><lpage>168</lpage><volume>19</volume><year>2010</year></element-citation></ref><ref id="REF14"><label>14</label><element-citation publication-type="journal"><article-title>Intraspinal posterior epidural cysts associated with Baastrup’s disease: report of 10 patients</article-title><source>AJR Am J Roentgenol</source><person-group><name><surname>Chen</surname><given-names>CK</given-names></name><name><surname>Yeh</surname><given-names>L</given-names></name><name><surname>Resnick</surname><given-names>D</given-names></name><name><surname>Lai</surname><given-names>PH</given-names></name><name><surname>Liang</surname><given-names>HL</given-names></name><name><surname>Pan</surname><given-names>HB</given-names></name><name><surname>Yang</surname><given-names>CF</given-names></name></person-group><fpage>191</fpage><lpage>194</lpage><volume>182</volume><year>2004</year><pub-id pub-id-type="pmid">14684538</pub-id></element-citation></ref><ref id="REF15"><label>15</label><element-citation publication-type="journal"><article-title>Kissing spines: fact or fancy?</article-title><source>Acta Neurochir</source><person-group><name><surname>Beks</surname><given-names>JW</given-names></name></person-group><fpage>134</fpage><lpage>135</lpage><volume>100</volume><year>1989</year><pub-id pub-id-type="pmid">2589119</pub-id></element-citation></ref><ref id="REF16"><label>16</label><element-citation publication-type="journal"><article-title>Fluoroscopically-guided injections to treat “kissing spine” disease</article-title><source>Pain Physician</source><person-group><name><surname>Lamer</surname><given-names>TJ</given-names></name><name><surname>Tiede</surname><given-names>JM</given-names></name><name><surname>Fenton</surname><given-names>DS</given-names></name></person-group><fpage>549</fpage><lpage>554</lpage><volume>11</volume><year>2008</year><pub-id pub-id-type="pmid">18690283</pub-id></element-citation></ref><ref id="REF17"><label>17</label><element-citation publication-type="journal"><article-title>Interspinous ligament steroid injections for the management of Baastrup’s disease: a case report</article-title><source>Arch Phys Med Rehabil</source><person-group><name><surname>Mitra</surname><given-names>R</given-names></name><name><surname>Ghazi</surname><given-names>U</given-names></name><name><surname>Kirpalani</surname><given-names>D</given-names></name><name><surname>Cheng</surname><given-names>I</given-names></name></person-group><fpage>1353</fpage><lpage>1356</lpage><volume>88</volume><year>2007</year><pub-id pub-id-type="pmid">17908582</pub-id></element-citation></ref><ref id="REF18"><label>18</label><element-citation publication-type="journal"><article-title>Interspinous Ligament Lidocaine and Steroid Injections for the Management of Baastrup’s Disease: A Case Series</article-title><source>Asian Spine J</source><person-group><name><surname>Okada</surname><given-names>K</given-names></name><name><surname>Ohtori</surname><given-names>S</given-names></name><name><surname>Inoue</surname><given-names>G</given-names></name><etal></etal></person-group><fpage>260</fpage><lpage>266</lpage><volume>8</volume><year>2014</year><pub-id pub-id-type="pmid">24967039</pub-id></element-citation></ref><ref id="REF19"><label>19</label><element-citation publication-type="journal"><article-title>A conceptual model of compensation/decompensation in lumbar segmental instability</article-title><source>Med Hypotheses</source><person-group><name><surname>Barz</surname><given-names>T</given-names></name><name><surname>Melloh</surname><given-names>M</given-names></name><name><surname>Lord</surname><given-names>SJ</given-names></name><name><surname>Kasch</surname><given-names>R</given-names></name><name><surname>Merk</surname><given-names>HR</given-names></name><name><surname>Staub</surname><given-names>LP</given-names></name></person-group><fpage>312</fpage><lpage>316</lpage><volume>83</volume><year>2014</year><pub-id pub-id-type="pmid">25001025</pub-id></element-citation></ref></ref-list></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
EXPLOR_STEP=$WICRI_ROOT/Wicri/Archeologie/explor/PaleopathV1/Data/Pmc/Corpus
HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 000040 | SxmlIndent | more
Ou
HfdSelect -h $EXPLOR_AREA/Data/Pmc/Corpus/biblio.hfd -nk 000040 | SxmlIndent | more
Pour mettre un lien sur cette page dans le réseau Wicri
{{Explor lien
|wiki= Wicri/Archeologie
|area= PaleopathV1
|flux= Pmc
|étape= Corpus
|type= RBID
|clé= PMC:4762769
|texte= Baastrup’s Disease: An Often Missed Etiology for Back Pain
}}
Pour générer des pages wiki
HfdIndexSelect -h $EXPLOR_AREA/Data/Pmc/Corpus/RBID.i -Sk "pubmed:26929892" \
| HfdSelect -Kh $EXPLOR_AREA/Data/Pmc/Corpus/biblio.hfd \
| NlmPubMed2Wicri -a PaleopathV1
| This area was generated with Dilib version V0.6.27. |  |