B) Central canal stenosis
C) Disc herniation
D) Baastrup’s disease
Figure 1. Illustration of Baastrup’s disease. Adopted from .
Diagnosis can be challenging and imaging is usually needed. The “kissing” if closely approximated spinous processes can be seen on lateral plain films with sometimes visible sclerosis of the articulating surfaces. It may be beneficial to get flexion and extension views fir improved visualization. Computed Tomography (CT) can visualize the bony changes and show degenerative changes in greater detail. However, plain films and CT scans are not suitable for demonstrating pathological changes in the soft tissues of the spine.
Figure 2. Mild lumbar spondylosis with prominent, hypertrophic spinous processes, contacting one another between L3 and L5 with adjacent sclerosis. Adopted from .
There is paucity of evidence in regards to the treatment for Baastrup’s disease. Physical therapy can be attempted and focus should be on reducing interspinous strain and lordosis, increasing core strength and improving hip mobility. This should be done while limiting any axial loading with the spine in extension. It can play an important role in long-term management and many will choose physical therapy as a first choice. Percutaneous injections with long-acting corticosteroids and/or local anesthetics have been used to treat inflammation and pain and can help localize pain [5-7]. In one series with 17 patients, fifteen of seventeen reported the treatment met expectations and had significant relief of pain at 1.4 years .
Figure 3. (A) Profile view of X-ray films showed that these spinous processes did not contact in flexion position, (B) but did contact in extension position (arrows). (C) Magnetic resonance imaging showed low signal intensity on T1-weighted imagesand (D) high signal intensity on T2-weighted imagesof the interspinous ligament (arrows). Adopted from .
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