Extensive Degeneration of Vertebral Body Leading to Baastrup’s Disease: A Radiographic Review of an Image

Abstract

Baastrup’s disease, known colloquially as “kissing spine disease”, is a degenerative process, most commonly occurring in the lumbar spine, in which adjacent spinous processes closely approximate or even touch (Filippiadis et al. in Insights Imaging. 10.1007/s13244-014-0376-7, 2015). We present the case of an 86-year-old woman presenting with left low back, hip, and anterolateral thigh pain. Magnetic resonance imaging noted an approximation of the L2/3 spinous processes, with degeneration of the vertebral processes. This article is based on previously conducted studies and does not contain any studies with human participants or animals performed by any of the authors. Informed consent for publication was obtained from the participant.

Key Summary Points

Baastrup’s disease occurs in the lumbar spine when adjacent spinous processes closely approximate or even touch, most often seen in elderly women, with symptomatology mimicking spinal stenosis, with localized back pain at the vertebral segment worsened with extension and improved with flexion.

Imaging will possibly show loss of disk height, spondylolisthesis, spondylosis, and osteophyte formation.

Although less common in presentation, Baastrup’s disease must be on the interventional pain medicine physician’s differential diagnosis when an elderly patient is presenting with symptoms similar to spinal stenosis.

Case

Baastrup’s disease, known colloquially as “kissing spine disease”, is a degenerative process, most commonly occurring in the lumbar spine, in which adjacent spinous processes closely approximate or even touch [1]. Most often seen in elderly females, symptomatology mimics spinal stenosis with localized back pain at the vertebral segment worsened with extension and improved with flexion [2]. Lordosis of the lumbar spine with mechanical pressure over time produces repeated strain on the interspinous ligament, thinning it, with resultant collapse of the spinous process. Baastrup’s disease is commonly associated with loss of disk height, spondylolisthesis, spondylosis, and osteophyte formation [3]. Magnetic resonance imaging (MRI) of the lumbar spine can sometimes illustrate interspinous ligament bursitis characterized as a fluid-like intensity between the affected spinous processes [1].

Our case involved an 86-year-old woman with a history of chronic osteoarthritis and left low back, hip, and anterolateral thigh pain. She had undergone previous intra-articular hip injections with no relief of symptomatology. MRI radiographic findings (Fig. 1) demonstrated the vertebral spinous processes of the L2 and L3 levels approximating, almost touching. The treatment course of Baastrup’s disease includes conservative management, with non-steroidal anti-inflammatory drugs and percutaneous intervention. Although controversial, surgical removal of the inflicted spinous processes may be indicated in medically refractory cases.

Fig. 1.

T2-weighted sagittal magnetic resonance image (MRI) of the lumbar spine displaying collapse of L2/3 spinous processes. Degeneration and extreme lordosis of the vertebral column can also be seen throughout