Insight on the Clinical Significance of Baastrup's Disease: from ...

<strong>Insight</strong> on the Clinical Significance of Baastrup’s
Disease: from Kissing Spine to Interspinous Bursitis
Austin Bourgeois MD, Hunter Pearson, Patrick Barlow, Dwayne John,
Ted Chang MD, and Geoffrey Laing MD
Department of Radiology, Graduate School of Medicine,
University of Tennessee Medical Center, Knoxville

Introduction
1825: Mayer portrayed spinous
processes as a source of back pain.
Fluid-filled cavities interposed between
adjacent lumbar spinous processes that
were hypertrophied .
1929: Brailsford coined the term
“kissing spines”.
In 1933, Christian Baastrup provided
both a radiological and clinical
explanation of the syndrome. 4

Baastrup’s Disease
Elderly soldiers
Low back pain, worsened by flexion
Relieved by local anesthetic
Closely approximated spinous processes
Neoarthrosis
Associated with “kissing spine” sign
Pain generator of debated significance

Baastrup’s Disease
10 year old spine 50 year old spine 70 year old spine
(Neo)Bursitis
Neo-arthrosis

Baastrup’s Disease
• Lack of adequate research correlating pathologic,
imaging, and clinical factors.
“Kissing spine” sign (Neo)Bursitis
Lateral Lumbar Spine Radiograph Sagittal Short Tau Inversion Recovery (STIR)
Sagittal Lumbar Spine MRI

“Kissing Spine” Sign Not Pathologic
“…characterized by the close
approximation of adjacent spinous
processes” 2
“…with resultant enlargement,
flattening, and reactive end plate
sclerosis of the apposing
interspinous surfaces” 3

Baastrup’s Disease: Research Questions
What is the
prevalence?
What are the
concomitant
pathologic findings?
Is Baastrup’s disease
a harbinger of
degenerative change
elsewhere?
Interspinous bursitis

Materials and Methods
IRB exemption
Softek Illuminate ®
862 patients with routine non-contrast lumbar spine MRI
and:
Lumbar spine CT or
Lumbar spine radiograph
Those with radiographic evidence of “kissing spine” were
evaluated for MR evidence of interspinous bursitis.
Independently reviewed by board certified radiologists.
Same level degenerative disc disease (DDD), facet
hypertrophy (FH), fracture, spondylolisthesis, and
spondylolysis were recorded.
DDD and FH were scaled as mild, moderate, or severe.

Results
862 total patients
103 (11.9%) had “kissing spine” changes
Average age ~ 80
Of these 103 patients, 17 (16.5%) had evidence of
bursitis which affected 22 levels
Prevalence of bursitis with fracture (24%)
Prevalence without fracture (14.7%)
OR for fracture of 1.84 (95% CI=.60 – 5.62), p=.357

Results
• Suggestion that bursitis is associated with less degenerative change.

Results
• L3-4 and L4-5 were most common site (N=9)

Conclusion
Demographic biased to symptomatic patients at a
regional level 1 trauma center.
Interspinous bursitis component of the Baastrup’s
spectrum is present in a small proportion of patients and
likely corresponds with more advanced disease.
Our data suggest that lumbar interspinous bursitis may
be associated with a lesser degree of degenerative
change.
There is suggestion of a positive correlation between
interspinous bursitis and compression fracture at any
level, possibly related to altered lumbar spine mechanics
and load-bearing.
Prospective evaluation of percutaneous corticosteroid
therapy may help to further delineate clinical significance.

References
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