1) The document describes a case of a 50-year-old female patient presenting with low back ache. MRI images show degenerative changes at L4-L5 with reduced disc height and a linear hyperintensity noted at the same level. 2) It provides information on Baastrup's disease, also known as kissing spines disease, which is a type of pseudoarthrosis between adjacent lumbar spinous processes. Repeated flexion and extension can cause ligament damage and spur formation. 3) Imaging findings on lateral spine radiographs, MRI, and bone scans are described to identify the pathology. Treatment options including rest, cavity resection, and fusion surgery are mentioned.

1. 1 )
Prof Dr. Ahmed Al_Gebaly
BY

2.  Low back
ache.
 50 years -
Female
Case 6

4.  Low back
ache.
 50 years -
Female
Case 6

5.  Sagittal T1 T2 and STIR images of lumbar region spine shows:
Degenerative changes marked at L4-5 with reduced height of disc
and degenerative intra discal vacume phenomenon. An abnormal linear
hyper intensity of an inter spinous odema noted at the same level.

6.  Baastrup’s Disease
Syn: Kissing Spines Disease, intraspinous odema, intraspinous neo-arthrosis.
Baastrup’s Disease is a type of pseudo / neo-arthrosis between adjacent spinous processes.
Common in lumbar region at L4-5.
Extreme forward flexion may result in supraspinous and intraspinous ligaments sprain with
development of a spur. Repeated extension interferes with the healing. An interspinous bursae
may develop due to an associated supraspinous ligament laxity and intraspinous ligament
breakdown. The interspinous ligament degenerates with aging resulting in the formation of a
cavity, the adjacent spinous processes keep coming in contact with each other during
extension and result in formation of a joint which precede pain.
Risk Factors are degenerative disc disease, Athletics, Hyper lordosis, Paraspinal muscle
atrophy, Pars interarticularis defect.
Clinically characterized by localized interspinous or spinous process pain without a referral
pattern, pain present for many years with progressive worsening over time.
Imaging:
Lateral view LS spine radiograph may demonstrate sclerotic changes or flattening of adjacent
spinous processes.
MRI sagittal T2 and STIR images are needed assess interspinous edema.
Bone scan with SPECT can detect increased osteoblastic activity that is associated with
reactive sclerosis.
Treatment: Bed rest in semi upright sitting position, Surgical cavity resection, Surgical fusion.

7.  Baastrup syndrome (also referred to as kissing spines) results from adjacent
spinous processes in the lumbar spine rubbing against each other and resulting
in hypertrophy and sclerosis with focal midline pain and tenderness relieved by
flexion and aggravated by extension.
 Focal midline pain and tenderness relieved by flexion and aggravated by
extension.
 Pathology
 This process can result in a degenerative hypertrophy, inflammatory change (as
seen in case 1) and even a pseudoarthrosis 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
 Plain radiograph 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
 MRI
 May demonstrate interspinous bursal fluid and a posterocentral epidural cyst(s).
MRI can be very helpful in determining whether there is resulting posterior
compression of the thecal sac.

8. ‫ال‬‫ا‬‫له‬‫ا‬‫ال‬ ‫ن‬‫ا‬‫شهد‬‫ا‬ ‫وبحمدك‬ ‫اللهم‬‫سبحانك‬
‫ستغفرك‬‫ا‬ ‫نت‬‫ا‬
‫ت‬‫وا‬
‫ليه‬‫ا‬‫وب‬