Fluoroscopically-Guided Injections to Treat “Kissing Spine” Disease

Abstract

Background: Any spine structure that is innervated by afferent nociceptive nerve fibers is a potential pain generator. In the lumbar spine, the most studied pain generators include: sacroiliac joints, the zygapophysial joints, the intervertebral discs, myofascial structures. Anomalous lumbosacral articulations, the spinous processes, and lumbar spine osteophytes are less commonly reported. Objective: To describe the diagnostic and therapeutic features of “kissing spine” disease or Baastrup’s Sign with particular attention to MRI findings and fluoroscopicallyguided injection therapy. Design: A series of 3 patients with axial low back pain presented with exam findings and MRI changes suggestive of pain emanating from adjacent spinous processes that appeared to be in direct contact or very closely opposed. This has been described in the literature as “kissing spine” disease or Baastrup’s sign. Fluoroscopically-guided injections were performed and the responses were studied. Results: The 3 patients had MRI findings consisting of inflammation and/or edema in the spinous processes and surrounding soft tissues. Fluoroscopically-guided injections provided pain relief in all 3 patients. One patient with recurrent pain eventually underwent successful surgical resection of the involved spinous processes. Conclusion: Painful adjacent and closely opposed spinous processes can be a source of axial low back pain. We have described MRI features and the responses to fluoroscopically-guided injections in 3 patients with this condition. Key words: Baastrup’s, kissing spine, spine injection

Partial Spinous Process Decompression in Baastrup’s Disease: A Case Report and Literature Review

“…Regarding conservative treatment, adequate analgesia along with physical therapy should be started as the first-line treatment strategy [ 5 ]. Infiltration of the affected spinous with a local anesthetic and cortisone can be helpful as a confirmatory diagnostic test, on the one hand, and as an intermittent treatment modality, on the other [ 7 ]. However, the latter usually provides only short-term symptom relief, as in cases of severe approximation of the spinous processes, the underlying etiology is not eliminated but only treated symptomatically [ 5 ].…”

“…Computed tomography (CT) and magnetic resonance imaging (MRI) are necessary imaging modalities for the workup of differential diagnoses [ 5 ]. Targeted interspinous infiltration using local anesthetics combined with cortisone may achieve local symptom relief [ 7 ]. Adequate pain management along with physiotherapy are the basics of conservative treatment options [ 6 ].…”

“…So far, there is no uniformly defined treatment strategy for Baastrup’s disease that can be used as a therapeutic escalation when conservative treatment methods fail [ 7 ]. Despite being an often missed pathology with little available scientific evidence regarding invasive treatment modalities, there is a need for a potentially curative treatment approach [ 8 ].…”

Baastrup's Disease as a Rare Cause of Cauda Equina Syndrome

“…Physical therapy is crucial in the long-term management of Baastrup's syndrome, focusing on reducing interspinous strain and lordosis. In case of failure of the physical therapy, percutaneous injections of long-acting corticosteroids and occasionally local anesthetics have been used to treat inflammation and pain 10,11 and the results show encouraging outcomes in pain scores at 1 year after the injection 12 . There have been mixed results from surgical excision of affected spinous processes.…”

Spezifische und nicht spezifische Rückenschmerzen

“…Die klinische Bedeutung des Baastrup Phänomens ist nicht geklärt [51]. Gezielte Applikationen von Lokalanästhetika deuten darauf hin, dass die sich berührenden Dornfortsätze als Schmerzgenerator wirken können [52][53][54]. Mit modernen bildgebenden Verfahren (MRT) zeigte sich bei 8.2 % eine interspinöse Bursitis [55], die hoch signifikant mit dem Alter und einem Baastrup-Phänomen sowie verschiedenen degenerativen Veränderungen assoziiert war.…”