Full‐Endoscopic Approach Forchronic Low Back Pain from Baastrup's Disease: Interspinous Plasty

Abstract

The objective was to introduce a new endoscopic technique‐interspinous plasty for low back pain from Baastrup's disease; based on clinical manifestations, imaging findings and diagnostic test, to discuss a detailed diagnostic procedure for Baastrup's disease; and to explore the mechanism of interspinous plasty in pain relief. To our knowledge, there is no report about the results of endoscopic lumbar technique for Baastrup's disease. This study described the successful full‐endoscopic surgical treatment for Baastrup's disease, providing a brand‐new therapeutic method for patients. Clinical manifestations, imaging findings, including X‐ray, computed tomography (CT) and magnetic resonance imaging, and a “positive” diagnostic test with local anesthetic were used to confirm Baastrup's disease in the three included patients. The interspinous plasty procedure, which aimed to recover a physiological gap between the adjacent spinous processes, was performed by full‐endoscopic resection of marginal osteophytes. The removal of local inflamed tissue and reducing inflammation via intraoperative saline irrigation also lead to pain relief. Clinical outcomes included visual analog scale (VAS) for low back pain and the Oswestry Disability Index (ODI). The distance between the adjacent spinous processes was measured from the preoperative and postoperative CT scan. We calculated and recorded the difference between preoperative and postoperative measurements. Technical procedures and advantages of interspinous plasty are introduced. The three patients showed improvement in terms of the postoperative VAS of low back pain (from 8 to 2, from 7 to 1 and from 8 to 2) and ODI (from 68.9% to 33.3%, from 77.8% to 28.9% and from 71.1% to 28.9%, respectively) at the 12‐month follow‐up. Compared postoperative ODI index, the ODI index increased from 26.7% to 33.3% and from 24.4% to 28.9% in two of the cases at the 12‐month follow‐up. At 1 week, CT confirmed an obvious reduction in the marginal osteophytes between the adjacent spinous processes. Compared with those on preoperative CT images, the distance between adjacent spinous processes on postoperative CT was enlarged from 1 to 4 mm, and a repeated CT scan 3 months later reconfirmed little recrudescent osteoproliferation. In selected cases, full‐endoscopic surgical treatment for chronic mechanical back pain as part of the phenomena of Baastrup's disease may be beneficial. The operations in this study were performed under local anesthesia, with satisfactory early clinical outcomes and a low incidence of complications or adverse events. This may be a feasible therapeutic method or an alternative option for patients who cannot tolerate general anesthesia surgery.

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

“…Other studies continue to demonstrate the value of either partial or complete resection of the spinous processes leading to a complete recovery with a follow-up of up to 2.5 years [ 16 , 17 ]. As a minimally invasive approach, an endoscopic partial resection demonstrated clinical improvements in the visual analog scale and Oswestry disability index scores [ 18 ]. None of the studies showed surgically associated complications.…”

Enfermedad de Baastrup: una etiología frecuente de dolor lumbar

“…El tratamiento del síndrome de Baastrup es un tema de debate constante a nivel internacional, algunos autores recomiendan el uso de infiltraciones percutáneas con corticosteroides de acción prolongada y en ocasiones anestésicos locales para tratar la inflamación y el dolor, cuyos resultados han mostrado una mejora significativa en las puntuaciones de dolor a más de un año después del tratamiento. 6,7 Se mencionan además técnicas quirúrgicas resectivas y no resectivas (dispositivos interlaminares o ablaciones por radiofrecuencia) con resultados variables entre diversos autores. En 1944, Franck y colaboradores describieron su experiencia con la resección parcial de las apófisis espinosas realizada en 10 pacientes; 2 encontraron recuperación completa en 40%, mejoría clínica en otro 40% y el restante 20% no presentó cambios; destacaron que los pacientes que no respondieron al tratamiento tenían comorbilidades vertebrales como fracturas que podrían explicar la persistencia del dolor.…”

“…Algunos autores recomiendan el uso de infiltraciones percutáneas con corticosteroides de acción prolongada y en ocasiones, anestésicos locales para tratar la inflamación y el dolor, cuyos resultados han mostrado una mejora significativa en las puntuaciones de dolor a más de un año después del tratamiento. 6,7 Además, se mencionan técnicas quirúrgicas resectivas y no resectivas (dispositivos interlaminares o ablaciones por radiofrecuencia) con resultados variables entre diversos autores. 6,8,9…”

“…6,7 Además, se mencionan técnicas quirúrgicas resectivas y no resectivas (dispositivos interlaminares o ablaciones por radiofrecuencia) con resultados variables entre diversos autores. 6,8,9…”

Complications and radiographic changes after implantation of interspinous process devices: average eight-year follow-up

“…It is prevalent among middle-aged and older people with slow progression. It is characterized by hypertrophy of the spinous process as imaging features and often causes low back pain [ 22 – 24 ]. The lateral radiographs of the patients revealed that their spinous processes were consistent with each other and had corresponding bone sclerosis.…”