Baastrup Syndrome: Difference between revisions
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== Clinically Relevant Anatomy == | == Clinically Relevant Anatomy == | ||
The spinous processes of the lumbar spine are orientated dorsally and caudally. All of the muscles that are involved in spinal movement and stabilization are only attached to the posterior elements of the spine. Therefore the spinous processes are subjected to major forces with movement or stabilization of the spine.<ref name="8">M.J.Depalma. Ispine: Evidence based interventional spine care. 2011, Demos Medical Publishing. (Level of Evidence 2)</ref> | |||
The interspinous ligament arches between two adjoining spinous processes. Anteriorly, it is continuous with the ligamentum flavum and posteriorly it fuses with the supraspinous ligament. The external layer of the interspinous ligament contains fibers of the aponeuroses of the M. longissimus, which contributes to the stability at that level. The interspinous ligament functions primarily to prevent excessive spinal flexion and thereby separation of two adjacent spinous processes. Secondary it has been suggested that the interspinous ligament also aids with controlling vertebral rotation during flexion helping the facet joints remain in contact while gliding.<ref name="8" /> | |||
The supraspinous ligament is attached to the posterior tips of the spinous processes from approximately C7 to L4-L5. It contributes to limit spinal flexion and resist separation of two neighboring spinous processes. <br>The posterior part of the interspinous and supraspinous ligaments are sensory innervated. Its role is thought to give proprioceptive information and protect against excessive forces.<ref name="8" /><br><br><br> | |||
== Epidemiology /Etiology == | == Epidemiology /Etiology == | ||
Revision as of 09:41, 19 June 2013
Original Editors - Sofie Bourdinon
Top Contributors - Sofie Bourdinon, Scott Cornish, Nikki Rommers, Arno Vrambout, Admin, Kim Jackson, Fien Selderslaghs, Lucinda hampton, Uchechukwu Chukwuemeka, Vidya Acharya, Ceulemans Lisa, Aarti Sareen, WikiSysop and 127.0.0.1
Search Strategy[edit | edit source]
Search engines: Pubmed, Web of knowledge. Google Scholar and Google Books are practical too.
Keywords: Baastrup syndrome, Baastrup AND etiology, Baastrup disease, kissing spines, Baastrup’s sign, Baastrup syndrome AND physical therapy, Baastrup syndrome AND exercise, Kissing spines AND conservative therapy, Baastrup disease AND surgical management, hyperlordosis AND physical therapy.
Definition/Description[edit | edit source]
Baastrup Syndrome is named after Christian Ingerslev Baastrup, a Danish radiologist (1855-1950). It is also known as ‘kissing spines’. Kissing spines is a common disorder of the vertebral column. It is characterized by close approximation and contact of the spinous processes of two neighboring vertebrae. This can result in the formation of a new joint between them. This possibly causes mechanical back pain. The hypertrophied spinous processes of adjoining lumbar vertebrae in close approximation or in actual contact may undergo reactive sclerosis or degeneration. This is mostly observed in the lumbar segment, but has also been reported to occur in the cervical spine in some cases.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Clinically Relevant Anatomy[edit | edit source]
The spinous processes of the lumbar spine are orientated dorsally and caudally. All of the muscles that are involved in spinal movement and stabilization are only attached to the posterior elements of the spine. Therefore the spinous processes are subjected to major forces with movement or stabilization of the spine.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
The interspinous ligament arches between two adjoining spinous processes. Anteriorly, it is continuous with the ligamentum flavum and posteriorly it fuses with the supraspinous ligament. The external layer of the interspinous ligament contains fibers of the aponeuroses of the M. longissimus, which contributes to the stability at that level. The interspinous ligament functions primarily to prevent excessive spinal flexion and thereby separation of two adjacent spinous processes. Secondary it has been suggested that the interspinous ligament also aids with controlling vertebral rotation during flexion helping the facet joints remain in contact while gliding.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
The supraspinous ligament is attached to the posterior tips of the spinous processes from approximately C7 to L4-L5. It contributes to limit spinal flexion and resist separation of two neighboring spinous processes.
The posterior part of the interspinous and supraspinous ligaments are sensory innervated. Its role is thought to give proprioceptive information and protect against excessive forces.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Epidemiology /Etiology[edit | edit source]
It tends to be more common in elderly.
Characteristics/Clinical Presentation[edit | edit source]
• Localized interspinous or spinous process pain with or without a referral pattern
• May be present for many years with progressive worsening over time
• The pain may be significant enough to limit activities of daily living
Differential Diagnosis[edit | edit source]
• Central spinal canal stenosis
• Infection
• Lumbar spondylosis
• Muscle strain
• Paracentral disc herniation
• Spinous process fracture
• Spondylolisthesis
• Vertebral compression fracture
Diagnostic Procedures[edit | edit source]
Plain film 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 postero-central epidural cyst(s). MRI can be very helpful in determining whether there is resulting posterior compression of the thecal sac.
Outcome Measures[edit | edit source]
add links to outcome measures here (also see Outcome Measures Database)
Examination[edit | edit source]
add text here related to physical examination and assessment
Medical Management
[edit | edit source]
Injections
If the complains are the cause of a single trauma, then an injection with a corticosteroid on the painful place, will be very effective. If the condition is the cause of a chronic micro trauma, then two to four infiltrations are indicated. The injection is given once every two weeks. During the treatment period, extension movements of the lumbar spine should be avoided. In intractable cases, surgery is sometimes indicated.
Surgery
According to the article[1]: “Kissing Spines: Fact or Fancy?” by J. W. F. Beks, surgical activities were not very satisfactory. Of the 64 patients who participated, only 11 were free of complaints after the operation. In the other 53 patients, the complaints remained or returned after a short time. The discussion is that the kissing spines are phenomenon due to another pathology, especially spondylosis with osteophyte formation.
Physical Therapy Management
[edit | edit source]
The supraspinous and intraspinous ligaments are sprained with extreme forward flexion which may result in the development of a spur
Repetitive extension may disrupt the healing process
Physiotherapy
The therapy is ALWAYS conservative because kissing spines are the causes of a hyperlordosis of the lumbar back, physiotherapists should work on a more kyphotic position of the lumbar back using stretching exercises of the back. Is that a description of your physiotherapy treatment
Key Research[edit | edit source]
add links and reviews of high quality evidence here (case studies should be added on new pages using the case study template)
Resources
[edit | edit source]
Clinical Bottom Line[edit | edit source]
add text here
Recent Related Research (from Pubmed)[edit | edit source]
see tutorial on Adding PubMed Feed
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References[edit | edit source]
- ↑ Becks JWF. Kissing spines: fact or fancy? Acta Neurochir (Wien), 1989; 134-135
