Baastrup Syndrome

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Original Editors - Sofie Bourdinon

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Search Strategy

The first step of my search strategy was consulting the VUB library website. Then I searched the Pubmed database typing the keywords: Baastrup Syndrome, kissing spines, treatment. When I clicked on free full texts, the amount of results was eleven. Of those eleven articles, only one had and abstract and link to free full text. The following step was reading the full article of which the abstract was interesting for my subject. Because I didn't find exactly what I hoped for I went to Web of Science for a second search. I typed the same keywords and found an eligible article.

Definition/Description

Named after Christian Ingerslev Baastrup, a Danish radiologist (1855-1950), the Baastrup syndrome, also know as ‘kissing spines’ is a common injury in dancers. It results from adjacent spinous processes mostly in the lumbar spine rubbing against each other and resulting in pain. Most common at the level of L4-L5.

Clinically Relevant Anatomy

Where the spinous processes touch each other when the low back is in hyperlordosis is a result of the forced hip turning technique when dancing. This technique is a turnout. It is an external rotation of the hip, causing the knee and foot to turn outward, away from the center of the body. In dancers, kissing spines commonly affects the lower lumbar vertebra.
It can also be caused when the thoracic spine or the thoracolumbar transition is stiff. The Baastrup syndrome is only one aspect or symptom that can appear in other disorders and has some risk factors attached. Especially during extension of the lumbar spine can the spinous processes touch, which can cause irritation of the inter-spinal ligament . When the rotation and lateral flexion is examined, they find that it is a sensitive movement and flexion in the least painful of all.

Epidemiology /Etiology

It tends to be more common in elderly.

Characteristics/Clinical Presentation

• 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

• Central spinal canal stenosis
• Infection
• Lumbar spondylosis
• Muscle strain
• Paracentral disc herniation
• Spinous process fracture
• Spondylolisthesis
• Vertebral compression fracture

Diagnostic Procedures

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

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Examination

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Medical Management

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: “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

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: explanation WHAT? en exercises WHAT (evidence of efficacy?). 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

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Resources

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Clinical Bottom Line

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Recent Related Research (from Pubmed)

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