Baastrup Syndrome
Original Editors - Sofie Bourdinon
Top Contributors - Sofie Bourdinon, Scott Cornish, Nikki Rommers, Admin, Arno Vrambout, Kim Jackson, Fien Selderslaghs, Lucinda hampton, Uchechukwu Chukwuemeka, Vidya Acharya, Ceulemans Lisa, Aarti Sareen, 127.0.0.1 and WikiSysop
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]
The exact etiology of Baastrup’s sign is unknown. The hypothesis is that an excessive lordosis or extensive loss of intervertebral space is linked to degeneration of the vertebral disc which can lead to contact between spinous processes and to degeneration of intervening ligaments.
Incorrect posture and traumatic injuries can also cause this condition. Other possible causes of kissing spines are: excessive lordosis due to scoliosis and kyphoscoliosis, spondylolysthesis, tuberculous spondylitis, bilateral forms of congenital hip dislocation and obesity. Also increased spinous process dimensions linked to several rare disorders can cause kissing spines.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 title
It can also be caused when the thoracic spine or the thoracolumbar transition is stiffCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title.
The Baastrup syndrome is only one aspect or symptom that can appear in several disordersCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title and it has some risk factorsCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title attached like painful lumbar extension. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
There is controversy regarding the etiology of pain in this condition. The cause of pain has been described to be mainly mechanical because of the neighboring spinous processes coming into contact. This is worse with hyperextension or increased lordosis, as in patients with obesity or limitation of hip movements and champion swimmers.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 title
The epidemiology of Baastrup’s sign in the general population is unknown. It seems to be high according to the relatively frequent abnormal changes of the interspinous spaces and spinous
processes seen at autopsy.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
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]
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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]
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Resources
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Clinical Bottom Line[edit | edit source]
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Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
- ↑ Becks JWF. Kissing spines: fact or fancy? Acta Neurochir (Wien), 1989; 134-135
