lunedì 22 febbraio 2010

Baastrup's disease


There is diffuse disk desiccation and multilevel narrowing of the lumbar spine disc spaces with multilevel disc bulges or protrusion. There is close approximation of the spinous processes of the lower lumbar spine with sclerosis (low signal) and flattening of the adjacent spinous processes. There are focal fluid collections seen as high signal on the T2 sequence between the opposing spinous processes in the expected locations of the interspinous ligaments. These correspond with adventitious bursae and surrounding inflammatory changes. There are cystic changes of the L4 spinous process at the pseudarthrosis.

Diagnosis: Baastrup's disease

Key points

The clinical syndrome of pain in the back when standing erect which is relieved by bending forward was described in 1929. In 1933, Christian Baastrup, a Danish radiologist described in detail the clinical and radiological features of the syndrome. It manifests clinically as localized midline lumbar tenderness and pain on spinal extension that can be relieved by spinal flexion, local anesthetic injection and excision of part of the involved spinous processes.

Baastrups's disease is characterized on plain films by close approximation of spinous processes ("kissing spines") with associated sclerosis, enlargement and squaring off/ flattening of the involved spines. MR may document the development of adventitious bursae between the spines, seen as high signal fluid between the processes. This condition usually arises from chronic postural hyperlordosis and regional loss of discal spacings. Hypertrophy of the tips of the spinous processes may occur in the elderly persons especially in those with an occupational history of long periods of back flexion.

Synonyms: Arthrosis interspinosa, diarthrosis interspinosa, kissing osteophytes, kissing spine, kissing spinous disease, osteoarthrosis processus spinosi vertebrarum lumbalum, osteoarthrosis interspinalis

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