baastrup syndrome dr. muhammad bin zulfiqar

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Baastrup syndrome

Baastrup syndromeDr. Muhammad Bin ZulfiqarPGR IV FCPS Services Institute of Medical Sciences / Hospitalradiombz@gmail.com

Baastrup syndromeBaastrup syndrome(also referred to askissing spines) results from adjacent spinous processes in the lumbar spine rubbing against each other and resulting in hypertrophy and sclerosiswith focal midline pain and tenderness relieved by flexion and aggravated by extension.Often occurs in elderly.Focal midline pain and tenderness relieved by flexion and aggravated by extension.

Pathology

This process can result in a degenerative hypertrophy, inflammatory change and even a pseudoarthrosis with bursa formation. This interspinous bursa may extend between the ligamentum flavae in the midline forming an epidural cyst and further contributing to the already existing canal stenosis.This condition is usually seen patients with excessive lordosis of the lumbar spine.

AssociationsOlder ageAnterolisthesisCentral canal stenosis

Imaging LineagePlain radiographCT scanMRIPET CT

Plain RadiographOften shows close approximation and contact of adjacent spinous processes (kissing spines)There is resultant enlargement, flattening and reactive sclerosis of apposing interspinous surfaces

Close approximation and contact of adjacent spinous processes (kissing spines)There is resultant enlargement, flattening and reactive sclerosis of apposing interspinous surfaces.Anterior marginal kissing osteophytosis.

CT SCANOften shows close approximation and contact of adjacent spinous processes (kissing spines)There is resultant enlargement, flattening and reactive sclerosis of apposing interspinous surfaces

Spondylosis, osteochondrosis and degenerative intervertebral joint disease of the lumbar spine with massive disc space narrowing at L3/4/5 and their spinous processes L2-5 rubbing against each other. Osteophytes have formed at the contacting surfaces and there is a large geode at the base of the L3 spinous process indicating osteoarthritis in a nearthrosis.

MRIMay 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.

T1, T2, STIR and T1 Postcontrast Baastrup syndrome with marked enhancement

Baastrup syndrome, with high T2 signal between the rubbing spinous processes.

Baastrup's disease T2 sagittal MR. Note spondylolisthesis at L4-L5 level with anterior and posterior disc herniations. Note also inter-spinous bursal fluid collection at same level.Baastrup's disease T2 WI. Arrow points to inter-spinous bursal fluid collection.

FDG-PET/CT

May demonstrate FDG-avidity when associated with inflammatory response such as bursitis. Best diagnostic clue for avoiding misinterpretation may be scrutinizing sagittal multi planar reconstructions (MPR) and involvement being limited to spinous processes which is rare in malignancy.

Sagittal fused images reveal increased uptake in the spine, with involvement being limited to spinous processes, which is rare in malignancy.Kissing spinesconfirmed by MPR of SOA CT.

ManagementLocal steroid injection into the interspinous processes will often ease the back pain. Surgicaloptions include interspinous process decompression devices (e.g.Wallis system, X STOP), and steroid/local anesthetic injection into the bursa.

X-Stop - post opBut 2 months later symptoms recurred because of displacement of X stop.

THANX