KISSING SPINE DISEASE: A MISSING DIAGNOSIS IN LOW BACK PAIN CLINIC

Baastrup's disease, also known as "kissing spine disease" or lumbar interspinous bursitis, is a degenerative condition causing enlargement, attening, and reactive sclerosis of interspinous surfaces. It is primarily affecting the elderly, professional drivers, and college athletes. It worsens with spinal extension and is alleviated in exion. The condition is often misdiagnosed due to lack of familiarity and overexposure to spinous processes on radiographs. It is characterized by excessive lordosis, repetitive stress on interspinous ligaments, and abnormal contact between spinous processes, often affecting the lumbar spine. Conservative treatments, particularly physical therapy and exion exercises, have shown promise in managing this condition. A study by Maes et al. found no signicant correlation between Baastrup's disease and lordosis, likely due to the use of supine MRI, which can display less lordosis than upright imaging. Another study noted pain relief in patients with partial contact of spinous processes following interspinous ligament injections, showing mixed imaging results but overall positive treatment outcomes. Additionally, PET/CT imaging has demonstrated F-18 uorodeoxyglucose (FDG) uptake in adjacent spinous processes in cases of Baastrup's disease, further validating the condition's diagnosis. In a study involving 55 patients with Baastrup's disease, percutaneous injections of a corticosteroid and local anesthetic into the interspinous ligament resulted in a 22% rate of patients requiring follow-up injections within 7-10 days. There was notable pain reduction and improved ambulation reported. Surgical interventions, including bursa excision and spinous process removal, have limited evidence of effectiveness, with some surgeries failing to alleviate pain. Patients who had positive outcomes after spinous process resection often received prior diagnostic or therapeutic injections. Additionally, there are rare instances where Baastrup's disease leads to cyst formation in the interspinous region, which can result in neurogenic claudication, effectively resolved through the excision of the cyst and associated spinous processes.