Radiology Teaching Files > Case 17686648

Never visited LOW BACK PAIN
Contributed by: George Knight, Resident, University of Washington, Washington, USA.
Patient: 67 year old male
History: Patient presents with years of progressively worsening lower back pain, now with pain radiating down posterior right proximal leg and thigh.

Fig. 1: AP Lumbar Spine

Fig. 2: Lateral Lumbar Spine

Fig. 3: Sagittal T1

Fig. 4: Sagittal T2

Fig. 5: Sagittal T2

Close approximation and contact of adjacent L4-5 spinous processes (kissing spines)

Resultant enlargement, flattening, and reactive sclerosis of apposing interspinous surfaces

Diagnosis: Baastrup's disease with lumbar interspinous bursitis with likely bursal extension into posterior epidural space producing moderate central canal stenosis.
Baastrup's disease is characterized by close approximation and contact of adjacent spinous processes with resultant enlargement, flattening, and reactive sclerosis of apposing interspinous surfaces [1].

It is often asymptomatic, but may clinically present as midline localized lumbar tenderness and pain on back extension that can be relieved by flexion, local anesthetic injection, and excision of part of the spinous processes [2].

Interspinous bursography combined with CT confirmed that the interspinous bursitis extended to the intraspinal cystic mass in five of ten patients. [3]
References: 1. Resnick D. Degenerative diseases of the vertebral column. Radiology1985; 156:3 –14

2. Bywaters EG, Evans S. The lumbar interspinous bursae and Baastrup's syndrome: an autopsy study. Rheumatol Int1982; 2:87 –96

3. Chen CK, Yeh L. Intraspinal Posterior Epidural Cysts Associated with Baastrup's Disease: Report of 10 Patients.  AJR 2004; 182:191-194

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Additional Details:

Case Number: 17686648Last Updated: 2011-03-20
Anatomy: Spine and Peripheral Nervous System   Pathology: Benign Mass, Cyst
Modality: Conventional Radiograph, MRAccess Level: Readable by all users
Keywords: baastrup's, interspinous bursitis, posterior epidural cyst

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